Epidemiological and Clinical Features of Kawasaki Disease During the COVID-19 Pandemic in the United States

Burney, Jennifer; Roberts, Samantha C.; DeHaan, Laurel L.; Shimizu, Chisato; Bainto, Emelia; Dominguez, Samuel R.; Jone, Pei‐Ni; Jaggi, Preeti; Szmuszkovicz, Jacqueline R.; Rowley, Anne H.; Scalici, Paul; Tremoulet, Adriana H.; Cayan, Daniel R.; Burns, Jane C.; Arditi, Moshe; Szmuszkovicz, Jackie; Ashouri, Negar; Yeh, Sylvia H.; Michalik, David E.; Portman, Michael A.; Newcomer, Charles; Kurio, Gregory; McNellis, Amy; Kim, Katherine; Ang, Jocelyn Y.; Manaloor, John J.; Erdem, Güliz; Bartlett, Allison; Kumar, Madan; Feghaly, Rana E. El; Ansusinha, Emily; DeBiasi, Roberta L.; Harahsheh, Ashraf S.; Ronis, Tova; Jain, Supriya; Anderson, Marsha S.; Hite, Michelle; Simonsen, Kari; Chatterjee, Archana; Truong, Dongngan T.; Romero, José María Calvo; Lloyd, David; Samuy, Nichole; Sharma, Kavita; Halasa, Natasha

doi:10.1001/jamanetworkopen.2022.17436

Cited by 24 publications

(25 citation statements)

References 23 publications

(71 reference statements)

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“…Nevertheless, the KD and respiratory virus seasonality we observed matches the known KD 1,2,13 It is possible therefore that some of the cases classified as Kawasaki disease in our study might have been miscoded MIS-C patients, leading to an overestimate of the number of KD cases in the months after the COVID-19 lockdown. However, the fact that only a small percentage (6.9%) of children hospitalized with COVID-19 had MIS-C, 18 together with the consistency of our data on the magnitude of the KD decrease, especially as found by Burney et al, 6 argue that MIS-C miscoding did not substantially affect our post lockdown KD incidence.…”

Section: Discussionsupporting

confidence: 88%

“…1,2,7 However, during the summers and in the basically complete absence of enveloped respiratory viruses due to COVID-19 between April 2020 and March 2021, the incidence of KD never declined to the same degree as that of the respiratory viruses, suggesting that there is a baseline level of KD that is exacerbated during the respiratory virus seasonal peaks. [5][6][7][8][9][10][11] As shown in Figure 1A-D, there was a close temporal association between the typically winter viruses RSV, influenza and HMP with peak levels of KD. Based on the timing of the winter peaks of RSV, influenza and HMP, it is suggestive that all 3 contribute to some degree to the elevated winter levels of KD.…”

Section: Discussionmentioning

confidence: 73%

“…In addition, the degree of decrease in KD cases after the COVID-19 lockdown in our study was consistent with the decreases described by several other studies. 5–11 Of note, Burney et al 6 reported a COVID-related KD decrease of 28.2% in a national sample, and a 51% decrease in the San Diego region, based on KD cases confirmed by a clinical diagnosis of the pediatric infectious disease clinician-authors. The other major limitation was the occurrence of the MIS-C from COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that contact or droplet transmission was not a major route for transmission of Kawasaki disease. Burney et al 6 likewise found a 28.2% reduction in KD cases across the United States in 2020 compared with 2018 and 2019, and based on social distancing analysis, in San Diego, most cases were associated with acquisition in the home environment itself, and suggested a respiratory route other than aerosols.…”

mentioning

confidence: 93%

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Is Kawasaki Disease Caused by a Respiratory Virus?

Rand

Bhaduri‐McIntosh

Gurka

et al. 2023

Pediatric Infectious Disease Journal

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Background: Kawasaki disease is characterized by high fever, rash, cervical lymphadenopathy, conjunctival injection, oral mucous membrane changes and swelling of the extremities followed by skin sloughing. Despite >50 years of study, no bacterial, viral or other infectious agent has been consistently associated with the illness. The lockdown and social distancing for COVID-19 in March 2020 led to a marked decrease in respiratory virus circulation. This provided an "experiment of nature" to determine whether Kawasaki disease would decline in parallel. Methods: Discharge ICD-10 diagnosis codes were obtained from the Vizient Clinical Data Base for Kawasaki disease and respiratory viruses, and analyzed for the age group < 5 years. Weekly respiratory virus positivity data were also obtained from BioFire Diagnostics. Results: Common enveloped respiratory viruses declined precipitously from April 2020 through March 2021 to levels at or below historical seasonal minimum levels. Kawasaki Disease declined about 40% compared with 2018-2019, which is distinctly different from the pattern seen for the enveloped respiratory viruses. Strong seasonality was seen for Kawasaki disease as far back as 2010, and correlated most closely with respiratory syncytial virus, human metapneumovirus and less so with influenza virus suggesting there is a baseline level of Kawasaki disease activity that is heightened during yearly respiratory virus activity but that remains at a certain level even in the near total absence of respiratory viruses. Conclusions: The striking decrease in enveloped respiratory viruses after lockdown and social distancing was not paralleled by a comparable decrease in Kawasaki disease incidence, suggesting a different epidemiology.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 93%

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Is Kawasaki Disease Caused by a Respiratory Virus?

