The multisystem inflammatory syndrome in children, first documented in Great Britain in late April and which now has been seen in around 200 children in the U.S. who tested positive for the SARS-CoV-2 virus, has not been seen in Arkansas, pediatrician Dr. José Romero said at today’s COVID-19 briefing, but he said parents should “be aware.”
In an interview Wednesday, Romero, the chief medical officer for the Arkansas Department of Health and the section chief for pediatric infectious disease at Arkansas Children’s Hospital, said he “expects we’re going to see more cases as we heighten awareness.” Romero also talked about his more immediate concerns about the drop in immunizations for childhood diseases seen at Children’s, about half of what would normally be seen this time of year.
Children with multisystem inflammatory syndrome, which causes blood vessels to swell, present with fever, abdominal pain and a rash. The disease can affect the heart, lungs, kidneys, brain and gastrointestinal system, Romero said. The Centers for Disease Control has reported 15 deaths in children under the age of 15, from its effect on the heart.
Multisystem inflammatory syndrome can be confused with Kawasaki disease or toxic shock syndrome, both inflammatory diseases in children, Romero said. Children’s Hospital is part of a network doing Kawasaki research, and sees between 12 and 18 Kawasaki cases a year; it has not seen an increase in caseload this year, he said. The treatment that has been used for the new illness is similar to the therapy for Kawasaki: IV gamma globulin and monoclonal antibodies to slow down the overactive immune response.
Because so few children have been seen with the disease, there is little understanding of why the coronavirus has triggered the immune response or which children are vulnerable, Romero said.
In Arkansas to date, 246 children 18 and under have tested positive for the virus. The “overwhelming majority” of COVID-19 patients seen by Children’s physicians have had no symptoms. Children have been tested for the most part because they’ve come into contact with positive cases.
Like pediatricians around the country, Romero is more immediately concerned with the drop in childhood vaccinations. Parents are also not bringing their children for well-child visits to ACH in normal numbers, Romero said.
“There’s clearly some reluctance on the part of parents to bring children in for immunization,” Romero, who is also the chair of the Centers for Disease Control and Prevention Advisory Council on Immunization Practices, said.
More than 45,000 fewer childhood vaccines were administered in Arkansas in the months of March and April, as the novel coronavirus pandemic hit Arkansas, numbers released by the state Department of Health show.
From March 1 to April 30, 2019, children across Arkansas were administered 155,581 vaccines. In the same period this year, 109,139 vaccines were administered.
Romero is especially concerned about the threat to unvaccinated children of measles, a highly infectious disease that can cause pneumonia, encephalitis and damage to the immune system for a period of time. “If we have a large body of individuals added to an already growing number of vaccine-hesitant parents, there could be significant consequences,” he said. Romero fears “the resurgence of diseases we no longer see,” such as polio, which is enough of a concern that the CDC and the Pan American Health Organization are keeping a close eye on polio vaccinations, which have been dropping off.
To get children back up to speed on their immunizations, Children’s opened a drive-through clinic April 22.
Romero said he couldn’t say what the adverse effects have been for “not seeking medical care early” — the pandemic has kept adults away from their doctors to the detriment of their health — but that it was important and that Children’s is “urging essential care, routine care for children be resumed at this time.” Romero said he now does about half of his infectious disease follow-ups by phone and that other novel ways of delivering care, like the drive-throughs and visits by video should be used.
Like all other hospitals during the pandemic, Children’s patient census dropped. The hospital postponed non-emergency surgeries for a month but is now rescheduling procedures and the hospital’s patient volume is “slowly increasing,” spokeswoman Hilary DeMillo said. “We are what we like to say ‘open and ready’ to help with the entire range of pediatric illnesses,” she said Wednesday.
Romero has been actively getting health messages out to the Spanish-speaking community, doing radio interviews almost daily and Univision interviews. He has been interviewed about issues surrounding COVID-19 and is “starting to ramp up message about the importance of vaccines and routine checkups.”