new, rare syndrome puts children at risk

Multisystem Inflammation Syndrome was found in children (MIS-C), a rare disease that appears to have COVID-19 as a precursor, in children, several weeks after the onset of the virus infection.

Researchers at the University of Cape Town’s Faculty of Health Sciences’ Health Sciences have joined forces with other pediatric specialists from across the country to gather data that will provide a better understanding of this disease, further harming children’s immune systems.

When children contract COVID-19, they are often not severely affected. According to a rapid risk assessment by the European Center for Disease Prevention and Control, by mid-May 2020, only 2.1% of all laboratory-confirmed COVID-19 cases reported to the European Monitoring System were in the age group between 0 and and 14.

Furthermore, the report states that one of the reasons why the actual incidence in children is unknown may be that the milder symptoms that children display lead to a low test rate.

“This is the key to developing an understanding of this atypical immune response in this isolated group of children.”

MIS-C, also known as pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS), exhibits symptoms similar to those of both Kawasaki disease and toxic shock syndrome. It is characterized by, among other things, fever, abdominal pain and cardiac involvement.

The most important thing is to develop an understanding of this atypical immune response in this isolated group of children.

Dr Kate Webb, who is leading this research at UCT, said the virus appears to be causing the syndrome “and causing fever, rash, heart and other organ problems in children”.

Dr Webb is a research fellow of Crick African Network and consultant rheumatologist in the Department of Pediatrics and Child Health. She has collaborated with Professor Liesl Zühlke, a pediatric cardiologist based in the Division of Cardiology and a winner of the prestigious Medical Research Council of the United Kingdom (UK) and the Department of International Development (MRC / DFID) African Research Leader Award.

Collaborative platform

When the Wellcome Center for Infectious Disease Research in Africa (CIDRI-Africa) called for researchers to apply for COVID-19, Professor Zühlke, a member of the Institute of Infectious Diseases and Molecular Medicine, based at the UCT’s Faculty of Health Sciences, was one of the six applicants who received an award as a subsidiary of the center.

As lead researcher, she initially set up a bio-storage site for COVID-19 and then, in collaboration with Webb, developed the research project on MIS-C.

This research aims to capture data from children with COVID-19 and MIS-C across the country. Furthermore, a collaborative platform will be developed to collect this data from across sub-Saharan Africa.

The information provides an in-depth understanding of both the virus and the syndrome in these children, and provides valuable data for local, appropriate, evidence-based disease mitigation, strategies for stratification, and treatment.

“We will work hard to ensure that African and South African children are represented in the global data.”

Zühlke and Webb investigate the prevalence of MIS-C, which has expressed concern towards children of black, Asian and ethnic minorities (BAME) in other countries. The team saw their first case in June this year and since then there has been a group of children in the Western Cape who are critically ill with the syndrome.

“The majority of our patients are of BAME origin, and that was the trend around the world. We do not know why that is,” Webb said.

“There are many possible reasons, but we will work hard to ensure that African and South African children are represented in the global data, so that we can try to answer this question, while also making sure that the research questions and findings relevant, accessible and beneficial to these children. ‘

Quick action

Webb explained that local doctors had heeded the trends they were taking from overseas to get South Africa’s health system ready for this new job.

‘Since our pandemic was a little later than in Europe and the [United States], we have been warned about MIS-C. So as soon as we started seeing cases, we knew we were well placed to collect data and do research to quickly learn more about this new disease. ‘

It was because of their prompt action and early involvement that Webb and her team were able to publish the first case series in Africa to warn other medical practitioners about what to look out for and what to expect.

Collaboration is key to developing new insights, and it is this idea that has encouraged pediatricians from across the country to set up a MIS-C working group.

“We initially set it up informally by talking to each other via an online group. We now have representatives from each province and from most of the referral hospitals that will treat these children,” Webb said.

“This disease has no evidence-based treatment or diagnostic guidelines. That’s why we set up the group to spread awareness, learn from each other and work together to get answers and conduct this really urgent research.”

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