The Impact of Social Distancing for COVID-19 Upon Diagnosis of Kawasaki Disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mitigation policies have been associated with profound decreases in diagnoses of common childhood respiratory infections. A leading theory of etiology of Kawasaki disease (KD) is that it is triggered by presently unidentified ubiquitous respiratory agent. We document that mitigation policies instituted in mid-March 2020 were associated with strikingly fewer diagnoses of KD in April-December 2020 compared with the same period in the previous 8 years (P = .01), a >67% decline. This finding supports the hypothesis that KD is caused by a respiratory-transmitted agent.

Cell-mediated immune responses to respiratory syncytial virus infection: magnitude, kinetics, and correlates with morbidity and age.

We evaluated the cell-mediated immune (CMI) response to RSV acute infection including the magnitude, kinetics and correlates with morbidity and age. Twenty-nine RSV-infected patients with mean ± SD age of 15 ± 14 months were enrolled during their first week of disease. Th1, Th2, Th9, Th17 and Th22 responses were measured at entry and 2 and 6 weeks later. All subjects were hospitalized for a median (range) of 5 (3-11) days. RSV-specific effector and memory Th1 CMI measured by lymphocyte proliferation and IFNγ ELISPOT significantly increased over time (P ≤ 0.03). In contrast, Th22 responses decreased over time (P ≤ 0.03). Other changes did not reach statistical significance. The severity of RSV disease measured by the length of hospitalization positively correlated with the magnitude of Th9, Th22 and TNFα inflammatory responses (rho ≥ 0.4; P ≤ 0.04) and negatively with memory CMI (rho = -0.45; P = 0.04). The corollary of this observation is that robust Th1 and/or low Th9, Th22, and TNFα inflammatory responses may be associated with efficient clearance of RSV infection and therefore desirable characteristics of an RSV vaccine. Young age was associated with low memory and effector Th1 responses (rho ≥ 0.4; P ≤ 0.04) and high Th2, Th9, Th17, Th22 and TNFα inflammatory responses (rho ≤ -0.4; P ≤ 0.04), indicating that age at vaccination may be a major determinant of the CMI response pattern.

Acute Demyelinating Lesion of the Upper Thoracic Spine Complicating Kawasaki Disease.

We present the first reported case of a child with Kawasaki disease (KD) complicated by meningoencephalitis and an acute focal demyelinating lesion. Neurologic outcome in this patient was excellent without any persistent neurologic deficits. We also review the neurologic complications associated with KD.

Antibodies for prevention and treatment of respiratory syncytial virus infections in children.

Respiratory syncytial virus (RSV) infection causes respiratory illness in all ages, and is the leading cause of hospitalizations of infants and children around the world. Those at increased risk for severe disease include infants with congenital heart disease, premature infants, children with neuromuscular disease, airway abnormalities, underlying immunodeficiencies and the elderly. Attempts to develop a safe and effective vaccine have been unsuccessful thus far. However, significant progress has been achieved in the field of passive immunoprophylaxis for protection against RSV. This review will concentrate on the past, present and future history of RSV immunoprophylaxis with an emphasis on the role of polyclonal and monoclonal antibodies.