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The serious inflammatory syndrome sending some children and teens to the hospital remains extremely uncommon, doctors say. But if your child spikes a high, persistent fever, and has severe abdominal pain and vomiting that doesn't make them feel better, call your doctor as a precaution.; Credit: Sally Anscombe/Getty Images

Sixty-four children and teens in New York State are suspected of having a mysterious inflammatory syndrome that is believed to be linked to COVID-19, the New York Department of Health said in an alert issued Wednesday. A growing number of similar cases — including at least one death — have been reported in other parts of the U.S. and Europe, though the phenomenon is still not well-understood.

Pediatricians say parents should not panic; the condition remains extremely rare. But researchers also are taking a close look at this emerging syndrome, and say parents should be on the lookout for symptoms in their kids that might warrant a quick call to the doctor — a persistent high fever over several days and significant abdominal pains with repeated vomiting, after which the child does not feel better.

"If [the child is] looking particularly ill, you should definitely call the doctor," says Dr. Sean O'Leary, a pediatric infectious disease specialist at Children's Hospital Colorado Anschutz Medical Campus and member of the infectious disease committee for the American Academy of Pediatrics.

The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation, and evidence of one or more organs that are not functioning properly, says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children's Hospital.

"It's still very rare, but there's been a wave of cases. Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected," Newburger says.

Some symptoms can resemble features of Kawasaki Disease Shock Syndrome. Kawasaki Disease is an acute illness in children involving fever, together with symptoms of rash, conjunctivitis, redness in the lips, tongue and mucous membranes of the mouth and throat, swollen hands and/or feet, and sometimes a large group of lymph nodes on one side of the neck, says Newburger. Some children with the condition develop enlargement of the coronary arteries and aneurysms in those blood vessels.

A small percentage of Kawasaki cases go on to develop symptoms of shock – which can include a steep drop in systolic blood pressure and difficulty with sufficient blood supply to the body's organs. Kawasaki disease and KDSS more often affect young children, although they can sometimes affect teens, Newburger says.

Some cases of the new inflammatory syndrome have features that overlap with KD or with KDSS — including rash, conjunctivitis, and swollen hands or feet. The new inflammatory syndrome can affect not only young children but also older children and teens.

But patients with the new syndrome have lab results that look very different, in particular, "cardiac inflammation to a greater degree than we typically see in Kawasaki shock syndrome," which is usually very rare, O'Leary says. In New York City and London, which have seen large numbers of cases of COVID-19 cases, "those types of patients are being seen with greater frequency."

Some patients "come in very, very sick," with low blood pressure and high fever, O'Leary says. Some children have had coronary artery aneurysms, though most have not, he adds.

Other patients exhibit symptoms more similar to toxic shock syndrome, with abdominal pain, vomiting and diarrhea and high levels of inflammation in the body, as well as the heart, O'Leary says. Most cases are treated in the intensive care unit, he says. Treatment includes intravenous immunoglobulin, which can "calm the immune system," says Newburger, as well as steroids and cytokine blockers.

The evidence so far from Europe, where reports of the syndrome first emerged, suggests most children will recover with proper supportive care, says O'Leary, though one adolescent, a 14-year-old boy in London, has died, according to a report published Wednesday in The Lancet.

Most children with the syndrome, O'Leary and Newburger note, have either tested positive for a current infection with the coronavirus, or for antibodies to the virus, which would suggest they were infected earlier and recovered from it.

And, according to case reports, some of the kids with the inflammatory syndrome who tested negative on coronavirus tests had been exposed at some point to someone known to have COVID-19. The inflammatory syndrome can appear days to weeks after COVID-19 illness, doctors say, suggesting the syndrome arises out of the immune system's response to the virus.

"One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response," says Newburger. "This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn't happen in everybody. It's still a really uncommon event in children."

In late April, the U.K.'s National Health Service issued an alert to pediatricians about the syndrome. Reports have also surfaced in France, Spain and Italy, and probably number in the dozens globally, Newburger and O'Leary say, though doctors still don't have hard numbers. Newburger says there needs to be a registry where doctors can report cases "so we can begin to generate some statistics."

