Rhinovirus, RSV, varicella infections precede Kawasaki disease outbreaks by 1 to 3 months
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Infections caused by rhinovirus, respiratory syncytial virus and varicella, precede Kawasaki disease outbreaks by 1 to 3 months in children and young adults in South Korea, according to data published in JAMA Network Open.
“The etiological characteristics of [Kawasaki disease (KD)] remain unknown; however, a potential association between KD and infectious diseases has been previously postulated,” Ji-Man Kang, MD, of Yonsei University College of Medicine, in Seoul, and colleagues wrote. “Since the COVID-19 pandemic began, many countries worldwide, including South Korea, have implemented strong infection control measures based on nonpharmaceutical interventions (NPIs) to suppress the spread of the virus. NPIs include social distancing, mask-wearing, intensive contact tracing and isolation, and environmental cleaning.
“Since SARS-CoV-2 mainly spreads via droplet transmission and direct contact, the NPI policies implemented to suppress SARS-CoV-2 have also been associated with changes in rates of infectious and infection-related diseases that are prevalent in a community,” they added. “We previously reported that NPIs were associated with a decrease in the incidence of other respiratory infections and KD in South Korea, suggesting that infections may trigger KD occurrence.”
To examine the temporal correlation between Kawasaki disease and viral infections — specifically respiratory viruses — Kang and colleagues conducted a cohort study of patients from the Korean National Health Insurance Service. The researchers collected data from a total of 53,424 patients aged 0 to 19 years diagnosed with Kawasaki disease between January 2010 and September 2020.
In addition, they obtained data on infectious disease outbreaks from 2016 to 2019 from the Korea Disease Control and Prevention Agency, Korean Influenza and Respiratory Virus Monitoring System, Korea Enteroviruses Surveillance System and the Enteric Pathogens Active Surveillance Network in South Korea. Kang and colleagues used these databases to perform a time-series analysis of the correlation between viral infections and Kawasaki disease. Temporal correlations were assessed using the Granger causality test (G-test). A total of 14 infectious diseases were included in the analysis.
According to the researchers, rhinovirus infection outbreaks were significantly correlated at 1 to 3 months prior to Kawasaki disease outbreaks (r=0.3; P<.001 for months 1, 2 and 3). Meanwhile, respiratory syncytial virus infection was significantly correlated with Kawasaki disease outbreaks by 2 months (r=0.5; P<.001), and varicella was significantly correlated at 2 and 3 months before Kawasaki disease outbreaks (r=0.7; P<.001 for months 2 and 3). Meanwhile, the researchers found no temporal correlation between Kawasaki disease outbreaks and infections caused by enteric viruses, such as norovirus, rotavirus and enterovirus.
“Our findings suggest a temporal correlation between a set of respiratory viral infections preceding onset of KD in a large complete national data from South Korea,” Kang and colleagues wrote. “As such, constant monitoring of trends in infectious diseases and KD incidence is recommended. It would also be interesting to perform universal PCR viral testing in patients with acute KD to get a better profile of the viral agents present in that population. This, combined with temporal correlations, would help advance our knowledge of the etiological characteristics of KD.”
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