Recurrent Kawasaki disease: USA and Japan

• Authors: Ryan A. Maddox, Centers for Disease Control and Prevention; Robert C. Holman, Centers for Disease Control and Prevention; Ritei Uehara, Utsunomiya City Public Health Center; Laura S. Callinan, Centers for Disease Control and Prevention; Jodie L. Guest, Emory University; Lawrence B. Schonberger, Centers for Disease Control and Prevention; Yosikazu Nakamura, Jichi Medical University; Mayumi Yashiro, Jichi Medical University; Ermias D. Belay, Centers for Disease Control and Prevention
• Journal Title: Pediatrics International
• Volume: Volume 57, Number 6
• Publisher: Wiley: 12 months | 2015-12-01, Pages 1116-1120
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/ped.12733
• Subjects: Health Sciences, Pathology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; epidemiology; Kawasaki disease; Kawasaki syndrome; mucocutaneous lymph node syndrome; recurrence; CORONARY-ARTERY ABNORMALITIES; AMERICAN-HEART-ASSOCIATION; UNITED-STATES; RISK-FACTORS; NATIONWIDE SURVEYS; HOSPITALIZATIONS; CRITERIA

Abstract

Background Descriptive epidemiologic studies of recurrent and non-recurrent Kawasaki disease (KD) may identify other potentially important differences between these illnesses. Methods Data from the USA and Japan, the Centers for Disease Control and Prevention (CDC) national KD surveillance(1984-2008) and the 17th Japanese nationwide survey (2001-2002), respectively, were analyzed to examine recurrent KD patients <18 years of age meeting the CDC KD case or atypical KD case definition. These patients were compared with non-recurrent KD patients. Results Of the 5557 US KD patients <18 years of age during 1984-2008, 97 (1.7%) were identified as having had recurrent KD. Among the US Asian/Pacific Islander KD patients, 3.5% had recurrent KD, which was similar to the percentage identified among KD patients (3.5%) in the Japanese survey. Compared with non-recurrent KD patients, KD patients [with recurrent KD] were more likely to be older, fulfill the atypical KD case definition, and have coronary artery abnormalities (CAA) despite i.v. immunoglobulin (IVIG) treatment. Conclusions Differences in the age, race, and frequency of CAA exist between recurrent and non-recurrent KD patients. The increased association of CAA with recurrent KD suggests that more aggressive treatment strategies in conjunction with IVIG may be indicated for the second episode of KD.