"Doctors across countries are talking to each other, but we need for there to be some structure and some science so that everybody can interpret," she says.

Earlier this week, the New York City Health Department issued an alert saying 15 children ranging in age from 2 to 15 had been hospitalized with the syndrome. Newburger says that she's been contacted about cases in New Jersey and Philadelphia, as well.

While the syndrome's precise connection to the coronavirus isn't yet clear, O'Leary says the fact that the children in most of these cases are testing positive for exposure to the virus, one way or another, provides one point of evidence. The sheer number of cases — small in absolute terms, but still "much higher than we would expect normally for things like severe Kawasaki or toxic shock syndrome" — provides another, he says.

And then there's the fact that most reports of the syndrome have come out of the U.K. and New York City, places that have been hit with large numbers of COVID-19 cases.

"It's pure speculation at this point," he says, "but the U.K. cluster kind of went up about a month after their COVID-19 infections went up, which would suggest that it is some kind of an immune phenomenon."

This content is from Southern California Public Radio. View the original story at SCPR.org.

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000
WTPZ22 KNHC 161752
TCMEP2

POTENTIAL TROPICAL CYCLONE SEVENTEEN-E
SPECIAL FORECAST/ADVISORY NUMBER 4
NWS NATIONAL HURRICANE CENTER MIAMI FL EP172019
1800 UTC WED OCT 16 2019

CHANGES IN WATCHES AND WARNINGS WITH THIS ADVISORY...

THE GOVERNMENT OF MEXICO HAS DISCONTINUED THE TROPICAL STORM WATCH
FOR THE COAST OF SOUTHEASTERN MEXICO.

SUMMARY OF WATCHES AND WARNINGS IN EFFECT...

THERE ARE NO COASTAL WATCHES OF WARNINGS IN EFFECT.

POTENTIAL TROP CYCLONE CENTER LOCATED NEAR 16.6N 96.6W AT 16/1800Z
POSITION ACCURATE WITHIN 35 NM

PRESENT MOVEMENT TOWARD THE NORTHWEST OR 310 DEGREES AT 12 KT

ESTIMATED MINIMUM CENTRAL PRESSURE 1007 MB
MAX SUSTAINED WINDS 25 KT WITH GUSTS TO 35 KT.
WINDS AND SEAS VARY GREATLY IN EACH QUADRANT. RADII IN NAUTICAL
MILES ARE THE LARGEST RADII EXPECTED ANYWHERE IN THAT QUADRANT.

REPEAT...CENTER LOCATED NEAR 16.6N 96.6W AT 16/1800Z
AT 16/1200Z CENTER WAS LOCATED NEAR 15.8N 95.7W

FORECAST VALID 17/0000Z 17.3N 97.6W...INLAND
MAX WIND 20 KT...GUSTS 30 KT.

FORECAST VALID 17/1200Z...DISSIPATED

REQUEST FOR 3 HOURLY SHIP REPORTS WITHIN 300 MILES OF 16.6N 96.6W

THIS IS THE LAST FORECAST/ADVISORY ISSUED BY THE NATIONAL HURRICANE
CENTER ON THIS SYSTEM.

$$
FORECASTER BEVEN

000
WTPZ32 KNHC 161752
TCPEP2

BULLETIN
Potential Tropical Cyclone Seventeen-E Special Advisory Number 4
NWS National Hurricane Center Miami FL EP172019
100 PM CDT Wed Oct 16 2019

...DISTURBANCE NOW UNLIKELY TO BRING TROPICAL-STORM CONDITIONS TO
THE COAST OF MEXICO...
...RAINFALL THREAT CONTINUES FOR PORTIONS OF SOUTHEASTERN MEXICO...


SUMMARY OF 100 PM CDT...1800 UTC...INFORMATION
----------------------------------------------
LOCATION...16.6N 96.6W
ABOUT 95 MI...155 KM WNW OF SALINA CRUZ MEXICO
ABOUT 65 MI...100 KM N OF PUERTO ANGEL MEXICO
MAXIMUM SUSTAINED WINDS...30 MPH...45 KM/H
PRESENT MOVEMENT...NW OR 310 DEGREES AT 14 MPH...22 KM/H
MINIMUM CENTRAL PRESSURE...1007 MB...29.74 INCHES


WATCHES AND WARNINGS
--------------------
CHANGES WITH THIS ADVISORY:

The Government of Mexico has discontinued the Tropical Storm Watch
for the coast of southeastern Mexico.

