Multisystem Inflammatory Syndrome in Children (MIS-C): Information for Healthcare Providers About Talking with Families and Caregivers
The Council of State and Territorial Epidemiologists (CSTE) and CDC have developed a new CSTE/CDC MIS-C surveillance case definition, corresponding case report form [441 KB, 3 pages], and case report form guidance document [329 KB, 10 pages] to be used starting January 1, 2023. MIS-C cases with illness onset before January 1, 2023, but reported after January 1, 2023, will be assigned using the 2020 CDC MIS-C case definition but reported using the new case report form. An interim case reporting guidance document [181 KB, 4 pages] will be provided for these cases.
- This content offers information for healthcare providers to use when talking with families and caregivers about MIS-C.
- This content is based on responses from a sample of healthcare providers who participated in surveys and in-depth interviews about key questions of interest related to MIS-C.
- For details on the MIS-C case definition, clinical presentation, and evaluation, see Clinical Information for Healthcare Providers.
- For information on cases from national surveillance, see Health Department-Reported Cases of MIS-C.
- Download and print healthcare provider fact sheets to use and share with families, including How to Recognize MIS-C, What Parents Need to Know, and After Diagnosis of MIS-C. Parents can also learn about MIS-C.
MIS-C is a rare but serious complication associated with SARS-CoV-2, the virus that causes COVID-19. MIS-C occurs in children, adolescents, and young adults under 21 years of age and is characterized by inflammation across multiple body systems.
- The main risk factor for developing MIS-C is being infected with SARS-CoV-2, the virus that causes COVID-19.
- MIS-C symptoms generally appear 2–6 weeks after infection, and it is common that children with MIS-C would have had no or few symptoms of COVID-19.
- Most children with MIS-C do not have any reported underlying medical conditions, but of the children with MIS-C who do report an underlying medical condition, obesity is the most common.
- Throughout the COVID-19 pandemic, trends in MIS-C cases have generally followed trends in reported daily COVID-19 cases over time. Peaks in MIS-C cases generally follow peaks in COVID-19 cases by about a month.
- Studies have reported that early in the COVID-19 pandemic, MIS-C occurred in 1 of approximately 3,000 to 4,000 children and adolescents who had SARS-CoV-2 infection. MIS-C has become rarer since the start of the pandemic: the number of MIS-C cases reported decreased from 2020 to 2023. We do not know how that trend may change in the future and CDC continues to monitor reported cases of MIS-C.
- In the United States early in the COVID-19 pandemic, incidence of MIS-C was highest among disproportionally affected racial and ethnic groups of children and adolescents, including non-Hispanic Black and Hispanic or Latino children and adolescents. See the CDC COVID Data Tracker.
- In addition to fever, children with MIS-C commonly present with abdominal pain, vomiting, diarrhea, rash, conjunctivitis, and hypotension.
- Children should be evaluated by a medical provider immediately if these symptoms appear, especially in a child who had, or was exposed to someone with, COVID-19, within the prior 2–6 weeks.
Once a child has been diagnosed with MIS-C, they will be hospitalized and receive care from a variety of specialists. Some children will need to be treated in the intensive care unit (ICU) to closely monitor symptoms.
- Multiple pediatric specialists (e.g., cardiologists, critical care specialists, hematologists, infectious diseases specialists, and rheumatologists) may participate in MIS-C management.
- Children with MIS-C will have blood tests that identify markers of inflammation; these tests are usually repeated several times to ensure a response to treatment.
- Some children require respiratory and blood pressure support during their stay.
- Children with MIS-C will likely have at least one echocardiogram performed during their hospitalization, and evidence of inflammation involving the heart is common on echocardiogram and/or blood tests.
- Treatment for MIS-C continues to evolve and includes supporting the medical needs of each patient (such as management of shock), as well as the use of immune-modifying medications.
- Clinical management will generally include intravenous immunoglobulin (IVIG), steroids, or other medications that decrease inflammation and affect the immune system.
- Management of MIS-C often also includes medications that reduce the risk of blood clot development.
Follow-Up and Long-Term Effects
Specialists will generally monitor children who have had MIS-C before they are approved to return to certain activities such as sports.
Care After Hospitalization
- Evaluation and testing after hospitalization are based on the presentation and clinical course of each child with MIS-C.
- Pediatric cardiology follow-up is generally recommended, and most children will have a follow-up echocardiogram after hospitalization for MIS-C.
- Follow-up with the child’s primary care provider is important.
- A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS-C.
- Exercise and strenuous activity are generally limited until cleared by a cardiologist, which may take several months.
- Most patients with MIS-C have had good outcomes with no significant sequelae one year after diagnosis.
- Studies evaluating the long-term effects of MIS-C are ongoing.
- Limited available data show that elevated inflammatory markers will decrease to a normal range and abnormal echocardiogram findings will resolve 1–4 weeks after hospitalization in most patients.
- Most organ-specific complications resolve by 6 months; complications persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.
- For patients who do experience persistent symptoms, healthcare providers can learn more about longer term effects of COVID-19.