Epidemiology Of Kawasaki Disease Research Articles

The etiologies of Kawasaki disease.

Kawasaki disease (KD) is a systemic vasculitis that affects young children and can result in coronary artery aneurysms. The etiology is currently unknown, but new clues from the epidemiology of KD in Japan, the country of highest incidence, are beginning to shed light on what may trigger this acute inflammatory condition. Additional clues from the global changes in KD incidence during the COVID-19 pandemic, coupled with a new birth cohort study from Japan, point to the potential role of person-to-person transmission of an infectious agent. However, the rising incidence of KD in Japan, with coherent waves across the entire country, points to an increasing intensity of exposure that cannot be explained by person-to-person spread. This Review discusses new and historical observations that guide us toward a better understanding of KD etiology and explores hypotheses and interpretations that can provide direction for future investigations. Once the etiology of KD is determined, accurate diagnostic tests will become available, and new, less expensive, and more effective targeted therapies will likely be possible. Clearly, solving the mystery of the etiologies of KD remains a priority for pediatric research.

Epidemiology of Kawasaki Disease, Its Incomplete Form and Outcomes: A Single-Institution Experience in the United Arab Emirates.

Background and objective Kawasaki diseaseis a childhood vasculitis, the leading cause of acquired heart disease in children worldwide. Data is lacking in the United Arab Emirates and the Middle East region.We aimed to review the clinical characteristics of patients diagnosed with Kawasaki disease, the response to intravenous immunoglobulin, and the short-term and long-term echocardiographic findings. Study design This is a retrospective cohort study involving patients diagnosed with Kawasaki disease in Tawam Hospital from January 2011 to December 2021. Results A total of 74 patients with a mean age of 36 months were diagnosed with Kawasaki disease, of whom 18 (24%) were below one year of age. Complete Kawasaki disease criteria were fulfilled in 36 patients (49%), while the remaining 38 (51%) were incomplete Kawasaki disease. A positive response to intravenous immunoglobulinoccurred in less than 36 hours in 60 patients (84.5%). Echocardiography at the diagnosis of Kawasaki disease was performed on 71 patients, of whom 18 (25.35%) had cardiac involvement. The odds of coronary artery aneurysms in Kawasaki diseasewere 0.12 at diagnosis. Patients younger than 12 months were significantly more likely to be diagnosed with incomplete Kawasaki diseaseas compared to older patients (24 vs. 14 patients, P= 0.01). In the multivariate logistic regression analysis, only corticosteroid therapy remained statistically significantly associated with the development of coronary aneurysms (adjusted odds ratio (OR) 13.02, ci 1.05, 161.18; P= 0.045). Conclusion A high proportion of patients with Kawasaki diseasehad an atypical presentation, especially when under one year of age. There was no association between clinical characteristics or laboratory findings and prompt response to treatment within 36 hours.

Kawasaki disease and the environment: an enigmatic interplay.

Kawasaki disease (KD) is a common systemic vasculitis of childhood. Although it has been almost 6 decades since Dr. Tomisaku Kawasaki reported the first case series of KD, the underlying cause remains a mystery. KD is a self-limiting disease. However, a dreaded complication is development of coronary artery abnormalities (CAAs). KD is the most common cause of acquired heart disease in children in the developed world and is being increasingly reported from developing countries too. Over the years, significant observations have been made about epidemiology of KD. It usually affects children below 5, has male preponderance and has significantly higher incidence in North East Asian countries. While several hypotheses have been proffered for etiology of KD, none have been conclusive. These include associations of KD epidemics in Japan and the United Stated with changes in tropospheric wind patterns suggesting wind-borne agents, global studies showing peaks of incidence related to season, and increased rates in populations with a higher socioeconomic profile related to hygiene hypothesis and vaccination. Furthermore, the self-limiting, febrile nature of KD suggests an infectious etiology, more so with sudden decline noted in cases in Japan with onset of COVID-19 mitigation measures. Finally, single nucleotide polymorphisms have been identified as possible risk alleles in patients with KD and their significance in the pathogenesis of this disease are also being defined. The purpose of this review is to elucidate the puzzling associations of KD with different environmental factors. Looking at patterns associated with KD may help us better predict and understand this disease.

