Characteristics of Kawasaki Disease Before and After the COVID-19 Pandemic in a Large Pediatric Heart Disease Center

Yu, Huan; Xia, Yuhan; Li, Jie; Hang, Biyao; Chen, Han; Xu, Zhiyun; Luo, Ming; Rong, Xing; Zhu, Jinshun; Chu, Maoping

doi:10.3389/fped.2022.895408

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…Importantly, coronary artery outcomes remained unchanged, as has been found in the other studies (13) (25).…”

Section: Discussionsupporting

confidence: 82%

“…Although we have found no signi cant decrease in the age of onset, as did one of the Japanese studies (17), and we have found that the proportion of children under the age of 1 year did not vary, multiple other studies did not replicate our ndings. Instead, they showed a greater proportion of KD incidence in children under 1 year of age and, inversely, a smaller proportion of children between 1 and 5 years of age ( 14) (16), thus nding a decrease in their median age (18) (25). This phenomenon has been explained by older children changing lifestyles during the pandemic, such as lessened time outdoors and mask wearing, whereas younger children did not undergo as drastic lifestyle changes in comparison to before the pandemic (25).…”

Section: Discussionmentioning

confidence: 99%

“…Instead, they showed a greater proportion of KD incidence in children under 1 year of age and, inversely, a smaller proportion of children between 1 and 5 years of age ( 14) (16), thus nding a decrease in their median age (18) (25). This phenomenon has been explained by older children changing lifestyles during the pandemic, such as lessened time outdoors and mask wearing, whereas younger children did not undergo as drastic lifestyle changes in comparison to before the pandemic (25). Alternatively, Esmaeilzadeh H. et al suggested that SARS-CoV-2 infection acts as a KD trigger more strongly in younger children than in those over 1 year old (18).…”

Section: Discussionmentioning

confidence: 99%

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Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

Epitaux,

Sekarski,

Bressieux-Degueldre

2024

Preprint

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Background Kawasaki disease is a rare systemic inflammatory syndrome that mainly affects children under five years of age and is the first cause of pediatric acquired cardiovascular disease. The pathogenesis is complex and a viral trigger is suspected, as well as genetic susceptibility. Multiple studies around the world have shown a decrease in the incidence of Kawasaki disease and have hypothesized that the different sanitary measures enforced in each country during the pandemic period could be responsible to a certain extent. The aim of this study is to evaluate the effects of the COVID-19 pandemic on the disease’s incidence, defining characteristics, coronary artery outcomes and management in a tertiary center in Switzerland.Methods This study is a retrospective analysis of children who have been diagnosed with Kawasaki disease that compares clinical, laboratory, and echocardiographic data as well as treatments before (January 1st 2017 to February 24th 2020) and during (February 25th 2020 to December 31st 2022) the COVID-19 pandemic in Switzerland. Statistical significance of differences in the compared parameters was assessed.Results Of the 90 patients included, 31 belonged to the first group and 59 belonged to the second group. There was a statistically significant (p < 0.05) increase in incidence during the pandemic period (5.91/10,000 children) of 88% compared to the pre-pandemic period (3.14/10,000 children). A lesser seasonal variation was observed during the pandemic. There was no other notable difference in demographic factors, clinical presentation, coronary outcome or administered treatment.Conclusions To the best of our knowledge, this is the first extensive European study comparing Kawasaki disease before and during the COVID-19 pandemic. Interestingly, there was a significant increase in incidence in Kawasaki disease during the COVID-19 pandemic. In contrast, studies done in Japan, South Korea and the USA have shown a decrease in incidence. Differences in methodologies, genetics, ethnicities, environments, sanitary measures and SARS-CoV-2 spread are factors that should be considered. Further studies analyzing the differences between countries with increased incidence of Kawasaki disease could help better understand the relevance of such factors and provide more insight into the etiologies of this particular disease.

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“…Importantly, coronary artery outcomes remained unchanged, as has been found in the other studies (13) (25).…”

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

Epitaux,

Sekarski,

Bressieux-Degueldre

2024

Preprint

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“…Notably, these major outbreaks self-stabilized, regardless of vaccination status. During the major outbreaks in 2022, there was a shift towards infecting younger populations [73][74][75], particularly those with vitamin D deficiency. These factors contribute to the dominant Omicron variants, increasing hospitalization but fewer deaths.…”

Section: Vitamin D Deficiency Increases the Vulnerability To Sars-cov-2mentioning

confidence: 99%

Decoding the paradox: Understanding Elevated Hospitalization and Reduced Mortality in SARS-CoV-2 Variants

Sunil J. Wimalawansa

2024

Int. J. Front. Sci. Technol. Res.

