Kawasaki disease in siblings in close temporal proximity to each other—what are the implications?

Abstract

Kawasaki disease (KD) is the commonest medium vessel vasculitis in children. The etiology of KD remains an enigma despite extensive research. Infections are considered to be one of the triggers for KD, especially in genetically susceptible hosts. KD occurring within a short time interval among siblings is an important clinical observation supporting this hypothesis. In addition, siblings of children with KD are at a higher risk of developing the disease as compared with other children. Screening for KD in febrile siblings, therefore, seems prudent. This would help initiate timely therapy and prevent complications. We briefly review 16 English language reports of KD in siblings diagnosed within 1 month of each other to highlight its etiological and therapeutic implications. Key Points • KD should be suspected in febrile children who have a sibling recently diagnosed with KD. • Etiological studies should also focus on siblings who develop KD in close temporal proximity.

Outcomes of Kawasaki Disease in Families

“…KD occurring within a short interval among sibling children is an essential clinical observation supporting this hypothesis [27]. However, of the >201 sibling pairs reviewed, a specific infectious trigger was documented in only five pairs, which included streptococcus, adenovirus, parvovirus, varicellazoster virus, and measles virus [27]- [29]. In the present study, a specific infectious trigger was not documented in sibling pair number 3 with a 7-day interval (Table I).…”

“…Infections are considered to be a trigger for KD, especially in genetically susceptible hosts [27]. KD occurring within a short interval among sibling children is an essential clinical observation supporting this hypothesis [27].…”

“…Infections are considered to be a trigger for KD, especially in genetically susceptible hosts [27]. KD occurring within a short interval among sibling children is an essential clinical observation supporting this hypothesis [27]. However, of the >201 sibling pairs reviewed, a specific infectious trigger was documented in only five pairs, which included streptococcus, adenovirus, parvovirus, varicellazoster virus, and measles virus [27]- [29].…”

Kawasaki Disease and Pediatric Infectious Diseases During the Coronavirus Disease 2019 Pandemic

“…J o u r n a l P r e -p r o o f by Dr Tomisaku Kawasaki in 1967. 11 Previous studies strongly support that infectious agents trigger an abnormal acute immune response of KD, according to epidemiologic characteristics such as the age distribution, with the highest susceptibility among children aged <2 years and lowest in those aged <6 months, compatible with infection by a ubiquitous agent resulting in increasing immunity with age and with transplacental immunity; [1][2][3][4][12][13][14] occurrence through potential sibling-to-sibling transmission inside households; 13,[15][16][17][18] temporal-and municipallevel clustering; [19][20][21] seasonal difference in occurrence; [21][22][23][24][25][26] ; and epidemics observed during the past 50 years in Japan (1979, 1982, and 1986). [1][2][3][4] Recent studies have reported that the incidence of KD decreased during the coronavirus disease 2019 (COVID-19) pandemic period compared with the corresponding period in previous years.…”

Kawasaki Disease and Vaccination: Prospective Case-Control and Case-Crossover Studies among Infants in Japan

“…In studies on KD in siblings [ 16 , 17 , 18 ], the interval of the onset of KD in two sibling patients peaked on the same day and at less than a week to one month, suggesting the involvement of a KD trigger that mostly occurred within a 7-day incubation period and occasionally occurred within a 28-day incubation period. We, therefore, defined the “case period” as 7 days (S) or 28 days (L) before the date of the onset of KD.…”