Prevention Measures for COVID-19 and Changes in Kawasaki Disease Incidence

Katsumata, Nobuyuki; Harama, Daisuke; Toda, Takako; Sunaga, Yuto; Yoshizawa, Masashi; Kono, Yoshiaki; Hasebe, Yohei; Koizumi, Keiichi; Hoshiai, Minako; Saito, Tomohiro; Hokibara, Sho; Kobayashi, Koji; Goto, Miwa; Sano, Tomoaki; Tsuruta, Makoto; Nakamura, Makoto; Mizorogi, Sonoko; Ohta, Masanori; Mochizuki, M.; Sato, Hiroki; Yokomichi, Hiroshi; Inukai, Takeshi

doi:10.2188/jea.je20210132

Cited by 12 publications

(13 citation statements)

References 37 publications

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“…In other countries where COVID-19 infection rates are similarly low, such as Japan, South Korea, and Finland (cumulative COVID-19 incidence rates of 1363.841, 762.093, and 3231.09 per 100,000 people, respectively) [ 6 ], KD incidence rates declined following the implementation of public health measures in 2020. In Japan, where a state of emergency was declared from 7 April–25 May 2020, and school closures were enacted between 2 March–31 May 2020, incidence rates of KD began to decline beginning in March in 11 hospitals in the Yamanashi prefecture [ 14 ], in April in 18 hospitals in the Kobe area [ 15 ], and in June in six hospitals in Fukuoka [ 16 ]. In both Finland and South Korea, KD incidence rates declined after the implementation of school closures.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…This mechanism may also explain why the age distribution of KD in Japan has expanded in both directions since 1970 [ 49 ]. In 2020, the number of patients with KD decreased in Japan [ 46 , 58 ]. However, our window hypothesis predicts that the incidence of KD may increase after a transient decrease, in a way that has been observed for other infectious diseases [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Hygienic behaviors during the COVID-19 pandemic may decrease immunoglobulin G levels: Implications for Kawasaki disease

Yamaguchi

Hirata²,

Hatakeyama³

et al. 2022

PLoS ONE

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Background Due to the coronavirus disease 2019 (COVID-19) pandemic, hygienic behaviors became a new norm since January 2020. The hygiene hypothesis predicts that an excessively hygienic environment may adversely affect human health. Objective We quantified the effect of COVID-19 on immunological parameters linked to the hygiene hypothesis. Methods We examined age-specific levels of total nonspecific immunoglobulin G (IgG) and IgE in individuals who visited Fukuoka Tokushukai Hospital between 2010 and 2021. Pre-COVID (2010–2019) and COVID (2020–2021) periods were compared. Results IgG levels steadily decreased throughout Pre-COVID period. IgG levels fell abruptly from the pre-COVID period to the COVID period in all age groups (P = 0.0271, < 0.3 years; P = 0.0096, 0.3–5 years; P = 0.0074, ≥ 5 years). The declines in IgG in < 0.3 years and that in ≥ 5 years accelerated during the COVID period. IgE levels were seasonal, but did not change noticeably from the pre-COVID to COVID period. IgG levels recorded for patients with Kawasaki disease (KD) (mean 709 mg/dL) were significantly lower than for matched control subjects (826 mg/dL) (P<0.0001). Discussion Hygienic behaviors during the COVID-19 outbreak decreased the chance of infection, which may explain the decreases in IgG levels in children and adults. Neonatal IgG declined, possibly because of the decrease in maternal IgG. Conclusion Hygienic behaviors decreased the IgG levels in all age groups, from neonates to adults. This downturn in IgG may lead to vulnerability to infections as well as to KD.

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“…6 Using a far smaller sample of 868 Japanese children whose data were collected with web-based KD surveillance, they found a similar reduction of 35% in KD cases comparing 2020 with 2017 to 2019, a more pronounced reduction in case number in children 2 years or older compared with children younger than 2 years, and no change in time of KD symptom onset to presentation between the 2 time periods. Furthermore, the reduction in KD cases during the COVID-19 pandemic has been documented in other Japanese cohorts 7,8 and in countries throughout the world. Researchers in South Korea used a national insurance database to assess the incidence of KD following a variety of nonpharmaceutical interventions (masking, school closures, distancing) implemented from February to September 2020.…”

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confidence: 90%

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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Prevention Measures for COVID-19 and Changes in Kawasaki Disease Incidence

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record.

Cited by 12 publications

References 37 publications

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

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

Hygienic behaviors during the COVID-19 pandemic may decrease immunoglobulin G levels: Implications for Kawasaki disease

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

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