Spatial and Temporal Clustering of Kawasaki Syndrome Cases

Division of Epidemiology, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 10/2008; 27(11):981-5. DOI: 10.1097/INF.0b013e31817acf4f
Source: PubMed


The etiology of Kawasaki syndrome (KS) remains unknown despite 30 years of intensive search for an agent. Epidemiologic clues to a possible infectious etiology include the seasonal distribution of cases, the previous occurrence of epidemics, the clinical features of the syndrome that mimic other infectious rash/fever illnesses in children, the self-limited nature of the illness, and the peak age incidence in the toddler years.
We examined the epidemiology and spatial and temporal distribution of KS cases in San Diego County, California during the 6-year period from 1998 to 2003. Clustering in space and time was analyzed using geo-referenced data with the K-function, the local G-statistic, and Knox statistic.
A total of 318 patients were identified through active surveillance. The overall annual incidence was 21.7/100,000 in children <5 years, with rates in whites, white Hispanics, and Asian/Pacific Islanders of 15.3, 20.2, and 45.9/100,000, respectively. The Knox test showed significant clustering of cases within the space-time interval of 3 km and 3-5 days.
This is the first study of KS cases to use geo-referenced point pattern analysis to detect spatial and temporal clustering of KS cases. These data suggest that an infectious agent triggers the immunologic cascade of KS.

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    International Journal of Pediatric Otorhinolaryngology 07/2014; 78(10). DOI:10.1016/j.ijporl.2014.07.008 · 1.19 Impact Factor
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    The Open Pediatric Medicine Journal 06/2009; 3(1):38-44. DOI:10.2174/1874309900903010038
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    ABSTRACT: To determine the incidence of Kawasaki disease (KD) in Northern France by using new American Heart Association (AHA) criteria. A 1-year prospective multicenter cohort study was performed in all pediatric departments. Patients <18 years old, who were admitted for prolonged but initially unexplained fever or suspected KD were included. All patients received the standard treatment considered appropriate by their physicians. A descriptive analysis and comparison of patients with complete and incomplete forms of KD were performed. The incidence of confirmed cases of KD (complete and incomplete forms) was calculated. Seventy-seven children were included (39 in whom KD was diagnosed). Of the patients with KD, 26 (67%) met the classic AHA case definition, and 7 (18%) had incomplete KD. Cardiac ultrasound scanning was helpful in the diagnosis of 6 of 7 patients with incomplete KD (86%). The final incidence of confirmed KD was 9 of 100,000 children <5 years of age. In 6 children (15%) the diagnosis of KD was uncertain, but they were successfully treated for it. Coronary disease was identified in 48% of patients with confirmed KD. The incidence of KD is higher than previously reported, in part because earlier reports did not include incomplete forms. New AHA criteria (laboratory tests and early echocardiography) were helpful for the diagnosis of incomplete forms of KD.
    The Journal of pediatrics 07/2009; 155(5):695-9.e1. DOI:10.1016/j.jpeds.2009.04.058 · 3.79 Impact Factor
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