Kawasaki disease in children: a retrospective cross-sectional study.

Kawasaki disease (KD) is a systemic vasculitis, seen mostly in children. Epidemiology of KD is dependent on geographical location and seasonality. Although many years have passed since the first report of KD, multiple related factors are still unknown. We investigated the clinical, paraclinical, and therapeutic aspects of KD in Kerman, Iran by performing a retrospective, descriptive, cross-sectional study on all children hospitalized due to KD between 2007 and 2020. A total of 340 patients with mean ±SD age of 29.83 ±22.55 months participated in the study. Most of our patients were two to five years old. The male : female ratio was ~ 1.4 : 1. A few of our patients had a family history of KD or vasculitis (0.3%, 1.7%). Typical KD was more common by a large margin (316 patients with typical KD). More than half of our patients had a duration of hospitalization of under ten days. All of our patients were febrile. Hand/foot and lip/mouth changes were the second and third most common clinical findings in more than 60% of our patients. Other manifestations were conjunctivitis in 40%, skin rashes in 34.8%, gastrointestinal manifestations in 33.9%, and lymphadenopathy in 25.3%. Echocardiography revealed abnormalities in 78.6% of the participants; coronary artery aneurysm (CAA) was the most frequent (22.5%) and follow-up echocardiography revealed that all of them regressed within 6 months after treatment. The two laboratory tests with the highest ratio of abnormality were erythrocyte sedimentation rate (95%) and hemoglobin (83.3%). C-reactive protein and liver function tests were also abnormal in most patients. All of our patients received intravenous immunoglobulin and acetylsalicylic acid. Kawasaki disease must be considered in every febrile child, especially those with risk factors, because timely diagnosis and treatment are essential to prevent complications. Health policies should focus on appropriate diagnosis and treatment to prevent the occurrence of sequelae.

Epidemiology of Kawasaki Disease in children in Switzerland: a national prospective cohort study.

Kawasaki disease is a febrile illness which can lead to significant coronary artery lesions. Its incidence varies among countries and is highest in Japan (330.2 children under 5 years old/100,000 per year). Since the epidemiology of Kawasaki disease in Switzerland is unknown, we conducted a national prospective data collection between 2013 and 2017 to describe its incidence, diagnosis, and treatment. We collected demographic and clinical data of the children under 17 years old hospitalised with Kawasaki disease in Switzerland between March 2013 and February 2017 using anonymous data collection forms with the help of the Swiss Paediatric Surveillance Unit (SPSU). We defined Kawasaki disease per the 2004 American Heart Association criteria: patients with ≥5 days of fever and ≥4 of the 5 main clinical features were included as complete Kawasaki disease and patients with ≥5 days of fever and <4 of the 5 main clinical features were included as incomplete Kawasaki disease. The incidence was calculated with the data of the Federal Statistical Office of Switzerland, considering permanent residents of the country. The different groups were compared by the unpaired student t-test for continuous variables and Pearson's chi squared test for categorical variables, respectively. We included 175 patients: 60% were boys, with a mean age of 38.2 months. The incidence of Kawasaki disease was 3.1/100,000 [95% CI 2.6-3.7] per year in children under 17 years of age and 8.4/100,000 [95% CI 6.7-10.2] per year in children under 5 years of age. The most frequent clinical signs were a rash (85.4%) and changes of the lips and oral/pharyngeal mucosa (83.4%). The diagnosis of Kawasaki disease was made at a mean of 7.3 days after the first symptom. Echocardiography was abnormal in 52.3%. The treatment with intravenous immunoglobulins (IVIG) and acetylsalicylic acid was administered in accordance with international guidelines. Subgroup analysis showed that children older than 5 years old had significantly more complete Kawasaki disease than the younger ones (78.8% vs 57.4%, p = 0.021). Children with "extreme ages" (<1 year old and >8 years old) were diagnosed later (8.6 (±0.9) vs 7.0 (±0.3) days, p = 0.0129), had longer duration of fever (9.8 (±0.9) vs 8.1 (±0.3) days, p = 0.013) and had more echocardiographic abnormalities (n = 26 (70.3%) vs n = 65 (47.5%), p = 0.014) at diagnosis. One child died during the acute phase of the illness. The incidence of Kawasaki disease in Switzerland is in the lower range of other European countries.

