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2020 ; 4
(9
): 662-668
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gab.com Text
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English Wikipedia
Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of
the French COVID-19 epidemic: a time-series analysis
#MMPMID32622376
Ouldali N
; Pouletty M
; Mariani P
; Beyler C
; Blachier A
; Bonacorsi S
; Danis K
; Chomton M
; Maurice L
; Le Bourgeois F
; Caseris M
; Gaschignard J
; Poline J
; Cohen R
; Titomanlio L
; Faye A
; Melki I
; Meinzer U
Lancet Child Adolesc Health
2020[Sep]; 4
(9
): 662-668
PMID32622376
show ga
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.