Infectious Disease

The decline in Kawasaki disease could be related to pandemic preventive measures

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The decline in Kawasaki disease rates in South Korea during the COVID-19 pandemic could be due to pandemic prevention efforts, including mask wearing, hand washing and physical distancing, researchers reported.

“In Korea, non-pharmaceutical measures such as wearing masks, school closings, and testing and isolating symptomatic individuals with good compliance were introduced in February 2020,” said Ji-Man Kang, MD, of the Pediatrics Department at Severance Children’s Hospital and Institute for Immunology and Immunological Diseases at Yonsei University College of Medicine, Seoul, South Korea, and colleagues in Circulation. “This nationwide intervention gave us a unique opportunity to study the side effect of non-pharmaceutical interventions on the incidence of other diseases.”

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Researchers conducted a retrospective, environmental study that evaluated data from the National Health Insurance Service database on all 53,424 cases of Kawasaki disease in children ages 0-19 from 2010 to September 2020. The non-pharmaceutical intervention period was set from February to September 2020. The researchers compared the incidence rate of Kawasaki disease in the non-pharmaceutical intervention phase with the mean annual incidence rate during the pre-pharmaceutical intervention phase.

Of all cases, 83% occurred in children 5 years of age or younger and 17% were resistant to IV immunoglobulin. During the pre-pharmaceutical intervention period, the mean annual incidence of Kawasaki disease was 48.1 per 100,000 people, with a monthly mean incidence of 4.1 per 100,000 people. During the COVID-19 pandemic, the incidence of Kawasaki disease declined to less than 2 per 100,000 people after implementing non-pharmaceutical interventions.

From February to September 2020, the incidence of Kawasaki disease in the non-pharmaceutical intervention period was 18.8 per 100,000 people, which was 60% of the mean incidence in the pre-non-pharmaceutical intervention period and 58% of the predicted incidence (P = 0.085).

The highest incidence rate of Kawasaki disease in children ages 0-4 was 80 per 100,000, which was lower than the mean incidence of 123 per 100,000 during the pre-pharmaceutical intervention period (P = 0.003) and the predicted incidence of 123.3 per 100,000 people. In children 5 to 9 years of age, the incidence of Kawasaki disease was lower than the mean incidence in the pre-pharmaceutical intervention period (10.6 vs. 23.8 per 100,000 people; p = .04) and the predicted incidence of 24.7 per 100,000 people.

There was no difference in the incidence of Kawasaki disease before and after performing non-pharmaceutical intervention in subjects 10 to 19 years of age.

According to a press release, these results may have been possible because Kawasaki disease is an immunological response in genetically susceptible individuals exposed to viruses and other infectious agents.

“This nationwide study shows that the incidence of Kawasaki disease has decreased significantly after the introduction of non-pharmaceutical interventions in Korea,” the researchers write. “More long-term research is needed to determine whether the decline in the incidence of Kawasaki disease is solely due to the effects of non-pharmaceutical interventions.”

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