Concern rises over inflammation affecting children

The alert is worrying and the many pending questions will inevitably fuel anxiety. For several weeks, several medical teams in Europe have been worried about the growing appearance of serious inflammatory syndromes in children, some of which are associated with myocarditis (inflammation of the heart muscle). These teams wonder about the potential link with the current pandemic context. Spain, Italy and Belgium have documented cases. In the UK, it is the National Health Service itself that reports “Apparent increase in the number of children of all ages requiring intensive care.” In France, reports came from Paris hospitals.

In an email sent to the Ile-de-France Regional Health Agency (ARS) dated April 23, doctors at the AP-HP are alarmed by the “Care for two weeks of children with myocarditis pictures” who would tend “To put them on the track of a dysimmunity or post-infectious situation due to Covid.” “We think that these elements are serious enough to alert to this situation in children”, they write at the end of their text.

Interrogations

At Necker Hospital, members of M3C, the reference center for complex congenital heart defects, sent their observations by internal message to other departments on April 28. You can read: “It has become clear over the past three weeks that an increasing number of children of all ages have been hospitalized in a context of multi-systemic inflammation frequently associating circulatory failure with elements in favor of myocarditis.” Doctors do not formally establish the nature of the causation with Sars-CoV-2. However, they agree not to “Still understand why the start of this influx of young patients is delayed compared to that of the pandemic in Ile-de-France”. Questions they have also shared with learned societies of pediatrics and resuscitation.

What is it exactly? The clinical picture of these children, mainly aged 8 to 14, is very varied: high fever, rashes, abdominal pain, diarrhea, vomiting, fatigue, respiratory discomfort … Not all of them show all the symptoms. And if many of them have close but incomplete signs of Kawasaki disease (inflammation of the vessels), Ricardo Carbajal, head of the pediatric emergency department at Trousseau, believes that it is “Probably from a new entity”. He explains : “Typically, this disease affects children 6 months to 5 years of age. There, our patients are older and, moreover, do not meet all the criteria that lead to usually make this diagnosis. ” Above all, Kawasaki disease does not cause heart failure. A major difference with the new serious forms observed in hospitals in Ile-de-France.

MC3’s email says “That at least 25 children” have already been taken care of by the Ile-de-France resuscitation services. According to our information, thirteen were received in the pediatric resuscitation departments of Necker, three by the Trousseau hospital, four in Robert-Debré, two in Kremlin-Bicêtre… All have heart problems, but only some of them have have been tested positive for Covid-19 using the PCR test. To see more clearly, doctors are now awaiting all serological results. “We have initial feedback that gives us the impression that these serious forms are a post-infectious immune response to Covid. A remote reaction which would explain that we do not always find the virus by PCR test “, says Stéphane Dauger, head of the pediatric resuscitation service at Robert-Debré Hospital. While tempering insistently: “These are still only assumptions. Above all, this does not detract from the validity of the other epidemiological truths in children in this epidemic. Faced with Covid-19, young people are much less inclined to develop severe forms. ”

“Time”

Just last week, during its weekly epidemiological update, Public Health France recalled that children represent “Less than 1% of hospital patients and deaths”. In these new cases, no deaths have been reported to date. “To my knowledge, they are all evolving well”, says Ricardo Carbajal.

Asked this Wednesday in the National Assembly about the situation, the Minister of Health, Olivier Véran, replied “Take this alert very seriously”. With a concern to moderate his remarks to the maximum: “It’s time for clinical research, scientific research. All paediatricians and resuscitators from the euro zone are working together to see whether or not there is a need to make a link with the Covid-19. What I don’t know yet as I speak to you […]. At this point, this is an alert and not yet an observation. “

Anaïs Moran

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