Life-threatening but rare post-Covid illness hits kids

Dozens of Victorian children have been hospitalised with this extremely rare illness since 2020 — these are the symptoms to look out for.

The Royal Children’s Hospital has already treated more patients for PIMS-TS this year than for all of 2021. Picture: Getty

More than 50 Victorian children have been hospitalised with an extremely rare but dangerous post-Covid condition in Victoria, exclusive hospital data has revealed.

Paediatric Inflammatory Multisystem Syndrome (PIMS-TS) is a very rare but life-threatening disease which can occur in children in the weeks after a Covid infection.

The number of children treated at Melbourne’s Royal Children’s Hospital for the first five months of 2022 for the syndrome has already overtaken the total number of PIMS-TS patients for all of 2021.

The hospital has treated 15 children with the condition since January 2022 — compared to 12 cases in 2021 — including some who spent time in intensive care.

Melbourne’s other major paediatrics hospital, Monash Children’s Hospital, has treated 24 children for PIMS-TS since the beginning of the pandemic.

A Monash Health spokesman said this included the first ever PIMS-TS patient in Australia.

WHAT IS PIMS-TS?

The syndrome is “very rare”, the Royal Children’s Hospital Covid-19 clinical director Associate Professor Shidan Tosif said, but is the most significant complication of SARS Covid infection in children.

He said it developed about two to six weeks after Covid infection and symptoms included “fever, abdominal pain, rash and lethargy”.

“In some instances, (there is) a more severe presentation with what we call shock, where they actually are more unwell, have more severe pain, difficulty maintaining blood pressure and an altered conscious state,” Dr Tosif said.

“It has a potential risk for the heart and other organs and that’s why it’s important to recognise and treat it early.

“We have seen more cases this year, compared to all of last year … reflective of the omicron surge we had.”

He told the Herald Sun that children who were only mildly unwell or even asymptomatic during their initial Covid infection can still develop PIMS-TS.

“The severity of your initial Covid infection doesn’t predict developing the syndrome,” he said.

He said it can be treated, and all patients at the Royal Children’s Hospital have recovered.

“We have medications to treat it,” he said. “The medication aims to stop the inflammation for the child.

“Prompt recognition of the syndrome earlier allows us to treat it early.”

Dr Tosif said some children were arriving at the hospital early on with a milder version of PIMS, which allowed doctors to treat it, but others were admitted to intensive care.

“There are other kids who present later or have a more severe disease faster, and they’re the ones that become more unwell and require more treatment and ICU,” he said.

He said while it was a concerning syndrome, parents should be reassured that it is extremely rare and take their child to a doctor if they develop any fever, rash, abdominal pain from two to six weeks after Covid infection.

The good news, he added, was that new evidence from Denmark showed children who have been vaccinated were less likely to develop PIMS-TS.

Vaccination is the best way to protect your child against PIMS-TS, a new study has shown. Picture: Rob Leeson

“Vaccination helps to reduce the chance of this happening,” he said.

Dr Tosif said the direct cause of PIMS-TS was still unknown, with the exact immune pathways causing the syndrome still under evaluation.

“It’s something related to the way the immune system responds in these children,” he said.

He said the syndrome had some similarities to Kawasaki disease, which causes inflammation in children.

The disease existed before Covid and is characterised by inflammation of the blood vessels, with symptoms including fever, rash, enlarged lymph nodes and joint pain.

“We’ve always suspected viruses as a potential trigger for Kawasaki disease,” Professor Tosif said.

“So (PIMS-TS) has some relationships to known diseases.”

One of the earliest mentions of PIMS-TS in Australian media was in May 2020, when the federal government ordered an urgent investigation into the illness after it was suspected to have killed at least three children in the US.
The syndrome is also known as Multisystem Inflammatory Syndrome in Children (MIS-C) in the US.