The state Department of Public Health is ordering health care providers to notify it of cases of a rare and newly identified pediatric inflammatory disorder linked to the novel coronavirus that has hospitalized at least nine children in Massachusetts and afflicted more than 100 others across the country, most of them in New York.
State officials issued a clinical advisory Thursday morning, requiring hospitals to report confirmed and suspected cases of pediatric multi-system inflammatory syndrome, or PMIS, to the public health agency. By late afternoon Thursday, the Centers for Disease Control and Prevention had sent out a nationwide health alert on the new syndrome, criteria for its diagnosis, and instructions for health care providers to report cases to their local, state, or territorial health department.
The new syndrome resembles a rare childhood illness called Kawasaki disease, and its symptoms include fever, skin rashes, eye redness, and gastrointestinal issues. Dozens of cases of the dangerous new condition have cropped up in several European countries and across the United States. In New York, three children who were diagnosed with the syndrome have died.
“We do not know what the prevalence is of the condition in Massachusetts yet, and that’s why the public health order is so important," said Marylou Sudders, the state’s secretary of health and human services, at a press conference Thursday with Governor Charlie Baker. “We want to put out what the conditions are so that we know what the potential prevalence of this is in our state.”
Cases of the new disorder reported to the state Department of Public Health must meet the following criteria: The patients must be under the age of 21 and have a persistent fever of higher than 100.4 degrees Fahrenheit (30 degrees Celsius) for 24 hours or longer. They must also have laboratory evidence of inflammation and signs of serious illness, such as single or multi-organ dysfunction.
The order stipulates that there should be “no evidence of alternative plausible diagnoses." Patients must also test positive for COVID-19 or coronavirus antibodies. If their test results are negative for respiratory pathogens, they need to have been exposed to the coronavirus sometime in the past four weeks prior to the onset of symptoms.
Only nine suspected cases of the new syndrome have been reported to date in children at Massachusetts hospitals, according to the advisory. It did not list which hospitals have reported cases so far. Boston Children’s Hospital told the Globe this week that doctors have treated six patients with PMIS. According to physicians at MassGeneral Hospital for Children, two cases that met the state’s criteria for the new condition were reported to public health officials, and three additional cases remain under investigation.
“We have other patients that we’re concerned [about], and we’re doing thorough evaluations and we’re looking for alternative causes for their fevers and high inflammation," said Dr. Ann Murray, a pediatric infectious disease specialist at Mass. General. “We’re suspicious.”
The Floating Hospital for Children at Tufts Medical Center also has seen patients with symptoms consistent with PMIS, a spokesman said Thursday, but their diagnoses have not yet been confirmed or reported to DPH. At Baystate Children’s Hospital in Springfield, where a small but unspecified number of children with the syndrome have been treated, a spokesman said he had no further information when asked whether the hospital had reported its cases to the state.
Little is known about the new syndrome or why it has recently appeared in children, who were thought to suffer less severe complications from COVID-19 than adults. In a new study published Wednesday in The Lancet, doctors described an outbreak of a Kawasaki-like disease in the Bergamo province of northern Italy, one of the regions worst affected by the coronavirus pandemic. From Feb. 18 to April 20, doctors at Papa Giovanni XXIII Hospital diagnosed 10 children with an inflammatory syndrome similar to Kawasaki disease, eight whom tested positive for coronavirus antibodies.
It’s possible, doctors surmised, “confounding factors” were at play in the negative test results. The serology tests used to detect antibodies are not 100 percent accurate and could produce false negatives, and one of the children who tested negative had just received a high dose of immunoglobulins, which could have concealed the presence of antibodies in the child’s bloodstream.
According to the study, the 10 cases recorded in Italy over the two-month period represent a 30-fold increase in the monthly incidence of Kawaski-like cases, and compared with children who had been diagnosed with Kawasaki disease prior to the pandemic, these children had much more severe symptoms.
“We believe these findings have important implications for public health,” the doctors concluded. “The association between SARS-CoV-2 and Kawasaki-like disease should be taken into account when it comes to considering social reintegration policies for the [pediatric] population.”