Epidemiology of Kawasaki disease in Australia using two nationally complete datasets

The incidence of Kawasaki disease (KD) is reported to be increasing in some populations. We sought to describe long-term trends in the incidence and epidemiology of KD in Australia over 25 years. Two nationally complete administrative datasets relevant to KD in Australia were analysed and compared. The Australian Red Cross Lifeblood Supply Tracking Analysis Reporting System (STARS) recorded all doses of immunoglobulin (IVIG) approved in Australia between January 2007 and June 2016. The Australian Institute of Health and Welfare National Hospital Morbidity Database (NHMD) records all episodes of care in hospitals across Australia. Data relevant to KD were extracted an analysed, with comparisons made for the period of data overlap. During the period of data overlap (2007-2015) the IVIG treatment rate in the 0- to 4-year age group (calculated from STARS) was 14.31 per 100 000 person-years (95% confidence interval 13.67-14.97). The hospitalisation rate in the same age group (calculated from the NHMD) was 14.99 per 100 000 person-years (95% confidence interval 14.33-15.66). Hospitalisation rates rose at an average rate of 3.54% annually over the 25 years to 2017 in the 0- to 4-year age group, almost exclusively in the 1- to 4-year age group. There is evidence of increasing KD diagnosis in Australia. Similar trends have also been reported in Asia but not in North America or Europe. Increasing diagnosis may reflect a true increase in disease incidence, increasing recognition or overdiagnosis. Further research is needed to determine the cause for these trends.

Association between Mycoplasma pneumoniae Infection and Coronary Artery Aneurysm in Children with Kawasaki Disease

Background: The epidemiology of Kawasaki disease (KD) suggests that an infectious agent may be a potential disease trigger in susceptible children. Several studies have shown that the cause of KD may be associated with Mycoplasma pneumoniae (M. pneumoniae) infection. Objectives: We aimed to investigate the relationship between M. pneumoniae infection and coronary artery aneurysm (CAA) in children with KD in China. Methods: From January 2015 to December 2018, a total of 330 children with KD met the inclusion criteria. Relevant data were extracted and analysed. Results: The children were stratified into two groups according to M. pneumoniae infection status. Significant differences were identified in the proportion of patients with fever &gt; 10 days, the occurrence of small CAA, and the average serum sodium, pre-albumin (PA), and albumin levels but not in the occurrence of medium and giant CAA between the two groups. According to binary logistic regression, M. pneumoniae infection (OR: 0.515; 95% CI: 0.309 - 0.860; P = 0.011), serum sodium levels (OR: 0.910; 95% CI: 0.851 - 0.972; P =0.005), and PA (OR: 0.900; 95% CI: 0.854 - 0.949; P ≤ 0.001) levels were independently associated with occurrence of small CAA. Conclusions: We demonstrated that M. pneumoniae infection, serum sodium and PA levels are inversely related to the occurrence of small CAA. These results suggest that M. pneumoniae infection may be associated with a decreased incidence of small CAA. Further large-sample studies are needed.

Epidemiology of Kawasaki Disease in South Korea: A Nationwide Survey 2015-2017.

This study aimed to investigate recent epidemiologic features of Kawasaki disease (KD) in South Korea. The ninth triennial nationwide questionnaire survey collected data on the demographic findings, symptoms and signs, treatment patterns and coronary artery complications of acute-phase KD occurred in 2015-2017 from 98 hospitals with pediatric residency programs and 108 community hospitals without residency programs. We received data from 93 of the 98 hospitals (response rate: 94.9%) with residency programs and 75 of the 108 community-based children's hospitals (response rate: 69.4%) without residency programs. In the 3-year survey period, a total of 15,378 (5449 in 2015, 5171 in 2016 and 4758 in 2017) cases of KD were reported. The mean age at diagnosis was 33.0 ± 24.8 months (range: 0-205 months), and the male-to-female ratio was 1.41:1. The overall KD incidence was 196.9 (202.2 in 2015, 197.1 in 2016 and 191.0 in 2017) per 100,000 younger than 5 years population. Recurrent cases were 4.85%. KD occurred more frequently during winter (December-January) and late spring (May-June). Intravenous immunoglobulin (IVIG) was administered to 95% of the patients; nonresponder rate for the first IVIG was 14.8%. Coronary artery aneurysms and giant coronary artery aneurysms (internal diameter >8 mm) occurred in 1.7% and 19 patients, respectively. Two patients died due to multiorgan failure and hepatic encephalopathy. Peak incidence of KD in South Korea was 202.2 per 100,000 younger than 5 years population (2015), and the incidence of giant coronary artery aneurysm decreased to 0.09% (2017).