SUMMARY OF WATCHES AND WARNINGS IN EFFECT:

There are no coastal watches of warnings in effect.


DISCUSSION AND OUTLOOK
----------------------
At 100 PM CDT (1800 UTC), the disturbance was centered near latitude
16.6 North, longitude 96.6 West. The system is moving toward the
northwest near 14 mph (22 km/h), and this motion is expected to
continue through tonight. On this track, the disturbance is
expected to move farther inland over southeastern Mexico during the
next several hours.

Maximum sustained winds are near 30 mph (45 km/h) with higher gusts.
While the chances that the disturbance will become a tropical
cyclone are decreasing, there is still a small chance that a
tropical depression could develop if the center can re-form along
the coast later today or tonight.
* Formation chance through 48 hours...low...20 percent
* Formation chance through 5 days...low...20 percent

The estimated minimum central pressure is 1007 mb (29.74 inches).


HAZARDS AFFECTING LAND
----------------------
RAINFALL: The disturbance is expected to produce total rainfall
accumulations of 5 to 10 inches along the southwest coast of Mexico
from Chiapas to Jalisco, and 2 to 4 inches over southern Guatemala.
Isolated maximum amounts of 15 inches are possible in Mexico.
Rainfall in both Guatemala and Mexico could produce life-threatening
flash floods and mudslides.

WIND: A few wind gusts to tropical-storm force may occur along
portions of the coast of southeastern Mexico today.


NEXT ADVISORY
-------------
This is the last public advisory issued by the National Hurricane
Center on this system. Please refer to forecasts and warnings from
the Meteorological Service of Mexico for more information on the
ongoing rainfall threat.

$$
Forecaster Beven

 
 000
 FKPZ22 KNHC 161752
 TCAPZ2
 
 POTENTIAL TROPICAL CYCLONE SEVENTEEN-E
 SPECIAL ICAO ADVISORY NUMBER   4
 NWS NATIONAL HURRICANE CENTER MIAMI FL       EP172019
 1800 UTC WED OCT 16 2019
 
 TC ADVISORY
 DTG:                      20191016/1800Z
 TCAC:                     KNHC
 TC:                       SEVENTEEN-E
 NR:                       004
 PSN:                      N1636 W09636
 MOV:                      NW 12KT
 C:                        1007HPA
 MAX WIND:                 025KT
 FCST PSN +6 HR:           16/2100Z N1657 W09706
 FCST MAX WIND +6 HR:      025KT
 FCST PSN +12 HR:          17/0300Z N//// W/////
 FCST MAX WIND +12 HR:     ///KT
 FCST PSN +18 HR:          17/0900Z N//// W/////
 FCST MAX WIND +18 HR:     ///KT
 FCST PSN +24 HR:          17/1500Z N//// W/////
 FCST MAX WIND +24 HR:     ///KT
 RMK:                      THE FORECAST POSITION INFORMATION IN
                           THIS PRODUCT IS INTERPOLATED FROM
                           OFFICIAL FORECAST DATA VALID AT 0000...
                           0600...1200...AND 1800Z.
 NXT MSG:                  NO MSG EXP
 
 ..
 
 

000
WTPZ42 KNHC 161752
TCDEP2

Potential Tropical Cyclone Seventeen-E Special Discussion Number 4
NWS National Hurricane Center Miami FL EP172019
100 PM CDT Wed Oct 16 2019

Satellite imagery and surface observations indicate that the
disturbance has become less organized, and there is no sign of a
new center forming offshore at this time. So, while there is still
a small chance that the system could form into a tropical cyclone,
the system no longer poses a threat of bringing tropical-storm
conditions to the coast of Mexico, and this special advisory is
being issued to discontinue the tropical storm watch for the coast
of Mexico. The disturbance should continue to interact with the
mountains of southern Mexico during the next day or so, which should
most likely cause its dissipation after 12 h.

