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Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis.
Ouldali, Naim; Pouletty, Marie; Mariani, Patricia; Beyler, Constance; Blachier, Audrey; Bonacorsi, Stephane; Danis, Kostas; Chomton, Maryline; Maurice, Laure; Le Bourgeois, Fleur; Caseris, Marion; Gaschignard, Jean; Poline, Julie; Cohen, Robert; Titomanlio, Luigi; Faye, Albert; Melki, Isabelle; Meinzer, Ulrich.
  • Ouldali N; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INS
  • Pouletty M; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR
  • Mariani P; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Beyler C; Department of Pediatric Cardiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Blachier A; Department of Medical Information, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Bonacorsi S; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France.
  • Danis K; Santé Publique France, Saint Maurice, France.
  • Chomton M; Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Maurice L; Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Le Bourgeois F; Paediatric Intensive Care Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Caseris M; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Microbiolo
  • Gaschignard J; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR
  • Poline J; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Center for Research on I
  • Cohen R; Université de Paris, UFR de Médecine Paris Nord, Paris, France.
  • Titomanlio L; Université de Paris, UFR de Médecine Paris Nord, Paris, France; Department of Paediatric Emergency Care, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Faye A; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, INS
  • Melki I; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Neurogenet
  • Meinzer U; Department of General Paediatrics, Paediatric Internal Medicine, Rheumatology and Infectious Diseases, National Referee Centre for Rheumatic, Autoimmune and Systemic Diseases in Children, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, UFR
Lancet Child Adolesc Health ; 4(9): 662-668, 2020 09.
Article in English | MEDLINE | ID: covidwho-624286
ABSTRACT

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Forecasting / Betacoronavirus / Mucocutaneous Lymph Node Syndrome Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn Country/Region as subject: Europa Language: English Journal: Lancet Child Adolesc Health Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Pandemics / Forecasting / Betacoronavirus / Mucocutaneous Lymph Node Syndrome Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male / Infant, Newborn Country/Region as subject: Europa Language: English Journal: Lancet Child Adolesc Health Year: 2020 Document Type: Article