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Singh J, Chang A, Fusco NM, Hicar M. Predicting Intravenous Immunoglobulin Resistance Among North American Children Hospitalized With Kawasaki Disease. J Pediatr Pharmacol Ther 2022; 27:669-676. [PMID: 36186240 PMCID: PMC9514769 DOI: 10.5863/1551-6776-27.7.669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/10/2021] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The Kobayashi score (KS) is the most widely used tool for predicting intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD). The KS has shown good sensitivity (86%) and specificity (68%) in Japanese children; however, its use is limited outside of Japan. No models accurately predict IVIG resistance of children with KD in the United States. We sought to develop and test a novel scoring system to predict IVIG resistance in hospitalized children with KD. METHODS A retrospective chart review was conducted of all children diagnosed with KD from January 2000 to December 2015. Subjects were divided into 2 groups: IVIG susceptible or resistant. Variables that differed between the groups were identified and used to create a "new score" to predict resistance to IVIG. The new score was then compared with the KS and performance characteristics were determined. RESULTS A total of 208 subjects were reviewed. White blood cell count, neutrophil percentage, age, and serum albumin were used in the new score with equal weighting. Overall, the new score achieved improved sensitivity (54% vs 26%) and similar specificity (69% vs 74%) compared with the KS in predicting IVIG resistance in hospitalized children diagnosed with KD. CONCLUSIONS Predicting IVIG resistance in children diagnosed with KD remains challenging. The KS has low sensitivity in predicting IVIG resistance in children with KD in the United States. The new score resulted in improved sensitivity, but many children with true IVIG resistance may be missed. Further research is needed to improve IVIG resistance prediction.
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Affiliation(s)
- Jasdip Singh
- Department of Pharmacy Practice (JS, NF), University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY
| | - Arthur Chang
- Department of Pediatrics (AC, MH), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Nicholas M. Fusco
- Department of Pharmacy Practice (JS, NF), University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY
| | - Mark Hicar
- Department of Pediatrics (AC, MH), University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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2
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Kim J, Hong K, Yoo D, Chun BC. Spatiotemporal clusters of Kawasaki disease in South Korea from 2008 to 2017: A municipal-level ecological study. Front Pediatr 2022; 10:1054985. [PMID: 36760687 PMCID: PMC9904408 DOI: 10.3389/fped.2022.1054985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION As the etiology of Kawasaki disease (KD) remains unknown, identifying spatiotemporal clusters with proper stratification of KD could provide further evidence for investigating the triggers of KD. However, spatiotemporal distributions of KD with sex stratification have never been reported. Therefore, we aimed to analyze the spatiotemporal patterns of KD by sex in South Korea. METHODS We extracted epidemiologic week (Epiweek)-based KD cases in patients <5 years of age (ICD-10-CM code: M303) from 2008 to 2017 national health insurance service data at the 250 municipal level. To determine whether spatial autocorrelation and persistent municipal-level clusters exist, year- and sex-stratified global Moran's I statistics, Getis-Ord Gi* statistics, and emerging hotspot analysis on KD incidence were conducted. RESULTS A total of 72,510 KD cases were reported between 2008 and 2017 (male-to-female ratio = 1.40:1). Incidence has increased since 2008, with the highest incidence in 2016 (396.8 per 100,000 population). KD had seasonality of winter and summer but different by sex. Positive spatial autocorrelation was consistently reported in every stratum, with the 2011-2014 period having the strongest index value (total sex I = 0.286, p < 0.001; male I = 0.242, p < 0.001; female I = 0.213, p < 0.001). Hot spots were consistently detected in the northern parts, and cold spots were in the southern part for 9 years in both sexes. The emerging hot spot analysis showed new, consecutive, and sporadic hot spots on the northwestern and eastern coasts and new and sporadic cold spots in the southwestern part. However, the distribution and proportion of hot or cold spot types differed according to sex. DISCUSSION The spatiotemporal features of KD had limits to concluding that only infectious triggers result in KD occurrence. Therefore, our findings support the notion that KD is a syndrome with multiple factors, including infectious, genetic, and environmental factors, that are associated with sex differences.