This is the last advisory issued by the National Hurricane Center
on this system unless the threat of tropical storm conditions
increases along the coast of Mexico. However, the heavy rainfall
threat, as well as the potential for flash flooding and mudslides
in southern Mexico, should continue for the next day or two.
Please refer to forecasts and warnings from the Meteorological
Service of Mexico for more information on this ongoing threat.


FORECAST POSITIONS AND MAX WINDS

INIT 16/1800Z 16.6N 96.6W 25 KT 30 MPH...POTENTIAL TROP CYCLONE
12H 17/0000Z 17.3N 97.6W 20 KT 25 MPH...INLAND
24H 17/1200Z...DISSIPATED

$$
Forecaster Beven

 
 000
 FOPZ12 KNHC 161752
 PWSEP2
                                                                     
 POTENTIAL TROPICAL CYCLONE SEVENTEEN-E                              
 SPECIAL WIND SPEED PROBABILITIES NUMBER   4                         
 NWS NATIONAL HURRICANE CENTER MIAMI FL       EP172019               
 1800 UTC WED OCT 16 2019                                            
                                                                     
 AT 1800Z THE CENTER OF POTENTIAL TROPICAL CYCLONE SEVENTEEN-E WAS   
 LOCATED NEAR LATITUDE 16.6 NORTH...LONGITUDE 96.6 WEST WITH MAXIMUM 
 SUSTAINED WINDS NEAR 25 KTS...30 MPH...45 KM/H.                     
                                                                     
 Z INDICATES COORDINATED UNIVERSAL TIME (GREENWICH)                  
    PACIFIC  DAYLIGHT TIME (PDT)...SUBTRACT 7 HOURS FROM Z TIME      
    HAWAIIAN STANDARD TIME (HST)...SUBTRACT 10 HOURS FROM Z TIME     
                                                                     
 WIND SPEED PROBABILITY TABLE FOR SPECIFIC LOCATIONS                 
                                                                     
 CHANCES OF SUSTAINED (1-MINUTE AVERAGE) WIND SPEEDS OF AT LEAST     
    ...34 KT (39 MPH... 63 KM/H)...                                  
    ...50 KT (58 MPH... 93 KM/H)...                                  
    ...64 KT (74 MPH...119 KM/H)...                                  
 FOR LOCATIONS AND TIME PERIODS DURING THE NEXT 5 DAYS               
                                                                     
 PROBABILITIES FOR LOCATIONS ARE GIVEN AS OP(CP) WHERE               
     OP  IS THE PROBABILITY OF THE EVENT BEGINNING DURING            
         AN INDIVIDUAL TIME PERIOD (ONSET PROBABILITY)               
    (CP) IS THE PROBABILITY OF THE EVENT OCCURRING BETWEEN           
         12Z WED AND THE FORECAST HOUR (CUMULATIVE PROBABILITY)      
                                                                     
 PROBABILITIES ARE GIVEN IN PERCENT                                  
 X INDICATES PROBABILITIES LESS THAN 1 PERCENT                       
 PROBABILITIES FOR 34 KT AND 50 KT ARE SHOWN AT A GIVEN LOCATION WHEN
 THE 5-DAY CUMULATIVE PROBABILITY IS AT LEAST 3 PERCENT.             
 PROBABILITIES FOR 34...50...64 KT SHOWN WHEN THE 5-DAY              
 64-KT CUMULATIVE PROBABILITY IS AT LEAST 1 PERCENT.                 
                                                                     
                                                                     
   - - - - WIND SPEED PROBABILITIES FOR SELECTED LOCATIONS - - - -   
                                                                     
                FROM    FROM    FROM    FROM    FROM    FROM    FROM 
   TIME       12Z WED 00Z THU 12Z THU 00Z FRI 12Z FRI 12Z SAT 12Z SUN
 PERIODS         TO      TO      TO      TO      TO      TO      TO  
              00Z THU 12Z THU 00Z FRI 12Z FRI 12Z SAT 12Z SUN 12Z MON
                                                                     
 FORECAST HOUR    (12)   (24)    (36)    (48)    (72)    (96)   (120)
 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 LOCATION       KT                                                   
                                                                     
 $$                                                                  
 FORECASTER BEVEN                                                    
 

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