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Introduction and aim: SARS-CoV-2 outbreaks occur cyclically, aligning with winter when vitamin D levels are lowest, except after new variant outbreaks. Adequate vitamin D is crucial for robust immune function. Hypovitaminosis diminishes immune responses, increasing susceptibility to viral infections. The manuscript explores the discrepancy between increased SARS-CoV-2 hospitalizations and lower mortality. Method: SARS-CoV-2 mutants, including Delta, BQ, and XBB Omicron lineages, developed immune evasion capabilities, reducing the effectiveness of COVID-19 vaccines and bivalent boosters. The failure of COVID-19 vaccines to prevent infections and spread to others, coupled with the immune evasion exhibited by mutant viruses, contributed to continued SARS-CoV-2 outbreaks. Interestingly, dominant new mutants, despite their increased transmissibility, have caused fewer deaths. This article scrutinizes the mentioned incongruity through an analysis of published data. Results: Achieving herd immunity and eradicating SARS-CoV-2 has proven elusive due to ongoing mutagenesis and immune evasion, leading to recurrent viral outbreaks. The failure to approve repurposed early therapies for COVID-19 by regulators, as well as misinformation and weak strategies undertaken by leading health authorities, exacerbated the situation. Repurposed agents, including vitamin D and ivermectin, have demonstrated high efficacy against SARS-CoV-2 from the beginning, and remain unaffected by mutations. Despite their cost-effectiveness and widespread availability, regulatory approval for these generic agents in COVID-19 treatment is pending. Conclusion: Regulators hesitated to approve cost-effective, repurposed generic agents primarily to safeguard the temporary approval status of COVID-19 vaccines and anti-viral agents under Emergency Use Authorization, which persists. This reluctance overlooked the opportunity to implement an integrated approach with repurposed agents alongside COVID-19 vaccines, potentially reducing hospitalizations and fatalities and preventing outbreaks; this led to the failure to eradicate SARS-CoV-2 and becoming endemic. It is imperative that regulators now reconsider approving affordable generics for SARS-CoV-2 to effectively control future viral outbreaks. Non-technical Importance (Lay Abstract) Adequate vitamin D levels significantly bolster the human immune system—deficiency compromises immune responses and increases susceptibility, particularly to viruses. While new SARS-CoV-2 mutations like Omicron are less severe, they are more infectious and adept at evading immunity from vaccines; thus, they offer a limited spectrum of protection and duration. Primary COVID-19 vaccines have reduced disease severity but have failed to prevent viral spread, contributing to outbreaks. Booster doses had little effect on the virus but caused immune paresis, thus increasing susceptibility to infections. Regulators should consider approving generic, repurposed agents like vitamin D and ivermectin as adjunct therapies to address this challenge and better prepare for future pandemics. Proactively integrating vitamin D supplementation to fortify the immune system can mitigate vital outbreaks, alleviate hospital burdens, and reduce healthcare costs.

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Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

Epitaux,

Sekarski,

Bressieux-Degueldre

2024

BMC Pediatr

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Background Kawasaki disease is a rare systemic inflammatory syndrome that mainly affects children under five years of age and is the first cause of pediatric acquired cardiovascular disease. The pathogenesis is complex and a viral trigger is suspected, as well as genetic susceptibility. Multiple studies around the world have shown a decrease in the incidence of Kawasaki disease and have hypothesized that the different sanitary measures enforced in each country during the pandemic period could be responsible to a certain extent. The aim of this study is to evaluate the effects of the COVID-19 pandemic on the disease’s incidence, defining characteristics, coronary artery outcomes and management in a tertiary center in Switzerland. Methods This study is a retrospective analysis of children who have been diagnosed with Kawasaki disease that compares clinical, laboratory, SARS-CoV-2 exposure, and echocardiographic data as well as treatments before (January 1st 2017 to February 24th 2020) and during (February 25th 2020 to December 31st 2022) the COVID-19 pandemic in Switzerland. Statistical significance of differences in the compared parameters was assessed. Results Of the 90 patients included, 31 belonged to the first group and 59 belonged to the second group. There was a statistically significant (p < 0.05) increase in incidence during the pandemic period (5.91/100,000 children) of 88% compared to the pre-pandemic period (3.14/100,000 children). A lesser seasonal variation was observed during the pandemic. 30% of the patients in the pandemic group had an exposure to SARS-CoV-2. There was no other notable difference in demographic factors, clinical presentation, coronary outcome or administered treatment. Conclusions To the best of our knowledge, this is the first prolonged European study comparing Kawasaki disease before and during the COVID-19 pandemic. There was a significant increase in incidence in Kawasaki disease during the COVID-19 pandemic. In contrast, studies done in Japan, South Korea and the USA have shown a decrease in incidence. Differences in methodologies, genetics, ethnicities, environments, microbiome-altering behaviors, sanitary measures and SARS-CoV-2 spread are factors that should be considered. Further studies analyzing the differences between countries with increased incidence of Kawasaki disease could help better understand the relevance of such factors and provide more insight into the etiologies of this particular disease.

show abstract

Characteristics of Kawasaki Disease Before and After the COVID-19 Pandemic in a Large Pediatric Heart Disease Center

Cited by 3 publications

References 28 publications

Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

Decoding the paradox: Understanding Elevated Hospitalization and Reduced Mortality in SARS-CoV-2 Variants

Kawasaki disease before and during the COVID-19 pandemic: a single-center comparative study in Switzerland

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