The Epidemiology and Clinical Features of Kawasaki Disease in Australia

Abstract

OBJECTIVES: The current Australian epidemiology of Kawasaki disease (KD) is poorly defined. Previous enhanced surveillance (1993–1995) estimated an incidence of 3.7/100 000 <5 years. METHODS: We identified all patients hospitalized in Western Australia (current population ∼2.4 million) 1979 through 2009 with a discharge diagnosis of KD. We reviewed demographic, clinical, laboratory, and echocardiographic data from individual patient files and derived age-specific population estimates. KD diagnosis was made using standard criteria. RESULTS: There were 353 KD cases, with incomplete KD in 34 (9.6%). Male to female ratio was 1.7:1 and median age was 3.8 years (interquartile range 12–60 months). Fifty (18.1%) patients were Asian. Mean annual incidence increased from 2.82 per 100 000 children aged <5 years (95% confidence interval, 1.93–3.99) in 1980 to 1989, to 7.96 (6.48–9.67) in 1990 to 1999, to 9.34 (7.72–11.20) in 2000 to 2009. The highest incidence was 15.7 in 2005. A total of 293 children (83%) received intravenous immunoglobulin and 331 (95.4%) aspirin. Of 282 children who completed echocardiographic studies, 47 (16.7%) had coronary artery (CA) ectasia/dilatation and 19 (6.8%) had CA aneurysms; male gender was significantly associated with CA abnormalities. CONCLUSIONS: KD epidemiology in Western Australia mirrors that of other industrialized, predominantly European-Caucasian populations. The rising incidence likely reflects both improved ascertainment and a real increase in disease burden. The current Australian incidence is threefold higher than previously reported and similar to the United Kingdom. The CA outcomes, which include the pre-intravenous immunoglobulin era, are comparable to those reported elsewhere.

The epidemiology of Kawasaki disease: a global update

“…The report also noted a higher incidence of KD in children of Chinese ethnicity 21. In Australia and New Zealand, in which much of the recent population immigration in the last ∼150 years has been from northern Europe, the incidence rate (approximately 8–10/100 000) has increased in the last four decades and is now similar to the UK 7 16. It is unclear whether the incidence in Australia is continuing to increase or has levelled off.…”

“…KD has been reported to occur more commonly in the winter months in mainland USA, Canada and Europe, and in the more temperate regions of Australia 7 9. Winter peaks in incidence are not discernible in Hawaii, where the seasonal weather patterns are different from mainland USA 9 19.…”

“…We have followed this convention in this review and the incidence data presented here relate to this age group unless otherwise stated. However a significant proportion of KD occurs in school-age children7 and the total disease burden is therefore greater than that implicit in using preschool children as the denominator for incidence rates.…”

Surgical abdomen with intestinal pseudo‐obstruction as presenting feature of atypical Kawasaki disease

“…Atypical KD is defined as one in which atypical signs and/or symptoms not belonging to the classical KD criteria herald the onset of the disease; abdominal involvement, cholestasis or acute pancreatitis, pneumonia, aseptic meningitis, facial palsy, retropharyngeal abscess, tonsillitis, limping joint pain, urinary incontinency and renal dysfunction are the most frequently presenting features in atypical KD . Atypical KD is now reported with increased incidence up to 9.6% . It appears to be more frequent in infants than in older children, and shows an unusually severe course with more serious complications compared with typical KD, as a higher risk of coronary abnormalities, due to delayed diagnosis and therapy …”

Curso atípico o incompleto de la enfermedad de Kawasaki en edades pediátricas

“…En las series publicadas en México, tanto las que recopilan lo registrado en la literatura hasta el año 2012 como las que contienen el mayor número de casos de enfermedad de Kawasaki 4---7 , el porcentaje de pacientes con curso atípico o incompleto varia del 20% al 30% en México, contra el 9%, el 15% y el 20% reportado en otras latitudes 11,15,16 . Es evidente que tenemos un mayor número de registros de enfermedad de Kawasaki que evoluciona en forma atípica, lo cual resulta significativo y hace indispensable conocer los criterios prevalentes, aunque no definitivos, señalados hasta ahora para establecer la diferencia de este curso de la enfermedad.…”