Kawasaki disease in the COVID-19 era: a distinct clinical phenotype?

Kawasaki disease in the COVID-19 era: a distinct clinical phenotype?

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

Is it Kawasaki shock syndrome, Kawasaki-like disease or pediatric inflammatory multisystem disease? The importance of semantic in the era of COVID-19 pandemic.

A few weeks after the peak of the global 2019 novel coronavirus disease pandemic, cases of shock, multisystem inflammation and severe myocarditis have occurred in children and adolescents, generating some concerns and above all many questions. An almost immediate association raised with shock syndrome related to Kawasaki disease (KD). However, in light of bo/th experience and literature have taught us about severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection, and what already known on the epidemiology of KD, we suggest here the hypothesis of a new ‘post-viral’ systemic inflammatory disease related to excessive adaptive immune response rather than a form of KD caused by SARS-COV-2. We discuss analogies and differences between the two forms.

Epidemiology of Kawasaki disease before and after universal Bacille Calmette-Guérin vaccination program was discontinued.

Bacille Calmette-Guérin (BCG) vaccine (BCG) has been suggested to induce the primary immunity needed for the subsequent Kawasaki disease (KD). We studied the epidemiology of KD before and after the universal BCG vaccination ended in Finland in September 2006. Kawasaki disease cases were retrieved from national health registries from 1996 to 2016 for annual incidence rates. We then compared 612433 children born in the BCG vaccination era, from 1 January 1996 to 30 August 2006, to 604163 born after BCG era, from 1 September 2006 to 31 December 2016. The annual incidence rates did not change after the BCG vaccination stopped. We found 370 first visits for KD by children born in the BCG era and 341 after universal BCG vaccination ended. The mean age at diagnosis increased from 2.6years to 3.0years (95% CI-0.64 to -0.012, P=.04) and the proportion of children with Kawasaki disease under 5years decreased from 87% to 81% (95% CI 1%-12%, P=.02). Discontinuing the universal BCG vaccination programme did not change the incidence rates of KD. The increased age at diagnosis could suggest that the pathogenesis of KD may be associated with the immunological pathways primed by BCG immunisation.

Coronary artery aneurysm risk factors for Kawasaki disease patients in North of France

Kawasaki Disease (KD) is a child vasculitis. The prognosis is associated with a higher risk of coronary artery aneurysm (CAA). Currently the main goal of treatment consists of preventing CAA. At first the treatment consists on immunoglobulin (IVIG). The last American 2016 guidelines recommends echographical coronary diameter express as z-score. The epidemiology of KD is not well known in France. The aim of this study was to describe the population of the children in a region of North of France and to look for risk factors of CAA. We included patients with KD who were admitted in hospital centers of the region from 2006 to 2016. We reviewed retrospectively the medical, biological and echographical records and their monitoring data. We compared patients in group with and without CAA at 4 weeks from the diagnosis. We included 240 children from 6 hospital centers. The median age was 28 months (14–50), 20% were less than 1 year old. The male-to-female ratio was 1.8. Diagnosis was done after 7 days of fever at mean. We found 87 children with initial z-score ≥ 2DS and 28 with CAA. Patients were treated with IVIG and 35 get more than one cure, 95% get aspirin for anti-inflammatory then 87% as antiplatelet therapy. Five received corticosteroids, 1 an anti-TNFα and 1 an anti-IL1. Risk scores of CAA from Kobayashi, Egami and Sano present low sensitivity and low specificity. Several risk factors were associated with CAA: age < 6 months (OR = 4, P = 0.05), IVIG resistance (OR = 3.6, P = 0.007), z-score ≥ 2DS at diagnosis (OR = 6.7, P = 0.09 10−4) and platelet count (Pq) ≥ 444 G/L (P = 0.04). Only the initial z-score ≥ 2 DS (P = 0.02) and Pq ≥ 444 G/l (P = 0.04) were significant in multivariate analysis. The Japanese risk scores were not significant in the French population, as previously shown in North American or English populations. The initial z-score ≥ 2 DS is a good risk factor of CAA so is the Pq ≥ 444 G/l after the day 7th of fever in our population.

