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May 11, 2020 - Interim Guidance Regarding Pediatric Multi-System Inflammatory Syndrome Possibly Associated with COVID-19

Monday, May 11, 2020


This guidance outlines current information and reporting requirements of a pediatric multi-system inflammatory syndrome that may be related to COVID-19. Recent reports from the United Kingdom and across the United States identify previously well children and young adults exhibiting clinical features of Kawasaki Disease, Incomplete Kawasaki Disease, or Shock-like presentation with a portion of them being positive for SARS-CoV-2 either by PCR or serology. Specific clinical signs and symptoms of this syndrome include persistent fever (4 days or more) and elevated inflammatory markers. Other reported clinical features include respiratory distress, rash, abdominal pain, vomiting, diarrhea, conjunctivitis, and myalgia. Hemodynamic instability and respiratory failure are the life threatening sequela of this syndrome.

Over a two week period in New York City, 15 patients between 2 – 15 years of age suspected of this syndrome were hospitalized, in which eight required blood pressure support and five required mechanical ventilation.1 No deaths were reported. While only four patients tested positive for SARS-CoV-2 by PCR, serology was positive for an additional six patients who initially tested negative by PCR. Evelina London Children’s Hospital in the United Kingdom has reported 20 or more children with this syndrome presentation, in which ten have tested positive for the SARSCoV- 2 antibody.2

In the District of Columbia, one child living in DC has been identified as potentially having pediatric multi-system inflammatory syndrome. This child was positive for SARS-CoV-2 and required critical care intervention.3 This health notice provides the most recent updates on this topic and new reporting requirements for DC healthcare providers.

1. New York City Department of Health, Pediatric multi-system inflammatory syndrome potentially associated with coronavirus disease (COVID-19) in children
2. Riphagen S, Gomez X, et al. Hyperinflammatory shock in children during COVID-19
pandemic. The Lancet. May 07, 2020. Available at:
3. DC Health correspondence with Children’s National Hospital, Washington, D.C.