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Affiliation(s)
- Jeehyun Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Daesung Yoo
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Department of Animal Disease Control and Quarantine, Animal and Plant Quarantine Agency, Gimcheon, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, Republic of Korea
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3
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Burney JA, DeHaan LL, Shimizu C, Bainto EV, Newburger JW, DeBiasi RL, Dominguez SR, Portman MA, Melish M, Bratincsak A, Fabi M, Corinaldesi E, Yu JJ, Gee P, Kitano N, Tremoulet AH, Cayan DR, Burns JC. Temporal clustering of Kawasaki disease cases around the world. Sci Rep 2021; 11:22584. [PMID: 34799633 PMCID: PMC8605018 DOI: 10.1038/s41598-021-01961-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022] Open
Abstract
In a single-site study (San Diego, CA, USA), we previously showed that Kawasaki Disease (KD) cases cluster temporally in bursts of approximately 7 days. These clusters occurred more often than would be expected at random even after accounting for long-term trends and seasonality. This finding raised the question of whether other locations around the world experience similar temporal clusters of KD that might offer clues to disease etiology. Here we combine data from San Diego and nine additional sites around the world with hospitals that care for large numbers of KD patients, as well as two multi-hospital catchment regions. We found that across these sites, KD cases clustered at short time scales and there were anomalously long quiet periods with no cases. Both of these phenomena occurred more often than would be expected given local trends and seasonality. Additionally, we found unusually frequent temporal overlaps of KD clusters and quiet periods between pairs of sites. These findings suggest that regional and planetary range environmental influences create periods of higher or lower exposure to KD triggers that may offer clues to the etiology of KD.
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Affiliation(s)
- Jennifer A Burney
- School of Global Policy & Strategy, University of California San Diego, La Jolla, CA, USA
| | - Laurel L DeHaan
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Chisato Shimizu
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego and Rady Children's Hospital San Diego, 9500 Gilman Dr., La Jolla, CA, 92037, USA
| | - Emelia V Bainto
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego and Rady Children's Hospital San Diego, 9500 Gilman Dr., La Jolla, CA, 92037, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Roberta L DeBiasi
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Samuel R Dominguez
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Michael A Portman
- Department of Pediatrics, Seattle Childrens Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Marian Melish
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Andras Bratincsak
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Marianna Fabi
- Pediatric Emergency Unit, Medical and Surgical Sciences Department, S.Orsola-Malpighi Hospital, University of Bologna, 40138, Bologna, Italy
| | - Elena Corinaldesi
- Pediatric Department, Ramazzini Hospital, Carpi, 41012, Modena, Italy
| | - Jeong Jin Yu
- Pediatric Cardiology Division, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Paul Gee
- Emergency Department, Christchurch Hospital and University of Otago, Christchurch, New Zealand
| | - Naomi Kitano
- Research Center for Community Medicine and Department of Public Health, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Adriana H Tremoulet
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego and Rady Children's Hospital San Diego, 9500 Gilman Dr., La Jolla, CA, 92037, USA
| | - Daniel R Cayan
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Jane C Burns
- Department of Pediatrics, UCSD School of Medicine, University of California San Diego and Rady Children's Hospital San Diego, 9500 Gilman Dr., La Jolla, CA, 92037, USA.
