Number of Kawasaki Disease Admissions Is Associated with Number of Domestic COVID-19 and Severe Enterovirus Case Numbers in Taiwan

Abstract

Background: Non-pharmaceutical interventions (NPIs) introduced in response to the COVID-19 pandemic, including mask-wearing and social distancing, have changed the prevalence of circulating viruses in the community. Since viral infections represent a potential triggering factor for the development of Kawasaki disease (KD), we examined the relationship between KD admission rates and the number of COVID-19, severe influenza, and severe enterovirus infections both before and after the COVID-19 pandemic. Methods: We conducted a retrospective study using data obtained from the Chang Gung Research Database (including seven Taiwanese hospitals and more than 10,000 beds) and the Centers for Disease Control in Taiwan from January 2018 to December 2020. We recorded the number of KD admissions, as well as COVID-19, severe influenza, and severe enterovirus infections. Results: The numbers of KD admissions, severe enterovirus infections, and severe influenza infections were significantly lower from April to September 2020. The number of KD hospitalizations was positively correlated with the number of domestic COVID-19 cases (p = 0.001). A decrease in KD admission numbers was positively correlated with a decrease in severe enterovirus case numbers (p = 0.007). Conclusion: Our findings provide further evidence that viral infections may be an important trigger factor in the development of KD. Therefore, NPIs may not only prevent transmissible viral infections in children, but also decrease the risk of KD.

Emerging evidence of microbial infection in causing systematic immune vasculitis in Kawasaki disease

“…The cumulative incidence of KD in enterovirus-infected cohort was significantly higher than that in non-EVinfected cohort Weng et al (2018) The decrease in the number of KD hospitalizations was positively correlated with the decrease in the number of severe enterovirus infections Guo et al (2022) HCoV-NL63 A lack of evidence proving human coronavirus NL63 infection associated with KD induction Shimizu et al (2005) The infection rate of HCoV-NL63 in KD patients is very low Dominguez et al (2006) Lack of association between infection with HCoV-NL63 virus and KD Chang et al (2006) Serological data showed no association with HCoV-NL63 infection in KD children Lehmann et al (2009) Serological data support that HCoV-NL63 is not involved in KD, but suggest that HCoV-229E may be involved in KD Shirato et al ( 2014)…”

“…It has been demonstrated that the KD incidence in the enterovirus (EV)-infected cohort was significantly higher than that in the non-EV-infected cohort ( Weng et al, 2018 ), thereby indicating a high correlation between EV infection and KD. In addition, a decreased incidence of severe enterovirus infection cases is simultaneously correlated with decreased KD hospitalizations during the SARS-CoV-2 epidemic ( Guo et al, 2022 ), thus suggesting that enterovirus might function as a critical mediator during the pathogenesis of KD.…”