BENGALURU: The demand for Intravenous Immunoglobulins (IVIG) needed for treating post-COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C) has gone up. MIS-C includes symptoms of fever, reddish rash over the body, red eyes and severe abdominal pain and occurs 2-6 weeks after COVID-19 infection. It's 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 of the Covid-19 pandemic, we are coming across a lot of children developing MIS-C that can be cured only with IVIG treatment. The life-saving drug can prove extremely crucial when the COVID-19 virus impacts the heart muscles of the children. We usually give a 2gm dosage to children who are affected with MIS-C and it is also routinely used in lot of other immunological diseases like cancer and other infections," said Dr. Chetan Ginigeri, Lead Consultant - Dept. of Pediatrics 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 2 weeks.
As 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 preparations for the next wave. IVIG has been used for Kawasaki disease, which is similar to MIS-C, said Dr Chandrika Bhat, consultant, Pediatric 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. In extremely few cases, it includes kidney involvement and liver dysfunction which leads to mortality as well. Even serious cases have recovered with the help of supportive management such as use of ECMO (Extracorporeal membrane oxygenation is an artificial lung and heart)," Dr. Bhat added.
"IVIG along with steroids was used to treat the initial cases of MIS-C in the UK. They worked well and the children recovered and because it seemed to help, the same treatment is being continued. So the evidence for using IVIG comes from these diseases. We also see that the response to both these medications even in the sickest of children is quite dramatic," said Dr Shivakumar Shamarao, Consultant, Pediatric intensive care unit, Manipal hospitals.
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"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. IVIG may not be needed in the mild forms. Most of the moderate to severe spectrum of the disease (which presents like Kawasaki disease and children presenting with circulatory shock) is being treated with a combination of IVIG and steroids," Dr. Shamarao said. MIS-C can be fatal if not recognized and treated on time and the chances of recovery are very good if the same is done timely.
Imported drug used to treat MIS-C
In a first, paediatricians at Rainbow Children's Hospital used Anakinra, an imported drug, to treat MIS-C. Two children had significant inflammation of the heart leading to decreased cardiac function and low blood pressure. Apart from medications to increase blood pressure, they were given immunoglobulin and steroids to control the inflammation. Despite this, they continued to have persistent inflammation of the heart and were eventually administered a medication named Anakinra which belongs to a group of drugs called monoclonal antibodies.
"In the western world, this is the drug of choice in children who do not respond to conventional treatment. Unfortunately, Anakinra is not available in India and must be imported. At RCH, we were able to procure this medication in time for these children and it proved to be life-saving. We are probably the first centre in India to use this drug in children with MIS-C. Both the children responded well to treatment and are now recovering," said Dr Chandrika Bhat, consultant, Pediatric Rheumatology Services, Rainbow Children’s Hospital.