Australia’s active hospital-based surveillance for severe childhood disease


Principal investigator

Dr Phil Britton

In April 2020, a cluster of severely unwell children with fever and shock were described in the United Kingdom (UK) in association with SARS-CoV-2 infection. No such cases had been reported before this from China. Further cases were identified in the UK, and the condition was labelled Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS). Reports rapidly emerged from other high-burden settings, including New York, Northern Italy and France, of children with fever, shock, rash and abdominal pain, some of whom met diagnostic criteria for Kawasaki disease (KD). Majority of these children had evidence of prior SARS-CoV-2 infection and a minority showed concurrent detection of SARS-CoV-2. The United States Centers for Disease Control has named the syndrome Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C).

Recommendations for management of patients with possible PIMS-TS/MIS-C were developed by PAEDS in partnership with specialist clinicians (Inflammatory Vasculitis working group) from Australia and endorsed by the Royal Australasian College of Physicians (RACP).

While the overall risk remains extremely low for severe complications of COVID-19 in children in Australia, the PAEDS network is monitoring these rare, but clinically significant, complications of SARS-CoV-2 infection. 

Case definition of Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS)


Children and adolescents (up to 18 years of age) with fever ≥3 days 

AND two of the following:

  • rash or bilateral non-purulent conjunctivitis or muco-cutaneous inflammation signs (oral, hands or feet)
  • age-specific hypotension or “shock” within first 24 hours of presentation
  • features of myocardial dysfunction, pericarditis, valvulitis or coronary abnormalities (including ECHO findings or elevated Troponin/NT-proBNP)
  • evidence of coagulopathy (by PT, PTT, elevated d-Dimers)
  • acute gastrointestinal problems (diarrhoea, vomiting or abdominal pain).

AND elevated markers of inflammation such as ESR, C-reactive protein or procalcitonin.

AND exclusion of other infectious causes of inflammation, including bacterial sepsis, staphylococcal or streptococcal toxic shock syndromes.


AND evidence of SARS-CoV-2 infection (positive RT-PCR), or confirmed contact with a person with SARS-CoV-2 infection (public health defined), or confirmed positive SARS-CoV-2 serology (noting testing may be delayed, particularly serology. If all other criteria are met, collect data pending results).

Refer also to the clinical advice statement on PIMS-TS.

Click on the tile below to view the latest PIMS-TS case data