tetano
Editor, Senior Moderator
Lancet Child Adolesc Health
. 2020 Jul 2;S2352-4642(20)30175-9.
doi: 10.1016/S2352-4642(20)30175-9. Online ahead of print.
Emergence of Kawasaki Disease Related to SARS-CoV-2 Infection in an Epicentre of the French COVID-19 Epidemic: A Time-Series Analysis
Naim Ouldali[SUP] 1 [/SUP], Marie Pouletty[SUP] 2 [/SUP], Patricia Mariani[SUP] 3 [/SUP], Constance Beyler[SUP] 4 [/SUP], Audrey Blachier[SUP] 5 [/SUP], Stephane Bonacorsi[SUP] 6 [/SUP], Kostas Danis[SUP] 7 [/SUP], Maryline Chomton[SUP] 8 [/SUP], Laure Maurice[SUP] 8 [/SUP], Fleur Le Bourgeois[SUP] 8 [/SUP], Marion Caseris[SUP] 9 [/SUP], Jean Gaschignard[SUP] 10 [/SUP], Julie Poline[SUP] 11 [/SUP], Robert Cohen[SUP] 12 [/SUP], Luigi Titomanlio[SUP] 13 [/SUP], Albert Faye[SUP] 14 [/SUP], Isabelle Melki[SUP] 15 [/SUP], Ulrich Meinzer[SUP] 16 [/SUP]
Affiliations
Abstract
Background: Kawasaki disease is an acute febrile systemic childhood vasculitis, which is suspected to be triggered by respiratory viral infections. We aimed to examine whether the ongoing COVID-19 epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an increase in the incidence of Kawasaki disease.
Methods: We did a quasi-experimental interrupted time series analysis over the past 15 years in a tertiary paediatric centre in the Paris region, a French epicentre of the COVID-19 outbreak. The main outcome was the number of Kawasaki disease cases over time, estimated by quasi-Poisson regression. In the same centre, we recorded the number of hospital admissions from the emergency department (2005-2020) and the results of nasopharyngeal multiplex PCR to identify respiratory pathogens (2017-2020). These data were compared with daily hospital admissions due to confirmed COVID-19 in the same region, recorded by Public Health France.
Findings: Between Dec 1, 2005, and May 20, 2020, we included 230 patients with Kawasaki disease. The median number of Kawasaki disease hospitalisations estimated by the quasi-Poisson model was 1?2 per month (IQR 1?1-1?3). In April, 2020, we identified a rapid increase of Kawasaki disease that was related to SARS-CoV-2 (six cases per month; 497% increase [95% CI 72-1082]; p=0?0011), starting 2 weeks after the peak of the COVID-19 epidemic. SARS-CoV-2 was the only virus circulating intensely during this period, and was found in eight (80%) of ten patients with Kawasaki disease since April 15 (SARS-CoV-2-positive PCR or serology). A second peak of hospital admissions due to Kawasaki disease was observed in December, 2009 (six cases per month; 365% increase ([31-719]; p=0.0053), concomitant with the influenza A H1N1 pandemic.
Interpretation: Our study further suggests that viral respiratory infections, including SAR-CoV-2, could be triggers for Kawasaki disease and indicates the potential timing of an increase in incidence of the disease in COVID-19 epidemics. Health-care providers should be prepared to manage an influx of patients with severe Kawasaki disease, particularly in countries where the peak of COVID-19 has recently been reached.
Funding: French National Research Agency.
. 2020 Jul 2;S2352-4642(20)30175-9.
doi: 10.1016/S2352-4642(20)30175-9. Online ahead of print.
Emergence of Kawasaki Disease Related to SARS-CoV-2 Infection in an Epicentre of the French COVID-19 Epidemic: A Time-Series Analysis
Naim Ouldali[SUP] 1 [/SUP], Marie Pouletty[SUP] 2 [/SUP], Patricia Mariani[SUP] 3 [/SUP], Constance Beyler[SUP] 4 [/SUP], Audrey Blachier[SUP] 5 [/SUP], Stephane Bonacorsi[SUP] 6 [/SUP], Kostas Danis[SUP] 7 [/SUP], Maryline Chomton[SUP] 8 [/SUP], Laure Maurice[SUP] 8 [/SUP], Fleur Le Bourgeois[SUP] 8 [/SUP], Marion Caseris[SUP] 9 [/SUP], Jean Gaschignard[SUP] 10 [/SUP], Julie Poline[SUP] 11 [/SUP], Robert Cohen[SUP] 12 [/SUP], Luigi Titomanlio[SUP] 13 [/SUP], Albert Faye[SUP] 14 [/SUP], Isabelle Melki[SUP] 15 [/SUP], Ulrich Meinzer[SUP] 16 [/SUP]
Affiliations
- PMID: 32622376
- PMCID: PMC7332278
- DOI: 10.1016/S2352-4642(20)30175-9
Abstract
Background: Kawasaki disease is an acute febrile systemic childhood vasculitis, which is suspected to be triggered by respiratory viral infections. We aimed to examine whether the ongoing COVID-19 epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an increase in the incidence of Kawasaki disease.
Methods: We did a quasi-experimental interrupted time series analysis over the past 15 years in a tertiary paediatric centre in the Paris region, a French epicentre of the COVID-19 outbreak. The main outcome was the number of Kawasaki disease cases over time, estimated by quasi-Poisson regression. In the same centre, we recorded the number of hospital admissions from the emergency department (2005-2020) and the results of nasopharyngeal multiplex PCR to identify respiratory pathogens (2017-2020). These data were compared with daily hospital admissions due to confirmed COVID-19 in the same region, recorded by Public Health France.
Findings: Between Dec 1, 2005, and May 20, 2020, we included 230 patients with Kawasaki disease. The median number of Kawasaki disease hospitalisations estimated by the quasi-Poisson model was 1?2 per month (IQR 1?1-1?3). In April, 2020, we identified a rapid increase of Kawasaki disease that was related to SARS-CoV-2 (six cases per month; 497% increase [95% CI 72-1082]; p=0?0011), starting 2 weeks after the peak of the COVID-19 epidemic. SARS-CoV-2 was the only virus circulating intensely during this period, and was found in eight (80%) of ten patients with Kawasaki disease since April 15 (SARS-CoV-2-positive PCR or serology). A second peak of hospital admissions due to Kawasaki disease was observed in December, 2009 (six cases per month; 365% increase ([31-719]; p=0.0053), concomitant with the influenza A H1N1 pandemic.
Interpretation: Our study further suggests that viral respiratory infections, including SAR-CoV-2, could be triggers for Kawasaki disease and indicates the potential timing of an increase in incidence of the disease in COVID-19 epidemics. Health-care providers should be prepared to manage an influx of patients with severe Kawasaki disease, particularly in countries where the peak of COVID-19 has recently been reached.
Funding: French National Research Agency.