Seasonal Variation in Epidemiology of Kawasaki Disease-Related Coronary Artery Abnormalities in Japan, 1999-2017.

Naomi Kitano,Takashi Yamano,Takashi Takeuchi,Hiroyuki Suzuki,Nobuhito Takekoshi,Tomoya Tsuchihashi,Nobuyuki Kakimoto,Takayuki Suzuki,Shoichi Shibuta,Shinya Tachibana,Akihiro Naka,Tomohiro Suenaga,Takashi Akasaka

doi:10.2188/jea.je20190189

Naomi Kitano, Takashi Yamano + Show 11 more

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https://doi.org/10.2188/jea.je20190189

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Abstract

BackgroundEpidemiological studies show a U-shaped tendency in Kawasaki disease (KD)-related coronary artery abnormalities (CAAs) across age categories. Since studies suggest seasonal variations in KD onset, this study aimed to clarify the epidemiologic features of CAAs, considering the seasons of KD-occurrence.MethodsWe analyzed 2,106 (males = 1,215, females = 891) consecutive KD cases from October 1999 through September 2017 using our electronic database of annual surveys, targeting all hospitals with pediatric departments across Wakayama, Japan. The primary outcome was the presence/absence of CAAs measured by echocardiography 1 month after KD onset. Odds ratios (ORs) and 95% confidence intervals (CIs) of combined patient age and sex for CAAs were calculated using logistic regression models adjusted for four seasons.ResultsThe median age was 25 (range, 1–212) months. The proportion of males decreased with increasing age. The youngest age group (<6 months) showed an inverse summer/autumn to winter/spring ratio (>1.0) in KD-occurrence. CAAs were observed in 2.8% of cases (males = 3.4%, females = 2.1%), which significantly lessened in summer than in other seasons. Moreover, 50% (n = 4/8) of cases with giant aneurysms experienced KD in autumn. Adjusted ORs for CAAs among males aged ≥60 months (3.0; 95%, CI 1.2–7.5) and females aged <6 months (3.6; 95%, CI 1.1–11.8) were significantly higher than those among males aged 12–35 months.ConclusionsCumulative 18-year data of consecutive KD cases from one area suggest the influence of interactions between patient age and sex on the development of KD-related CAAs. The season of KD-occurrence may reflect the diversity of agents.

Highlights

Kawasaki disease (KD) is a medium-vessel systemic vasculitis that principally affects coronary arteries.[1,2,3] Currently, KD is a leading cause of acquired heart disease in developed countries.[3,4,5] Fifty years after the first 50 cases reported in 1967,6 the etiology of KD remains unknown
Previous studies have revealed seasonal variations in the onset of KD worldwide[8,9]; the seasonality of KD may be related to the exposure to environmental factors including unspecified infectious agents.[7,24,25]. These findings suggest that the combination of patient age at KD onset and sex, which are predisposing non-modifiable host factors, plays a considerable role and contributes to the influence of seasonal variations on environmental factors in the development of KDrelated coronary artery abnormalities (CAAs)
This study primarily aimed to clarify the epidemiologic features of KD-related CAAs, based on consecutive KD cases that occurred in one area; this evaluation considered the seasons of the year in which KD occurred

Summary

Introduction

Kawasaki disease (KD) is a medium-vessel systemic vasculitis that principally affects coronary arteries.[1,2,3] Currently, KD is a leading cause of acquired heart disease in developed countries.[3,4,5] Fifty years after the first 50 cases reported in 1967,6 the etiology of KD remains unknown. Japan has the highest incidence rate of KD worldwide.[7,8,9] previous epidemiological studies have demonstrated seasonal variations of KD onset.[7,8,10,11,12,13]. Epidemiological studies show a U-shaped tendency in Kawasaki disease (KD)-related coronary artery abnormalities (CAAs) across age categories. Since studies suggest seasonal variations in KD onset, this study aimed to clarify the epidemiologic features of CAAs, considering the seasons of KD-occurrence

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