Temporal Correlation Between Kawasaki Disease and Infectious Diseases in South Korea

Kang, Joong Koo; Jung, Jaehun; Kim, Young Eun; Huh, Kyungmin; Hong, Jinwook; Kim, Dong Wook; Kim, Min Young; Jung, Se Yong; Kim, Jong-Hun; Ahn, Jong Gyun

doi:10.1001/jamanetworkopen.2021.47363

Cited by 21 publications

(29 citation statements)

References 33 publications

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“…Similar results were reported of epidemiological investigations of big data by Korean researchers, 17,18) suggesting that respiratory viruses may be causative pathogens that trigger KD among viral infections. Lim et al 17) reported that several viruses, including human respiratory syncytial virus, rotavirus, norovirus, and human rhinovirus, precede KD by 1-2 months in the same cycle as the trend of KD diagnosis in a study of big data in Korea, supporting the possibility that the virus is the major cause of KD.…”

Section: A C C E P T E D a R T I C L Esupporting

confidence: 87%

“…Recently, studies using big data and time series analysis of disease statistics have reported that various viral infection outbreaks precede KD. 17,18) Moreover, pathophysiologically, the pattern of explosive systemic vasculitis in the acute phase is associated with microbial toxins or superantigens, and the fact that systemic vasculitis is sometimes self-limiting is similar to viral infectious diseases.…”

Section: Research On Cause Of Kdmentioning

confidence: 99%

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Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections

Lee

2023

Clin Exp Pediatr

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Despite studies on the etiology of Kawasaki disease (KD) ongoing for half a century since its discovery, its cause has not yet been clearly identified. Although the clinical, epidemiological, and pathophysiological characteristics of KD are presumed to be closely related to infectious diseases, studies of various pathogens to identify its etiology have been actively conducted. To date, bacteria, fungi, and viruses have been investigated to determine the relationship between KD and infection, among which viruses have attracted the most attention. In particular, during the coronavirus disease 2019 pandemic, there were many reports in Europe of a sharp increase in cases of Kawasaki-like disease (KLD), while conflicting reports that the prevalence of KD decreased due to thorough "social distancing" or "wearing mask" in Asian countries drew more attention regarding the association between KD and viral infection. Therefore, the differential diagnosis of KD from KLD with these similar spectra has become a very important issue; simultaneously, research to solve questions about the association between KD and viral infections, including sudden acute respiratory syndrome coronavirus 2, is drawing attention again. Moreover, a new concept has emerged that immune responses occurring in patients with KD can be caused by the pathogen itself as well as host cells damaged by infection. This paper summarizes the research trends into KD etiology and related pathophysiology, especially its association with viral infections, and present future research tasks to increase our understanding of KD.

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Section: A C C E P T E D a R T I C L Esupporting

confidence: 87%

Section: Research On Cause Of Kdmentioning

confidence: 99%

Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections

Lee

2023

Clin Exp Pediatr

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“…In contrast, epidemiological studies point to longer intervals between infection and KD. Kang et al observed outbreaks of KD 1–3 mo after the outbreaks of varicella and respiratory viral infections in a large cohort in South Korea [ 6 ]. Reduction in incidence of KD was observed in South Korea after introduction of nonpharmaceutical interventions to reduce spread of COVID-19, thus implicating infections as probable triggers for KD [ 6 ].…”

mentioning

confidence: 99%

“…Kang et al observed outbreaks of KD 1–3 mo after the outbreaks of varicella and respiratory viral infections in a large cohort in South Korea [ 6 ]. Reduction in incidence of KD was observed in South Korea after introduction of nonpharmaceutical interventions to reduce spread of COVID-19, thus implicating infections as probable triggers for KD [ 6 ]. Hara et al documented more impressive reduction in droplet- and contact-transmitted infections (75%) than in KD (27%) during COVID-19 pandemic, thus excluding the role of droplet and contact transmission in development of KD in Japan [ 7 ].…”

mentioning

confidence: 99%

Kawasaki Disease and Infections: A Myth or a Reality?

Gupta

2022

Indian J Pediatr

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“…This is in keeping with prior research positing that a single, ubiquitous respiratory virus is the cause of KD. 15 Others describe a variety of identifiable viruses as preceding waves of KD 16 winds. 17 While the preponderance of data now supports entry of an inciting agent(s) through a respiratory portal of entry, the specific properties of that agent remain unknown.…”

mentioning

confidence: 99%

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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Temporal Correlation Between Kawasaki Disease and Infectious Diseases in South Korea

Cited by 21 publications

References 33 publications

Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections

Research trends on causes of Kawasaki disease in the COVID-19 era: focus on viral infections

Kawasaki Disease and Infections: A Myth or a Reality?

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

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