Kawasaki disease: epidemiology and the lessons from it.

A half of century has passed since Dr. Tomisaku Kawasaki reported his 50 cases with Kawasaki disease (KD) in 1967. Since then, more than 300 000 cases have been reported to the nationwide epidemiologic surveys in Japan. However, the etiology and risk factors of the disease are still unknown. In this paper, the author emphasizes that the epidemiology of KD may indicate an infectious agent to be a potential trigger of disease in susceptible children.

The diagnosis of Kawasaki disease among Nigerian children: a nightmare for the caregivers and the doctors

Background: The epidemiology of Kawasaki disease (KD) in developing countries is largely undefined although very few cases have been reported giving the impression that the condition is rare. The study aims to enumerate the presenting features, challenges encountered in the diagnosis and management of the subjects, the outcome of the subjects and increase awareness of KD among health practitioners in the sub region. Method: Prospective audit of patients that presented at one public hospital and three private hospitals in Lagos over a period of five years from January 2011 to December 2016. All patients diagnosed with KD in the above setting using the diagnostic criteria by the American Heart Association were included in the study. Echocardiography was done to determine the presence of a cardiac involvement. The main outcome measures were the incidence of KD, time to diagnosis, use of intravenous immunoglobulin (IVIG), cardiac features and outcome. Results: Eight cases of KD were identified and no mortality was seen. Cardiac complication of coronary dilatation was seen in 37.5% of the cases. The time from onset of fever to time of diagnosis ranged between three and nine days. IVIG was not readily available and when available was beyond the reach of common men. Conclusions: The prevalence of KD is largely unknown in Nigeria with a poor index of suspicion, late referral and hence late commencement of interventions and possibly missed diagnosis are common. Coronary dilatation is common among the subjects but with a good outcome. IVIG is not readily available and expensive in Nigeria as well as in the neighboring countries.

Epidemiologic features of Kawasaki disease: Winter versus summer

The epidemiology of Kawasaki disease (KD) shows seasonal variations, although the etiology of KD is unknown. In this study, we compared the clinical epidemiology of KD onset in winter versus that in summer to identify its etiology, that is, infectious agents. Epidemiologic features of KD were compared between two seasons with high incidence (January [winter] and July [summer]) using a dataset of the 22nd nationwide survey in Japan. Data on patients who visited hospital during 2011-2012 in Japan were analyzed after adjusting for age differences. Subgroup analysis was carried out for day of illness at the day of first hospital visit. The total number of KD patients reported in the survey was 26691. The number of patients who visited hospital with KD for the first time in January and July was 2,812 and 2,302, respectively. The proportion of patients in the age group 15months-3years was 38.8% in January and 33.5% in July. Mean serum albumin was significantly lower in January than in July (at days 2-5 of illness, P<0.05). There were no between-group differences with respect to treatment, incidence of cardiac lesions, recurrence, or history of KD among the patients' siblings and parents. No significant differences were observed between KD with onset in January and July, although minor differences with respect to age distribution and serum albumin were observed.

Epidemiology of Kawasaki disease in Italy: surveillance from national hospitalization records.

This is the first epidemiologic study on Kawasaki disease incidence in the country of Italy. Figures are in line but slightly higher than those reported for other European countries. What is known: • Kawasaki disease is more common in Asian populations. • European incidence data are scarce. What is new: • Epidemiological data in Italy show similar incidence, albeit slightly higher, than in other European countries. • Incidence data slightly rose in the recent past.

Revisiting the role of environmental and climate factors on the epidemiology of Kawasaki disease.

