Rare diseases

More Aussie kids are being diagnosed with Kawasaki disease

There is evidence of a “clear increasing trend” in diagnosis of Kawasaki disease (KD) in Australian children over the last 25 years, a new study shows.

According to national datasets of all IVIG treatment provided for Kawasaki disease between 2007 and 2016 and hospitalisations for Kawasaki disease from 1993-2018, the increase is primarily in 1-4 years olds.

The study, published in the Journal of Paediatrics and Child Health, said the IVIG-treatment rate was 14.31 per 100,000 person-years in the 0-4 year age group and the hospitalisation rate was 14.99 per 100,000 person-years during the overlapping nine year period 2007-2016.

The concordant results from two independent datasets increased confidence in the estimate of the high incidence rate.

“This is markedly higher than the previous estimate of Australian incidence of 9.34 per 100,000 person-years, suggesting that the incidence of KD in Australia is approaching that reported in the USA (20.8 per 100,000 per annum), and Canada (20.5 per 100,000 per annum), and is considerably higher than that reported most recently in the UK (8.39 per 100,000 per annum).”

The study said hospitalisation rates in the 0-4 year age group rose an average rate of 3.5% annually between 1993 and 2018, increasing from 9.39 per 100 000 person-years in 1993–1997 to 17.47 per 100,000 person-years in 2013– 2017.

“Similar rates of growth were observed in the 5- to 9-year and 10- to 14-year age groups, but not in the 0- to 1-year or 15- to 19-year age group.”

There was a disproportionate increase in the hospitalisation rate in the 1-4 year age group, it said.

“It is unclear whether this change in KD hospitalisations reflects a true increase in disease incidence, increasing recognition and/or diagnosis, or both,” the study authors said.

The investigators, led by Dr Ryan Lucas from the Sydney Children’s Hospitals Network, said increasing KD incidence has been inconsistently reported around the world but most convincingly in Japan.

Overall, males outnumbered females in all age groups in both datasets (1.52:1), with an exaggerated male predominance in the 0-1 year (2.08:1) and 10-14 year age groups (1.65:1).

The study authors, including Dr Kevin Murray of the Department of Rheumatology, Perth Children’s Hospital, also noted a peak in the IVIG treatment rate in September nationally.

“High-quality, standardised prospective surveillance is warranted to understand the evolving epidemiology of KD in Australia and elsewhere to inform clinical and scientific priorities,” they concluded.

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