Korean Circ J.  2014 Jul;44(4):250-254. 10.4070/kcj.2014.44.4.250.

Evaluation of the Temporal Association between Kawasaki Disease and Viral Infections in South Korea

• Kim GB
• Park S
• Kwon BS
• Han JW
• Park YW
• Hong YM

• KMID: 2223886
• DOI: http://doi.org/10.4070/kcj.2014.44.4.250

Abstract

BACKGROUND AND OBJECTIVES
This study is aimed at elucidating potential temporal associations between the occurrence of Kawasaki disease (KD) and various viral infections.
SUBJECTS AND METHODS
We obtained monthly patterns of KD from the seventh nationwide survey and viral detection data from the Korea Centers for Disease Control and Prevention from 2009 to 2011 and evaluated temporal correlations between them for each month. The respiratory viruses detected using a multiplex real-time-polymerase chain reaction kit were influenza virus (A/H1N1, A/H3N2, A/H5N1, and B), adenovirus, parainfluenza virus (type 1, 2, 3), respiratory syncytial virus (type A, B), human rhinovirus, human coronavirus (OC43/229E, NL63), human bocavirus, and enterovirus.
RESULTS
We obtained data from a total of 13031 patients who were treated for acute KD from 87 hospitals with pediatric residence programs. During this survey, KD showed highest overall incidence in summer and winter seasons and lowest incidence in February and October. We received viral detection data for a total of 14267 patients. Viral detection was highest during winter and spring seasons. The most commonly detected virus was human rhinovirus (32.6%), followed by influenza virus (26.8%). The monthly incidence of KD showed significant correlation with the monthly overall viral detection (p=0.022, r=0.382). In particular, human bocavirus and enterovirus have significant correlations with monthly patterns of KD occurrence (p=0.032 and p=0.007, respectively) and influenza virus correlated with KD occurrence with borderline significance (p=0.063).
CONCLUSION
The temporal association between monthly occurrence of KD and viral detection suggests the etiologic importance of precedent infection in the development of KD.

Keyword

Kawasaki disease; Infection; Association

MeSH Terms

Adenoviridae
Centers for Disease Control and Prevention (U.S.)
Coronavirus
Enterovirus
Human bocavirus
Humans
Incidence
Korea
Mucocutaneous Lymph Node Syndrome*
Orthomyxoviridae
Paramyxoviridae Infections
Respiratory Syncytial Viruses
Rhinovirus
Seasons

Figure

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  Fig. 1 Monthly patterns of Kawasaki disease occurrence. Kawasaki disease occurred most frequently in summer (arrow, especially July) and winter (arrow, especially December) seasons except for March 2010 (arrowhead). Kawasaki disease occurred least often in February and October.

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  Fig. 2 Monthly patterns of viral detection. Viral detection was the highest during the winter season (especially December, thin arrow) and relatively high in the spring season. Because influenza virus was epidemic in the spring of 2010, December 2010, and January 2011 (thick arrows), viral detection rates were the highest in December, April, and January. In contrast, viral detection rate was the lowest in February and August throughout the survey period.

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  Fig. 3 Correlation between monthly patterns of occurrence of Kawasaki disease (KD) and viral detection. There are 2 definite peaks of viral detection in April and December 2010 due to influenza virus epidemics (arrows).

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  Fig. 4 Scatter plot of monthly Kawasaki disease incidence and viral detection. The scatterplot between monthly occurrence of Kawasaki disease and total viral detection rates show a strong positive correlation (r=0.382, p=0.022).

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  Fig. 5 Monthly Kawasaki disease incidence and the detection of bocavirus (A) and enterovirus (B). Human bocavirus and enterovirus show significant correlation with monthly patterns of Kawasaki disease occurrence on scatter plot diagram (p=0.032 and p=0.007, respectively).

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