Multisystem inflammatory syndrome in children and adolescents with Covid-19 (WATCH)

A scientific brief released by the World Health Organisation (WHO) stated that reports from Europe and North America described clusters of children and adolescents requiring admission to intensive care units with a multisystem inflammatory condition with some features similar to those of Kawasaki disease and toxic shock syndrome.

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Initial hypotheses are that this syndrome may be related to Covid-19 based on initial laboratory testing.

Case reports described a presentation of acute illness accompanied by a hyper-inflammatory syndrome, leading to multi-organ failure and shock.

Children have been treated with anti-inflammatory treatment, including parenteral immunoglobulin and steroids.

“It is essential to characterise this syndrome and its risk factors to understand causality and describe treatment interventions.

.@WHO released a scientific brief on Multisystem Inflammatory Syndrome in Children: https://t.co/06owv1gLeo

I call on all clinicians worldwide to work with your national authorities and WHO to be on the alert and better understand this syndrome in children. #COVID19 pic.twitter.com/amlIaBsI5k

— Tedros Adhanom Ghebreyesus (@DrTedros) May 16, 2020

“The full spectrum of the disease is not yet clear, and whether the geographical distribution in Europe and North America reflects a true pattern, or if the condition has simply not been recognised elsewhere,” WHO stated.

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The organisation is in need of standardised data collection, describing clinical presentations, severity, outcomes and epidemiology.

WHO has developed a preliminary case definition and case report form for multisystem inflammatory disorder in children and adolescents.

The preliminary case definition reflects the clinical and laboratory features observed in children reported and serves to identify suspected or confirmed cases both for the purpose of providing treatment and for provisional reporting and surveillance.

The case definition will be revised as more data becomes available.

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Preliminary case definition

Children and adolescents, 0–19 years of age, with fever for three days and two of the following:

• Rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet).
• Hypotension or shock.
• Features of myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities.
• Evidence of coagulopathy.
• Acute gastrointestinal problems (diarrhoea, vomiting or abdominal pain).
• Elevated markers of inflammation.
• No other obvious microbial cause of inflammation, including bacterial sepsis, staphylococcal or streptococcal shock syndromes.
• Evidence of Covid-19 or likely contact with patients with Covid-19.

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Global Covid-19 Clinical Data Platform

WHO has an established platform for standardised, anonymised clinical data.

Contributors can enter data into the web-based WHO Covid-19 Clinical Data Platform which captures all Covid-19 variables listed in the case report forms.

Using the platform facilitates aggregation, tabulation and analysis across different settings globally and provides a secure, access-limited, password-protected, electronic database hosted on a secure server at WHO.

The organisation will maintain appropriate technical and organisational security measures to protect confidentiality and prevent the unauthorised disclosure of the anonymised Covid-19 data.

Contributors will retain control of their data and health facilities will have access to their dataset in an analysable format.

“I call on all clinicians worldwide to work with your national authorities and WHO to be on the alert and better understand this syndrome in children,” said WHO Director-General, Tedros Adhanom Ghebreyesus.

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Become a contributor

Email COVID_ClinPlaftorm@who.int and request log-in credentials.

The data management team will contact you with instructions for data entry and will assign you a five-digit site code at that time.

Each CRF has two modules:

• Module One to be completed when multi-system inflammatory syndrome is suspected, and results of tests included in the case definition.
• Module Two to be completed at discharge or death.

If the patient is transferred from one ward to another within the same hospital, the CRF should be updated throughout the hospital stay, from the date of admission in the hospital, until the date of transfer to another hospital, discharge from the hospital, or death.

In settings where Covid-19 CRF data have already been entered in databases other than the WHO Covid-19 Clinical Data Platform, WHO will work with health facilities to transfer data from the original databases to the WHO platform.

• As the Covid-19 data collection is not considered a research study, but rather surveillance of public health importance, patient or parent/guardian consent is not expected to be required in most settings. Additionally, information is likely to be collected retrospectively through extraction from medical records in most cases.

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