BENGALURU : The demand for Intravenous immunoglobulins (IVIG) needed for treating post COVID-19 multisystem inflammatory syndrome in children (MIS-C) has gone up. Symptoms of MIS-C includes fever, reddish rash over the body, red eyes and severe abdominal pain and occurs 2-6 weeks after COVID infection. It is an immune reaction of the body to the virus.
IVIG are antibodies against certain viruses that are injected into the patients and help them combat several infections. In order to prepare IVIG, a pooled plasma is taken from several donors to get a good population mix.
"During the first and second wave, we are seeing a lot of children who are developing MIS-C that can be cured only with IVIG treatment. The life-saving drug can prove extremely crucial when the coronavirus impacts the heart muscles. We usually give a 2 gm dosage to children who are affected with MIS-C," said Dr Chetan Ginigeri, Lead Consultant, Department of Paediatrics and Neonatology, Aster CMI Hospital, where the demand has gone up by 3-4 times at the hospital's ICU as they have treated 20 kids in the last three weeks.
As the children with MIS-C are extremely sick, any shortage can prove to be fatal and hence, while the second wave is subsiding, Dr Ginigeri said hospitals need to start preparation for it. IVIG has been used for Kawasaki disease which is similar to MIS-C, said Dr Chandrika Bhat, Consultant, Paediatric Rheumatology Services, Rainbow Children’s Hospital.
"Simply put, with this good antibodies block the bad antibodies. It resolves inflammation and the demand for IVIG has gone up. We need to use it judiciously, so there is no potential shortage of it in the future. Immunoglobulins are filtered from blood content and it is not blood- group specific, which is an advantage. If MIS-C causes cardiac dysfunction, owing to inflammation, it leads to fatality. However, this is very rare," Dr Bhat added.
IVIG, along with steroids, was used to treat the initial cases of MIS-C in the UK . "We also see that the response to both these medications, even in the sickest of children, is quite dramatic," said Dr Shivakumar Shamarao, Consultant, Paediatric intensive care unit, Manipal Hospitals.
"We, along with several other centres in the country, are seeing more cases of MIS-C compared to the first wave and therefore the usage of IVIG has gone up. It is not exactly clear if IVIG is needed for all cases of MIS-C as it has a varied spectrum of illness. One category seems to be mild ones where they have self-limiting fever, rash with raised inflammatory markers. The second category is Kawasaki disease-like presentation and the third most worrisome category is presentation with heart dysfunction and circulatory shock," Dr Shamarao said.