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U.S. Population-Based background incidence rates of medical conditions for use in safety assessment of COVID-19 vaccines. Vaccine 2021; 39:3666-3677. [PMID: 34088506 PMCID: PMC8118666 DOI: 10.1016/j.vaccine.2021.05.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has had a devastating impact on global health, and has resulted in an unprecedented, international collaborative effort to develop vaccines to control the outbreak, protect human lives, and avoid further social and economic disruption. Mass vaccination campaigns are underway in multiple countries and are expected worldwide once more vaccine becomes available. Some early candidate vaccines use novel platforms, such as mRNA encapsulated in lipid nanoparticles, and relatively new platforms, such as replication-deficient viral vectors. While these new vaccine platforms hold promise, limited safety data in humans are available. Serious health outcomes linked to vaccinations are rare, and some outcomes may occur incidentally in the vaccinated population. Knowledge of background incidence rates of these medical conditions is a critical component of vaccine safety monitoring to aid in the assessment of adverse events temporally associated with vaccination and to put these events into context with what would be expected due to chance alone. A list of 22 potential adverse events of special interest (AESI), including neurologic, autoimmune, and cardiovascular disorders, was compiled by subject matter experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention. The most recently available U.S. background rates for these medical conditions, overall and by age, sex, and race/ethnicity (when available), were sourced from reported statistics (data published by medical panels/ associations or federal government reports), and literature reviews in PubMed. This review provides estimates of background incidence rates for medical conditions that may be monitored or studied as AESI during safety surveillance and research for COVID-19 vaccines and other new vaccines.
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Soysal A, Gönüllü E, Arslan H, Kibar BS, Pop S, Yurttaş GN, Demirbacak H, Ünal F, Öktem S, Atıcı S, Yücel Şen AD, Karabayır N, Karaböcüoğlu M. Comparison of Clinical and Laboratory Features and Treatment Options of 237 Symptomatic and Asymptomatic Children Infected with SARS-CoV-2 in the Early Phase of the COVID-19 Pandemic in Turkey. Jpn J Infect Dis 2020; 74:273-279. [PMID: 33250495 DOI: 10.7883/yoken.jjid.2020.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about the therapeutic use of hydroxychloroquine in pediatric patients with coronavirus disease 2019 (COVID-19). Here, we retrospectively retrieved data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive pediatric patients from 20 hospitals in 8 Turkish cities. We obtained epidemiological, clinical, and laboratory features of the patients, as well as the drugs used for treating COVID-19. A total of 237 nasopharyngeal swab SARS-CoV-2 PCR-positive children were included in the study from March 26, 2020 to June 20, 2020. The mean age of asymptomatic children (118 ± 62 months) was higher than that of symptomatic children (89 ± 69 months). Symptomatic children had significantly lower mean lymphocyte counts and higher mean CRP, D-dimer, procalcitonin, and LDH levels than asymptomatic children in the univariate analysis. Among 156 children, 78 (50%), 15, 44, and 21 were treated with a hydroxychloroquine-containing regimen, hydroxychloroquine + azithromycin + oseltamivir, hydroxychloroquine + azithromycin, and hydroxychloroquine alone, respectively. Among 156 patients who received medical treatment, 90 (58%) underwent pre- and/or post-treatment electrocardiogram (ECG). However, none of them had ECG abnormalities or required hydroxychloroquine discontinuation due to adverse drug reactions.
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Affiliation(s)
- Ahmet Soysal
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | - Erdem Gönüllü
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | | | | | | | - Füsun Ünal
- Medipol University, Department of Pediatrics, Turkey
| | - Sedat Öktem
- Medipol University, Department of Pediatrics, Turkey
| | - Serkan Atıcı
- Okan University Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | - Metin Karaböcüoğlu
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
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Hicar MD. Antibodies and Immunity During Kawasaki Disease. Front Cardiovasc Med 2020; 7:94. [PMID: 32671098 PMCID: PMC7326051 DOI: 10.3389/fcvm.2020.00094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
The cause of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology studies support that an infectious disease is involved in at least starting the inflammatory cascade set off during KD. Clues from epidemiology support that humoral immunity can have a protective effect. However, the role of the immune system, particularly of B cells and antibodies, in pathogenesis of KD is still unclear. Intravenous immunoglobulin (IVIG) and other therapies targeted at modulating inflammation can prevent development of coronary aneurysms. A number of autoantibody responses have been reported in children with KD and antibodies have been generated from aneurysmal plasma cell infiltrates. Recent reports show that children with KD have similar plasmablast responses as other children with infectious diseases, further supporting an infectious starting point. As ongoing studies are attempting to identify the etiology of KD through study of antibody responses, we sought to review the role of humoral immunity in KD pathogenesis, treatment, and recovery.
