Multisystem inflammatory syndrome in children (MIS-C), a rare condition linked to kids with coronavirus infections, is more likely to occur in Black, Latino and Asian children than their white counterparts, according to a new study.
“This virus does not affect everyone equally,” said Dr. Patrick Seed, a pediatrician at Ann and Robert H. Lurie Children’s Hospital of Chicago who was not part of the study.
Researchers analyzed data from the Centers for Disease Control and Prevention to study nearly 250 children under age 21 with the syndrome between April and June, 2020. Among their findings: 96 were Hispanic or Latino and 75 were Black, which accounted for nearly 69% of those studied.
The analysis also found a higher incidence of the inflammatory syndrome among children ages 5 and younger and between the ages of 6 and 10; and that more Latino, Black, Asian and Pacific Islander children were affected than white children.
“This to me really suggests that Black and brown individuals have higher rates of MIS-C,” said Seed, the former division head for infectious diseases at Lurie Children’s Hospital. “It suggests one of two things: Either the number of individuals who are getting MIS-C are living in environments that are somehow promoting going from having COVID-19 to later developing MIS-C, or there is something biological that is different in some of those populations that allows the virus to act differently and result in MIS-C in the end.”
Both Seed and authors of the paper say more research is needed to study risk factors for the condition, which usually occurs up to four weeks after a COVID-19 infection or time spent with someone who has COVID-19.
“When children show up with MIS-C, they have fever, they often feel quite ill and they usually have several organs affected by inflammation of the body,” Seed said. “MIS-C is rare but really very serious and we want parents to be aware of that.”
The syndrome can cause inflammation in the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs, according to the CDC. Symptoms include fever, abdominal pain, vomiting, diarrhea, rash, bloodshot eyes and feeling extra tired.
While the CDC states the cause of the syndrome is unknown, a recent study in The Journal of Clinical Investigation provides insight into the mechanics of the syndrome and identifies potential biomarkers for early detection, treatment and prevention.
In that study, researchers looked at 100 children – 19 with the inflammatory syndrome, 26 with COVID-19 and 55 healthy children – and found that viral particles can remain in the gut long after an initial COVID-19 infection and can travel into the bloodstream, triggering the inflammatory condition.
In children with the condition, the study found a prolonged presence of SARS-CoV-2 in the gastrointestinal tract, which researchers believe leads to the release of a specific protein that makes it possible for the virus to leak out of the gut and into the bloodstream, leading to hyperinflammation.
“That explains why kids’ guts are so upset,” said Seed, who was not part of the study but has treated patients with the condition. “They’ve now got this leaky gut, and it’s causing all this pain and discomfort.”
The study also documented the treatment of 17-month-old infant with the inflammatory syndrome using a drug to stop viral particles from leaking out of the gut into the bloodstream.
While that may be a promising potential treatment, more data is needed, according to Seed.
“It’s clear that one child is not nearly enough data to know if it’s safe to use, and this is not a drug approved for use in children,” he said, adding that researchers did get permission from the Food and Drug Administration to use it. “But (researchers) are giving us a proof in concept that this could be one approach that might work, and in fact may work for a lot of leaky gut syndrome that we see in children as well.”
Even with the latest study, questions remain about the association between the inflammatory syndrome and COVID-19.
“We don’t really know the cause and effect for all of these things,” Seed said. “Some of that work still needs to be done, and the really big question: Why are some children getting MIS-C and others aren’t when a lot of children are still getting COVID-19? … This paper is really wonderful and gives a lot of potential insights. There’s still a lot of work to do to understand, especially cause and effect, and to understand who are the children at risk.”
The best way to protect children from getting the inflammatory syndrome is to prevent them from getting COVID-19, which means vaccinating children who are eligible, according to Seed.
Children who aren’t yet eligible or those who have compromised immune systems should continue to wear masks, and adults can help protect them by getting vaccinated.
“We should be doing cocooning, creating communities around these children of people who are vaccinated, so they’re a buffer,” Seed said. “They’re a protection, in a way. They’re less likely to get an infection and give it to their children that can get infected.”