Can environmental factors, such as air-transported preformed toxins, be of key relevance to the health outcomes of poorly understood human ailments (e.g., rheumatic diseases such as vasculitides, some inflammatory diseases, or even severe childhood acquired heart diseases)? Can the physical, chemical, or biological features of air masses be linked to the emergence of diseases such as Kawasaki disease (KD), Henoch-Schönlein purpura, Takayasu's aortitis, and ANCA-associated vasculitis? These diseases surprisingly share some common epidemiological features. For example, they tend to appear as clusters of cases grouped geographically and temporarily progress in nonrandom sequences that repeat every year in a similar way. They also show concurrent trend changes within regions in countries and among different world regions. In this paper, we revisit transdisciplinary research on the role of environmental and climate factors in the epidemiology of KD as a paradigmatic example of this group of diseases. Early-warning systems based on environmental alerts, if successful, could be implemented as a way to better inform patients who are predisposed to, or at risk for, developing KD. Further research on the etiology of KD could facilitate the development of vaccines and specific medical therapies.

Abstract 15: Multicenter Kawasaki Disease Study In Children Of Argentina

Introduction: Kawasaki disease (KD) is a vasculitis that affects vessels of small and medium caliber. Objectives: 1 Determine clinical and epidemiology of KD in children in 22 pediatric referral centers in Argentina. 2 Identify risk factors for coronary complications (CC). Material and Methods: A retrospective and analytical study from 01/01/2010 to 31/12/2013. Variables: age, sex, heart rate (HR), clinic features, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), leukocytes (Gb), neutrophils, hemoglobin (Hb) and CC. Color Doppler echocardiography: acute phase and 4-6 weeks. Results: Subjects: 191, age (Md) 29 months (R: 2-144) .Ratio v / m: 1.8 / 1. Clinical: fever 100% (191/191) more frequent and adenopatía: 57% (110/191) less frequent. CC: 15.7% (30/191). Mortality: 0.52% (1/191 cases). Increased risk of CC: leukocytosis&gt; 20,000 / mm3 Odds ratio (OR) = 4.235 (95% CI 1704-10529). Hematocrit &lt;30, OR = 6.042. (95% CI 2469-14782) p &lt;0.0002; Hb &lt;10 OR = 5.056 (95% CI 2163-11814) p 100 mm / 1h OR = 3.725 (95% CI 1642-8447) p 100 mg / dl OR = 6.417. (95% CI 2441-16869) p &lt;0.0002 and other heart affections.OR = 7.964. (95% CI 2459-25794) p &lt;0.0010. Children from the West of the country have 2.7 times greater risk of CC OR = 2.714 (95% CI: 1228-5997) p &lt;0.019 compared to the rest. Conclusions: Increased frequency in males. Increased risk of CHD in subjects from western Argentina. Low mortality. Increased risk of CC: low hematocrit and hemoglobin; leukocytes, neutrophils, ESR, CRP, FC, high, Presence of other heart alterations and more days of fever at the time of establishing of treatment. Risk factors for coronary involvement

Central nervous system infection due to tick-borne encephalitis virus results in neurocognitive sequelae

Tick-borne encephalitis (TBE) is a vector-borne disease due to TBE virus (TBEv) and is endemic in areas throughout Europe and Asia. An effective vaccine is available. Burden of sequelae following central nervous system TBEv infection is unknown in children. Knowledge would inform optimal vaccination strategy. In this issue of The Journal, Fowler et al in Sweden reported follow-up of 55 children 2 to 7 years post-TBE using parent and teacher questionnaires and Wechsler Intelligence Scales for Children (WISC-IV). Two-thirds of children had one or more residual problems and one-third were reported by parents or teachers to have problems with executive functioning, primarily in initiating and organizing activities and in working memory. WISC-IV testing showed significantly lower working memory index compared with reference norms. These data show that, when followed and studied carefully, children have substantial rates of sequlae following TBE that are similar to adults. Article page 555▶ Epidemiology of Kawasaki Disease: Prevalence from National Database and Future Trends Projection by System Dynamics ModelingThe Journal of PediatricsVol. 163Issue 1PreviewTo update the epidemiologic trend in Kawasaki disease (KD) and develop models for projection. Full-Text PDF