Rand

Bhaduri‐McIntosh

Gurka

et al. 2023

Pediatric Infectious Disease Journal

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“… 53 , 78 It is possible that some of the decrease in KD may be related to misclassification of KD patients as having MIS-C, although this is more likely related to decrease exposure to possible infectious/environmental triggers. 79 , 80 A case series from Korea, where the incidence of MIS-C during the pandemic has been very low, compared 19 KD patients with a history of prior COVID-19 with 26 KD patients without, and noted few differences, although patients with prior COVID were older with more severe disease, which may suggest some similiarities with MIS-C. 81 The association of prior COVID-19 and vaccination with the risk of subsequent KD is largely unknown. In contrast, a report from Seattle noted that patients with a prior history of KD did not have adverse outcomes when either infected with SARS-CoV-2 or vaccinated with mRNA COVID-19 vaccines.…”

Section: Introductionmentioning

confidence: 99%

Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children

Lin

Harahsheh

Raghuveer

et al. 2023

Canadian Journal of Cardiology

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SARS-CoV-2–Related Mitigation Measures and Insights Into Kawasaki Disease

Son

2022

JAMA Pediatr

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Since Tomisaku Kawasaki first published the initial description of his eponymous disease 55 years ago, 1 investigators worldwide have endeavored to determine its pathogenesis. Although an infectious agent has long been suspected to trigger Kawasaki disease (KD), this has not been conclusively identified as the cause of the clinical syndrome characterized by fever, mucosal changes, rash, conjunctival injection, extremity changes, and unilateral lymphadenopathy. 2 While these classic criteria for KD are present only transiently, coronary aneurysms develop in up to 20% of children with KD in the first 6 weeks of disease. 3 This devastating complication, which can lead to angina, myocardial infarction, and sudden cardiac death, has driven the search for the pathogenesis of KD to develop both a pathognomonic test for early diagnosis and more targeted immunomodulatory treatments. However, the cause of KD has remained elusive despite decades of research. Now, in a natural experiment, societal changes to mitigate SARS-CoV-2 infection during the COVID-19 pandemic have exposed the importance of infectious and/or environmental exposures in the etiology of KD.In this issue of JAMA Pediatrics, Ae et al 4 present epidemiological evidence that etiologic agent(s) with a respiratory portal of entry have a seminal role in triggering KD. Since 1970, Japan has administered biennial nationwide surveys to hospitals specializing in pediatrics to study the epidemiology of KD, resulting in the world's largest KD data source. Using robust and carefully curated data from the 26th nationwide survey, the authors describe 3 important findings in comparing data from 2019 (17 347 patients with KD prepandemic) with data from 2020 (11 173 patients with KD during the pandemic). 4 First, KD cases decreased by 35.6% from 2019 to 2020, which was most evident during the special mitigation period in Japan (March through May 2020) when schools and day care facilities were closed. This reduction is highly notable given that the number of KD cases in Japan has steadily increased over the past 2 decades. 5 The highest rate recorded was 371 per 100 000 Japanese children aged 0 to 4 years in 2019. In 2020, the recorded rate in the same age group was only approximately 250 per 100 000, similar to the rate in 2006. The authors considered whether this striking reduction in incidence derived from reluctance of parents to bring their febrile children to medical care because of fear of contracting SARS-CoV-2 in medical settings. However, the number of days of illness at presentation did not differ between 2019 and 2020, with 96% of patients presenting by day 7 in both years, indicating that the lower incidence of KD was unlikely to have been caused by lower health care use or missed cases. Lastly, Ae et al 4 found that patient age affected the pandemic reduction of KD case numbers. Specifically, KD incidence fell more in children 2 years or older than in younger chil-

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Epidemiological and Clinical Features of Kawasaki Disease During the COVID-19 Pandemic in the United States

Cited by 24 publications

References 23 publications

Is Kawasaki Disease Caused by a Respiratory Virus?

Is Kawasaki Disease Caused by a Respiratory Virus?

Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children

SARS-CoV-2–Related Mitigation Measures and Insights Into Kawasaki Disease

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