Covid-19: Deadly Complications in Children, Say Paediatricians

PARENTS are advised to get their children vaccinated against Covid-19 to protect them from serious complications, particularly Multisystem Inflammatory Syndrome in Children (MIS-C).

Paediatricians cautioned that MIS-C — a condition where different tissues and organs become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs — is the most severe form of Covid-19 in children and can be deadly.

Consultant paediatrician Datuk Dr Musa Nordin said virtually all organs in a child’s body could be affected or become inflamed.

He said children aged 5 to 11 were at highest risk of MIS-C.

On Saturday, Health director-general Tan Sri Dr Noor Hisham Abdullah said the MIS-C Malaysia Study Group recorded 174 cases of the syndrome, with 57 per cent involving children aged 5 to 11.

He said the study found seven deaths resulting from MIS-C, or four per cent of cases.

Dr Musa said vaccination provided a high level of protection against severe Covid-19 and had proven effective in preventing MIS-C, which usually develops two to six weeks after coronavirus infection.

He cited a recent study by the United States Centers for Disease Control and Prevention (CDC), which found that two doses of the Pfizer-BioNTech Covid-19 vaccine (Comirnaty) were highly effective in protecting adolescents against MIS-C.

“The estimated effectiveness of two doses of the Comirnaty vaccine against MIS-C was 91 per cent,” he told the New Straits Times.

The study in the CDC report published on Jan 14, titled “Effectiveness of BNT162b2 (Pfizer-BioNTech) mRNA Vaccination Against Multisystem Inflammatory Syndrome in Children Among Persons Aged 12–18 Years”, was conducted in the US from July to December 2021, when the Delta variant was predominant.

The study found that 95 per cent of patients aged 12 to 18 hospitalised with MIS-C were unvaccinated.

It found that no fully vaccinated patients with MIS-C required respiratory or cardiovascular life support, compared with 39 per cent of unvaccinated MIS-C patients who did. This reinforced the recommendation for Covid-19 vaccination for eligible children.

Jefri Akhbar, 47, calming his daughter Qaisara Ardini, 7,  after she received a dose of a Covid-19 vaccine at the Padang Hiliran People’s Housing Project multipurpose hall vaccination centre in Kuala Terengganu yesterday. -NSTP/GHAZALI KORI
Jefri Akhbar, 47, calming his daughter Qaisara Ardini, 7, after she received a dose of a Covid-19 vaccine at the Padang Hiliran People’s Housing Project multipurpose hall vaccination centre in Kuala Terengganu yesterday. -NSTP/GHAZALI KORI

Dr Musa cautioned that MIS-C should not be taken lightly or compared with influenza (flu).

According to CDC data, he said, Covid-19 had killed more children in the US than the total number of paediatric flu deaths over five years before the coronavirus emerged.

“Covid is not like flu. It is much worse. Last year, in the US, three children died of flu compared with a whopping 539 deaths due to Covid. In 2022, thus far, two children have died of flu compared with 58 kids who succumbed to Covid.

“In five years (2015 to 2019), flu claimed the lives of 668 kids in the US, while Covid had killed 737 kids in a span of two years (2020-2021).”

Dr Musa said doctors would conduct tests to look for signs of organ inflammation or disease in children suspected of having MIS-C.

He said the tests include blood work, chest X-ray, heart ultrasound (echocardiogram) and abdomen ultrasound.

“In the hospital, children will be given intravenous fluids or medicines. For example, paracetamol for fever and pain relief to help the child feel better.

“Doctors may use medicines like steroids and Intravenous Immunoglobulins (IVIG) to treat the inflammation. Sicker children with MIS-C will be nursed in the paediatric intensive care unit.”

Up to Feb 17, more than 340,000 children aged 5 to 11 have received the first dose of a Covid-19 vaccine under the National Covid-19 Immunisation Programme for Children, which began on Feb 3.

According to the CovidNow portal, 12.8 per cent of children aged 5 to 11 have received at least one dose of the vaccine.

Dr Nik Khairulddin Nik Yusoff, a paediatrician at Raja Perempuan Zainab II Hospital in Kota Baru, said MIS-C could become very serious.

However, he said, with proper treatment, most children would recover from the illness.

Dr Nik Khairulddin, whose expertise is in paediatric infectious diseases, said MIS-C typically presented with a cluster of signs and symptoms.

“The children usually have ongoing fever, along with two or more of other symptoms, like abdominal pain, diarrhoea, vomiting, skin rash, red eyes, and dizziness, which are signs of low blood pressure.

“Not all children will exhibit the same symptoms. The symptoms and signs will usually appear two to six weeks after a child has had a Covid infection.

“But be aware that not all children, especially those without symptoms, may have been tested for or know of their Covid-19 infection.”

He said if parents suspect that their child has developed MIS-C, they should seek immediate medical care at the nearest health facility.

“Doctors will examine the child and may perform tests to confirm the diagnosis.

“MIS-C can be treated with medication for inflammation and supportive care. Most children will need to be treated in the hospital, but some will require care in the paediatric ICU.

“It is best to make sure children with MIS-C are treated as soon as possible. Delayed treatment may result in a poorer outcome.”

Dr Nik Khairulddin stressed that preventing children from catching Covid-19 remained the best way to protect them from MIS-C.

“Vaccinating children against Covid-19 is effective in reducing the risk of getting infected and developing MIS-C.”

For children below age 5 who are ineligible for Covid-19 vaccination, he said public health measures should be practised at all times to protect them and their family members and close contacts.

These measures include avoiding 3Cs (crowded places, confined spaces and close conversation), practising 3Ws (wash hands, wear face mask and watch your distance), ensuring good ventilation at home, schools, and nurseries, and ensuring individuals around children are fully vaccinated.


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