Kawasaki disease diagnoses fell one-third in Japan during first year of COVID pandemic
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The number of patients diagnosed with Kawasaki disease in Japan fell by approximately one-third in 2020, with no indication that parents eschewed necessary hospital visits, according to data published in JAMA Pediatrics.
“In Japan, a nationwide KD survey has been conducted biennially since 1970, aiming to provide epidemiological evidence that may suggest clues that could help identify KD pathogenesis,” Ryusuke Ae, MD, PhD, of the Center for Community Medicine at Jichi Medical University, in Tochigi, Japan, and colleagues wrote. “... The most recent survey results indicated a large epidemiological change before and after the start of the COVID-19 pandemic, suggesting potential implications of COVID-19 mitigation measures for the incidence of KD.
“Similar findings have been reported from other countries — the incidence of KD was largely reduced during the COVID-19 pandemic period compared with the corresponding period in previous years,” they added. “These studies suggest that the global pandemic and its accompanying mitigation measures may provide an important opportunity to explore the hypothesis of a potential KD pathogenesis involving transmission via human-to-human contact.”
To compare the incidence of Kawasaki disease in Japan before and after the beginning of the COVID-19 pandemic, Ae and colleagues conducted a cohort study using data from the country’s 26th nationwide survey investigating the disease. Survey responders were hospitals that either specialized in pediatrics or had more than 100 beds with a specific department specializing in pediatrics.
Pediatricians at included hospitals were selected as representatives, and surveys were sent through the postal system or email. Data included patients diagnosed with Kawasaki disease from Jan. 1, 2019, through Dec. 31, 2020.
The survey included demographics on patients’ age, sex, recurrent status, sibling and parental history of Kawasaki disease, principal disease signs, and the day of the first hospital visit for Kawasaki disease. Additionally, respondents were asked about initial intravenous immunoglobulin therapy and cardiac complications attributed to the disease. Finally, the survey also included information regarding PCR tests for SARS-CoV-2.
A total of 28,520 patients with Kawasaki disease were identified. Of those, 17,347 were diagnosed in 2019 and 11,173 were diagnosed in 2020, demonstrating a 35.6% reduction, according to the researchers. Distribution for days of illness at the first hospital visit were “almost identical” in 2019 and 2020, showing that there was likely not a delay in patients seeking care due to the pandemic, the researchers wrote. In 2020, the percentage of patients diagnosed with Kawasaki disease who were younger than 12 months was “significantly larger” than in 2019, at 21.6% vs. 19.4% (P < .001), according to Ae and colleagues.
Additionally, Kawasaki disease incidence in patients aged older than 24 months “declined rapidly” following the introduction of COVID-19 mitigation measures — with a 58.3% reduction reported in July — compared with younger patients, the researchers wrote. Meanwhile, the incidence in patients younger than 12 months declined moderately, with a 40.3% reduction in October.
“Compared with 2019, the number of patients diagnosed with KD in 2020 decreased by approximately 35% across Japan, with no indication of parents delaying or avoiding visiting a hospital in the setting of the global COVID-19 pandemic,” Ae and colleagues wrote. “We found differences in KD incidence reduction patterns between patients younger than 12 months and those 12 months or older. These findings suggest a potential KD pathogenesis involving transmission among children via human-to-human contact, especially among older children.”
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