Predicting the characteristics of the aetiological agent for Kawasaki disease from other paediatric infectious diseases in Japan

Abstract

SUMMARYAlthough Kawasaki disease (KD), which was first reported in the 1960s, is assumed to be infectious, its aetiological agent(s) remains unknown. We compared the geographical distribution of the force of infection and the super-annual periodicity of KD and seven other paediatric infectious diseases in Japan. The geographical distribution of the force of infection, which was estimated as the inverse of the mean patient age, was similar in KD and other paediatric viral infections. This similarity was due to the fact that the force of infection was determined largely by the total fertility rate. This finding suggests that KD shares a transmission route, i.e. sibling-to-sibling infection, with other paediatric infections. The super-annual periodicity, which is positively associated with the sum of an infectious disease's incubation period and infectious period, was much longer for KD and exanthema subitum than other paediatric infectious diseases. The virus for exanthema subitum is known to persist across the host's lifespan, which suggests that the aetiological agent for KD may also be capable of persistent infection. Taken together, these findings suggest that the aetiological agent for KD is transmitted through close contact and persists asymptomatically in most hosts.

A novel variant of torque teno virus 7 identified in patients with Kawasaki disease

“…Furthermore, it was mathematically predicted that the infectious etiological agent of KD would be relatively common [34], based upon the young mean age of KD patients in Japan [36]. Consistent with this line of thought, TTVs are highly prevalent among healthy adult individuals [37].…”

“…This pantrophic characteristic of TTV7 is consistent with the intestinal and respiratory symptoms that are prodromal to KD. Previous epidemiological studies predicted that at least one of the etiological agent(s) for KD would be capable of persistent infection [33, 34]. Notably, persistent infection is a characteristic reported to be shared by the anelloviruses [35].…”

Kawasaki disease: etiopathogenesis and novel treatment strategies

“…Cases are rarely seen below 6 months of age which could be attributed to the passive transmission of maternal immunoglobulins providing protection to the child at an early age, which gradually decreases over the time [37]. Recently, Nagao et al also reported that KD has a similar mode of transmission to infections upon close contact with infected persons [38]. …”

Revisiting the role of environmental and climate factors on the epidemiology of Kawasaki disease

“…These inflammatory processes could be produced only in response to either intrinsically autoimmune reactions or extrinsically inhaled particles, or as a result of infections. A recent study postulated that KD is similar to other pediatric viral infections and suggested a long‐term persistence in the host, as for Exanthema subitum . However, this assumption would imply long incubation times and lifelong persistence and, therefore, a large pool of asymptomatic infections, which has been disregarded on the basis of detailed studies of KD population epidemiology in Japanese prefectures …”

“…A recent study postulated that KD is similar to other pediatric viral infections and suggested a long-term persistence in the host, as for Exanthema subitum. 33 However, this assumption would imply long incubation times and lifelong persistence and, therefore, a large pool of asymptomatic infections, which has been disregarded on the basis of detailed studies of KD population epidemiology in Japanese prefectures. 34 In the present study, person-to-person spread of an infection was examined to determine if such an etiological agent could fit the observed data.…”