#VisualAbstract: SARS-CoV-2 is associated with higher incidence of Kawasaki disease in children

1. Severe acute respiratory syndrome coronavirus 2 infection increases the rate of Kawasaki disease in children.

2. Individuals with severe Kawasaki disease were more likely to have myocarditis, require combination therapy with inotrope treatment, and require admission to the intensive care unit.

Evidence Rating Level: 2 (Good)

Study Rundown: Viral disease is a known trigger for Kawasaki disease. Epidemiologic data examining the correlation between SARS-CoV-2 infection and the emergence of Kawasaki disease is limited. This quasi-experimental retrospective study examined the link between SaRS-CoV-2 infection and Kawasaki disease at the Robert Debré University Hospital in Paris, France. The number of pediatric patients (aged <18 years) with Kawasaki disease was recorded from December 1, 2005 to May 20, 2020. Results of nasopharyngeal polymerase chain reaction tests from September 2017 to May 2020 were also recorded. Between April 1, 2020 and May 20, 2020, patients diagnosed with Kawasaki disease were tested for SARS-CoV-2 infection. Similar to trends during the influenza A H1N1 pandemic, there was a five-fold increase in Kawasaki disease-related hospitalizations during the COVID-19 pandemic.. However, this was not associated with the total number of hospital admissions, which declined from March 2020. Among hospitalized patients with Kawasaki disease, 8 of 10 tested positive for COVID-19, and the majority required admission to the intensive care unit. This study was limited by a small sample size, with data obtained from a single tertiary care centre, thereby restricting the generalizability of findings. Additionally, because the centre was located in the epi-centre of a COVID-19 outbreak, the association between SARS-CoV-2 infection and Kawasaki disease may have been overestimated. Nonetheless, this study may have important clinical implications in terms of an expected increase in incidence of severe Kawasaki disease with ongoing SARS-CoV-2 transmission.

Click here to read the study in The Lancet Child & Adolescent Health

Relevant Reading: Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

In-depth [retrospective cohort]: This quasi-experimental study analyzed the number of patients (aged <18 years) who were admitted with Kawasaki disease to the Robert Debré University Hospital from Dec 1, 2005 to May 20, 2020. Individuals diagnosed with Kawasaki disease after April 1, 2020 were tested for SARS-CoV-2 serology. The number of monthly Kawasaki disease cases were studied, and changes in incidence and hospitalization rates before and after the COVID-19 outbreak was compared.

A significant rise in Kawasaki disease-related hospitalizations was noted from April 2020 (median 6 cases per month, 497% increase, 95% CI 72 to 1082), compared to the past 15 years (median 1.2 cases per month, IQR 1.1 to 1.3). In contrast to the increase in cases of Kawasaki disease, a decrease in total hospitalizations was noted from March 2020 to April 2020 (360 hospital admissions per month, 31% decrease, 95% CI -42 to -18). Among 10 individuals diagnosed with Kawasaki disease from April 15 to May 20, 8 (80%) tested positive for COVID-19. These patients ranged from 18 months to 15.8 years of age. Additionally, 6 (60%) children had cardiac abnormalities (1 with coronary aneurysm and 5 with myocarditis). In comparison to the spike in Kawasaki disease hospitalizations linked with COVID-19, the H1N1 outbreak was less severe (median 6 cases per month, 365% increase, 95% CI 31 to 719). Overall, this article highlights the need for healthcare institutions to prepare for an possible influx of patients with Kawasaki disease amidst the COVID-19 pandemic.

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