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Coronavirus Disease 2019 (COVID-19) Outbreak, Update # 17 Multisystem Inflammatory Syndrome in Children (MIS-C)

New Hampshire Public Health

Distributed by the NH Health Alert Network Health.Alert@nh.gov  May 15, 2020 Time 1700 (5:00 PM EDT) NH-HAN 20200515

Key Points and Recommendations:

  • Please review the attached U.S. CDC Health Advisory “Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)” for important information about a new clinical syndrome affecting children related to COVID-19. No cases of MIS-C have been reported to date in New Hampshire.
  • The new case definition below highlights important criteria to help clinicians identify Multisystem Inflammatory Syndrome in Children (MIS-C).
  • Providers should report patients potentially meeting the below criteria to the NH Division of Public Health Services (DPHS) at 603-271-4496 during normal business hours (after hours call 603-271-5300 and request the Public Health Professional on-call).
  • Additionally, providers and laboratories should continue to submit a completed COVID-19 Case Report Form for the following people:
  • Any new COVID-19 laboratory positive test regardless of test type (e.g. PCR, antibody, etc.)
  • Any new laboratory-confirmed COVID-19 hospitalization, even if the patient was a previously reported positive as an outpatient
  • Any suspected or confirmed COVID-19 death


NH-HAN 20200515 COVID-19, Update 17                                                                               

Additional Information

o CDC Information for Healthcare Professionals:


  • World Health Organization COVID-19 website:


  • For any questions regarding this notification, please call the NH DHHS, DPHS, Bureau of Infectious Disease Control at (603) 271-4496 during business hours (8:00 a.m. – 4:30 p.m.).
  • If you are calling after hours or on the weekend, please call the New Hampshire Hospital switchboard at (603) 271-5300 and request the Public Health Professional on-call.
  • To change your contact information in the NH Health Alert Network, please send an email to Health.Alert@dhhs.nh.gov

This is an official CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network May 14, 2020, 4:45 PM ET CDCHAN-00432

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated  with Coronavirus Disease 2019 (COVID-19)


The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.


On April 26, 2020, clinicians in the United Kingdom (UK) recognized increased reports of previously healthy children presenting with a severe inflammatory syndrome with Kawasaki disease-like features.1 The cases occurred in children testing positive for current or recent infection by SARS-CoV-2, the novel coronavirus that causes COVID-19, based on reverse-transcriptase polymerase chain reaction (RT-PCR) or serologic assay, or who had an epidemiologic link to a COVID-19 case. Patients presented with a persistent fever and a constellation of symptoms including hypotension, multiorgan (e.g., cardiac, gastrointestinal, renal, hematologic, dermatologic and neurologic) involvement, and elevated inflammatory markers.2 Respiratory symptoms were not present in all cases.

Eight cases, including one death, from the UK were described in a recent publication.3 In the limited sample of 8 children, it was reported that 75% of the patients were of Afro-Caribbean descent and 62.5% were male. The report also indicated that all 8 patients tested positive for SARS-CoV-2 through antibody testing, including the patient that died.3

During March and April, cases of COVID-19 rapidly increased in New York City and New York State. In early May 2020, the New York City Department of Health and Mental Hygiene received reports of children with multisystem inflammatory syndrome. From April 16 through May 4, 2020, 15 patients aged 2-15 years were hospitalized, many requiring admission to the intensive care unit. As of May 12, 2020, the New York State Department of Health identified 102 patients (including patients from New York City) with similar presentations, many of whom tested positive for SARS-CoV-2 infection by RT-PCR or serologic assay. New York State and New York City continue to receive additional reports of suspected cases.

Additional reports of children presenting with severe inflammatory syndrome with a laboratory-confirmed case of COVID-19 or an epidemiological link to a COVID-19 case have been reported by authorities in other countries.4

It is currently unknown if multisystem inflammatory syndrome is specific to children or if it also occurs in adults.

There is limited information currently available about risk factors, pathogenesis, clinical course, and treatment for MIS-C. CDC is requesting healthcare providers report suspected cases to public health authorities to better characterize this newly recognized condition in the pediatric population.


Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to their local, state, or territorial health department.

For additional information, please contact CDC’s 24-hour Emergency Operations Center at 770-488­7100. After hour phone numbers for health departments are available at the Council of State and Territorial Epidemiologist website. (https://www.cste.org/general/custom.asp?page=EbolaAHContact)


1 https://www.cdc.gov/kawasaki/index.html

2Royal College of Paediatrics and Child Health Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19, https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf.

3Riphagen S, Gomez X, Gonzales-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020. Advance online publication, doi: 10.1016/S0140­6736(20)31094 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31094-1/fulltext  4Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, Bonanomi E, D’Anitga L. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020. Advance online publication, doi: 10.1016/ S0140­6736(20)31129-6 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext

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