Relationship of climate, ethnicity and socioeconomic status to Kawasaki disease in San Diego County, 1994 through 1998

Bronstein, David; Dille, Amy N.; Austin, Jared P.; Williams, Christine M.; Palinkas, Lawrence A.; Burns, Jane C.

doi:10.1097/00006454-200011000-00012

Cited by 75 publications

(57 citation statements)

References 19 publications

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“…It is speculated that such regional variation in the seasonal pattern may be attributable to differences in the climate of these regions. In support of this, Bronstein et al 12 found the incidence of KD in San Diego correlates with temperature and rainfall. Future studies are needed to investigate the effect of climate on the epidemiology of KD.…”

Section: Discussionmentioning

confidence: 83%

Hospitalizations for Kawasaki Disease Among Children in the United States, 1988–1997

Chang

2002

Pediatrics

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ABSTRACT. Objective. To evaluate the epidemiologic pattern of Kawasaki disease (KD) in the United States over 10 years.Methods. The National Inpatient Sample, a stratified national sample of >900 hospitals in 22 states of the United States, was used. Data on hospital discharges from 1988 -1997 were analyzed. Patients <18 years of age with a discharge diagnosis of KD were identified.Results. There were 6442 patients with KD admitted to 651 hospitals. Median age at hospital admission was 2 years. Peak incidence by year of age was 1 year old. Children <2 years old accounted for 36.6% of all cases; <5 years old, 75.6%; and <10 years old, 95.6%. The age distribution seems to be wider than reported from Japan. The incidence for children <5 years old was 8.1 per 100 000 people in 1988, and increased to 18.5 in 1997. There were 3905 males (60.6%) and 2537 females (39.4%), for a male-to-female ratio of 1.54. The incidences were higher in winter and spring (December to May) and dropped to a nadir between July and September. No apparent change in seasonal pattern was noted over 10 years. The South census region showed a seasonal change 2 to 3 months ahead of other regions. The overall in-hospital mortality rate was 0.17%. The mortality rate in children >10 years (1.4%) was significantly higher in than children <10 years (0.11%).Conclusions. KD affects mainly children under 5 years of age, with a peak incidence in children 1 to 2 years of age. The incidence of KD was rising over the study period. There is a male predominance. Although KD occurs year-round, the lowest incidence is seen from July through September. Such seasonal variation did not change over the 10 years. Seasonal pattern may vary in different geographic regions. Mortality from KD is rare, although children >10 years are at higher risk. Pediatrics 2002;109(6). URL: http://www.pediatrics.org/cgi/content/ full/109/6/e87; Kawasaki disease, epidemiology, United States.ABBREVIATIONS. KD, Kawasaki disease; NIS, Nationwide Inpatient Sample; IVIG, intravenous immunoglobulin; AHA, American Heart Association. K awasaki disease (KD) is an acute febrile illness of unknown cause. [1][2][3] It is known to affect young children causing persistent high fever and signs of systemic inflammation. KD is associated with development of coronary aneurysm and myocarditis and is the leading cause of acquired heart disease among children in the United States and many developed nations. Although KD is much more common in Japan, cases of KD have been reported worldwide. Epidemiologic studies have shown that KD affects mainly children under 5 years of age with a male predominance. Most epidemiologic information on KD has come from Japan where a nationwide epidemiologic survey is conducted every 2 years. 4 -7 There has been limited, up-to-date epidemiologic information on KD in the United States. 8 -12 Recent reports indicate that most (Ͼ96%) children with KD are hospitalized. 13,14 Therefore, data from hospital discharges provide valuable sources for investigating the epidemiology of ...

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Section: Discussionmentioning

confidence: 83%

Hospitalizations for Kawasaki Disease Among Children in the United States, 1988–1997

Chang

2002

Pediatrics

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“…10 These estimates are similar to those reported in smaller studies. 12,13 Recent reports have emphasized the occurrence of Kawasaki disease in older children, who may have a higher prevalence of cardiovascular complications related to late diagnosis. 14 -16 Rates of recurrence and familial occurrence of Kawasaki disease are best documented in the literature from Japan; these rates may be lower in other races and ethnicities.…”

Section: Epidemiologymentioning

confidence: 99%

“…10,11 Reported associations of Kawasaki disease with antecedent respiratory illness and exposure to carpet-cleaning fluids have not been consistently confirmed. 12,13,[27][28][29][30] Other factors that are reportedly associated with Kawasaki disease include having preexisting eczema, 31 using a humidifier, 30 and living near a standing body of water. 32 The case fatality rate in Kawasaki disease in Japan is 0.08%.…”

Section: Epidemiologymentioning

confidence: 99%

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Newburger¹,

Takahashi²,

Gerber³

et al. 2004

Circulation

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Background— Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. Methods and Results— A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. Conclusions— Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

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“…Siblings of KD patients have a 6-10-fold greater incidence than the general population [12], and KD-affected children are more likely to have parents who had the condition [13]. Other aspects of the epidemiological evidence, including seasonality and spatiotemporal clustering of cases, together with the clinical features, suggest an infectious aetiology [2,5,6,14,15]. The age distribution of KD cases is similar to that of many childhood infections [2].…”

Section: Introductionmentioning

confidence: 99%

Modelling seasonal variations in the age and incidence of Kawasaki disease to explore possible infectious aetiologies

et al. 2012

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The average age of infection is expected to vary during seasonal epidemics in a way that is predictable from the epidemiological features, such as the duration of infectiousness and the nature of population mixing. However, it is not known whether such changes can be detected and verified using routinely collected data. We examined the correlation between the weekly number and average age of cases using data on pre-vaccination measles and rotavirus. We show that age -incidence patterns can be observed and predicted for these childhood infections. Incorporating additional information about important features of the transmission dynamics improves the correspondence between model predictions and empirical data. We then explored whether knowledge of the age -incidence pattern can shed light on the epidemiological features of diseases of unknown aetiology, such as Kawasaki disease (KD). Our results indicate KD is unlikely to be triggered by a single acute immunizing infection, but is consistent with an infection of longer duration, a non-immunizing infection or co-infection with an acute agent and one with longer duration. Age -incidence patterns can lend insight into important epidemiological features of infections, providing information on transmission-relevant population mixing for known infections and clues about the aetiology of complex paediatric diseases.

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Relationship of climate, ethnicity and socioeconomic status to Kawasaki disease in San Diego County, 1994 through 1998

Abstract: KD is a common childhood vasculitis of unknown etiology. The skewed ethnic distribution and seasonality are consistent with the hypothesis that KD is an infectious disease that is influenced by environmental and genetic factors.

Cited by 75 publications

References 19 publications

Hospitalizations for Kawasaki Disease Among Children in the United States, 1988–1997

Hospitalizations for Kawasaki Disease Among Children in the United States, 1988–1997

Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease

Modelling seasonal variations in the age and incidence of Kawasaki disease to explore possible infectious aetiologies

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