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Affiliation(s)
- Mark Daniel Hicar
- University at Buffalo, Buffalo, NY, United States.,John R. Oishei Children's Hospital, Buffalo, NY, United States.,Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
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7
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Fernandez-Cooke E, Barrios Tascón A, Sánchez-Manubens J, Antón J, Grasa Lozano CD, Aracil Santos J, Villalobos Pinto E, Clemente Garulo D, Mercader Rodríguez B, Bustillo Alonso M, Nuñez Cuadros E, Navarro Gómez ML, Domínguez-Rodríguez S, Calvo C. Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group. PLoS One 2019; 14:e0215665. [PMID: 31107862 PMCID: PMC6527399 DOI: 10.1371/journal.pone.0215665] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/07/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. OBJECTIVE This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. METHODS Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). RESULTS A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p<0.001). A total of 97% of the patients received intravenous immunoglobulin (IVIG) with a median number of days from fever onset to IVIG administration of 7.2. A second dose was given to 15.7% and steroids to 14.5% patients. Only 1.4% patients received infliximab. No deaths were reported. A multivariate analysis identified anemia, hypoalbuminemia, hyponatremia, higher creatinine and procalcitonin as independent risk factors for treatment failure and length under 103 cm, hemoglobin < 10.2 mg/dL, platelets > 900,000 cells/mm3, maximum temperature < 39.5°C, total duration of fever > 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. CONCLUSIONS In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary.
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Affiliation(s)
| | - Ana Barrios Tascón
- Department of Pediatrics, Hospital Universitario Infanta Sofia, Madrid, Spain
| | - Judith Sánchez-Manubens
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
- Department of Pediatric Rheumatology, Hospital Parc Tauli, Sabadell, Spain
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Sara Domínguez-Rodríguez
- Fundación de Investigación Hospital 12 Octubre (Madrid, Spain), Fondazione PENTA ONLUS, Padova, Italy
| | - Cristina Calvo
- Department of Pediatrics, Hospital Universitario La Paz, Madrid, Spain
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Lindquist ME, Hicar MD. B Cells and Antibodies in Kawasaki Disease. Int J Mol Sci 2019; 20:ijms20081834. [PMID: 31013925 PMCID: PMC6514959 DOI: 10.3390/ijms20081834] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
The etiology of Kawasaki disease (KD), the leading cause of acquired heart disease in children, is currently unknown. Epidemiology supports a relationship of KD to an infectious disease. Several pathological mechanisms are being considered, including a superantigen response, direct invasion by an infectious etiology or an autoimmune phenomenon. Treating affected patients with intravenous immunoglobulin is effective at reducing the rates of coronary aneurysms. However, the role of B cells and antibodies in KD pathogenesis remains unclear. Murine models are not clear on the role for B cells and antibodies in pathogenesis. Studies on rare aneurysm specimens reveal plasma cell infiltrates. Antibodies generated from these aneurysmal plasma cell infiltrates showed cross-reaction to intracellular inclusions in the bronchial epithelium of a number of pathologic specimens from children with KD. These antibodies have not defined an etiology. Notably, a number of autoantibody responses have been reported in children with KD. Recent studies show acute B cell responses are similar in children with KD compared to children with infections, lending further support of an infectious disease cause of KD. Here, we will review and discuss the inconsistencies in the literature in relation to B cell responses, specific antibodies, and a potential role for humoral immunity in KD pathogenesis or diagnosis.
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Affiliation(s)
- Michael E Lindquist
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA.
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14222, USA.
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