Pandemic prevention measures related to lower rates of Kawasaki disease in children

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According to new research published today in the flagship of the American Heart Association, the rate of Kawasaki disease in South Korea has decreased substantially during the COVID-19 pandemic, possibly due to pandemic prevention efforts, such as the use of masks, hand washing and physical distancing. magazine Circulation.

Kawasaki it is the most common cause of heart disease that develops after birth in children, creating inflammation in the blood vessels, especially in the arteries of the heart. Kawasaki disease usually appears before the age of 5 and is most common among children of Asian descent, although it affects children of all races and ethnicities. South Korea has the second highest incidence of Kawasaki disease in the world, after Japan.

According to the 2021 American Heart Association and stroke statistics, the incidence of Kawasaki disease in 2006 was 20.8 per 100,000 children under the age of 5 in the United States, the most recent national estimate available and is limited by the reliance on data from weighted hospitalizations of 38 states. Although Kawasaki disease can occur into adolescence (and rarely beyond), 76.8% of U.S. children with this disease are five years of age or younger. Boys have an incidence of Kawasaki disease 1.5 times higher than girls. The rate of Kawasaki disease seems to be increasing worldwide, possibly due to better awareness and recognition of the disease, the more frequent diagnosis of incomplete Kawasaki disease, and the true increasing incidence.

Symptoms of Kawasaki disease include fever, rash, red lips, and strawberry tongue (bumpy and red with enlarged taste buds). Rapid treatment is critical to preventing major heart problems and most children fully recover with treatment. Although the cause of Kawasaki disease is unknown, it may be an immune response to an acute infectious disease based in part on genetic susceptibilities.

Researchers in South Korea noted that efforts to prevent COVID-19 provided a unique opportunity to analyze the possible effects of mask use and social distancing on Kawasaki disease. Since February 2020, South Korea has required strict masked clothing, periodic school closures, physical distancing and frequent testing and isolation for people with COVID-19 symptoms.

The researchers reviewed health records from January 2010 to September 2020 in a South Korean national health insurance database to identify cases of Kawasaki disease among children from birth to age 19. They identified 53,424 cases of Kawasaki disease during the 10 years studied and 83% of cases occurred in children under 5 years of age.

The researchers compared the rate of Kawasaki disease from February 2020 to September 2020, when significant efforts were made to prevent COVID-19, with pre-COVID-19 rates of Kawasaki disease. . Their analyzes found that the number of cases of Kawasaki disease decreased substantially (approximately 40%) after COVID-19 prevention efforts were carried out in February 2020. By 2020, the average number of cases of Kawasaki disease between February and September was 31.5 per 100,000 people. , compared to 18.8 per 100,000 people in the same months of 2020 during the COVID-19 pandemic. The largest decrease in cases occurred in children up to 9 years of age, whereas there was no decrease among young people aged 10 to 19 years.

“Our findings emphasize the possible impact of environmental triggers on the onset of Kawasaki disease,” said study author Jong Gyun Ahn, MD, Ph.D., associate professor of pediatrics at the Hospital Infantile Severance of the Yonsei University of Medicine of Seoul. South Korea. “The decrease in the incidence of Kawasaki disease after the implementation of non-pharmaceutical interventions is very clear and it is unlikely that there have been other involuntary independent interventions.

“Extensive and intensive COVID-19 prevention interventions had the added effect of reducing the incidence of respiratory infections, which have previously been suggested as triggers for Kawasaki disease,” Ahn noted. “In addition, the seasonality of the Kawasaki disease epidemic disappeared in South Korea. It is usually more common in winter, with a second high in late spring-summer.”

American Heart Association volunteer expert Jane W. Newburger, MD, MPH, FAHA, notes that the results of the research are consistent with the hypothesis that Kawasaki disease is an immune reaction caused in genetically sensitive people when s ‘exposed to viruses or other infectious agents in the environment. Newburger is a member of the Young Hearts Council of the American Heart Association, chief associate cardiologist, academic affairs; medical director of the neurodevelopment program; and director of the Kawasaki Program at Boston Children’s Hospital; and professor of pediatrics at the Commonwealth at Harvard Medical School.

“During the COVID pandemic, children were exposed to fewer viruses and other infectious agents. Therefore, the ‘natural experiment’ that occurred from the isolation and masking of children

supports the likelihood that Kawasaki disease will be caused by viruses or other infectious agents in the environment, “Newburger said.” However, these dramatic lifestyle changes would be difficult to maintain if the sole purpose was to prevent Kawasaki disease. Kawasaki disease is a very rare disease in children and does not represent a public health emergency like COVID. “

Newburger also noted that many experts on Kawasaki disease in the U.S. have also noticed fewer cases at their centers during the pandemic.

This study has some limitations: cases of Kawasaki disease among patients who did not file insurance claims are not included in the national insurance database; and the study was observational and could not control other factors, such as whether or not patients sought medical attention, including screening and treatment for Kawasaki disease.

It is also important to note that Kawasaki disease is not the same as multisystem inflammatory syndrome. (MIS-C), the new condition identified this past year during the COVID-19 pandemic. Although the two conditions show some overlapping symptoms, they also show some different differences, including deeper inflammation and more gastrointestinal symptoms with MIS-C, and MIS-C is associated with COVID-19 infection.


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More information:
Circulation (2021). DOI: 10.1161 / CIRCULATIONAHA.121.054785

Citation: Pandemic Prevention Measures Related to Lower Rates of Kawasaki Disease in Children (2021, June 7) Retrieved June 7, 2021 at https://medicalxpress.com/news/2021-06-pandemic-linked -kawasaki-disease-children.html

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