Kawasaki disease drop during pandemic leaves hints at possible triggers
Rates of Kawasaki disease, a rare acquired cardiac condition in kids, fell nationally during peak COVID-19 transmission when control measures were in place, potentially providing a clue that multiple triggers and upper airway inhalation might be involved.
Researchers based at the University of California San Diego (UCSD) published the findings of their disease tracking study late last week in JAMA Network Open.
When the pandemic began, the team was already tracking national Kawasaki disease cases from 2018 to 2020 using a multicenter cohort approach. They were also conducting a detailed analysis of patients who were diagnosed at Rady Children’s Hospital in San Diego from Jan 1, 2002, to Nov 15, 2021.
The disease is puzzling, and triggers haven’t yet been identified. Jane Burns, MD, senior study author who directs the Kawasakai Disease Research Center at UCSD, said the pandemic provided an incredible natural experiment that the group took advantage of.
When they compared rates before and during the pandemic, they found that cases dropped by 28% during the peak pandemic period, then rebounded in the spring of 2021 when mask mandates were lifted and in-person school resumed. The findings hint at a role for social contact in exposure and an inhaled respiratory trigger
First author Jennifer Burney, PhD, part of the study team who is with the environmental science department at UCSD, said though numbers dropped dramatically during the shelter-in-place period, they didn’t disappear entirely, as did other respiratory diseases. Also, they found differences among age-groups, especially in kids ages 1 through 5 years, who experienced the steepest drops in cases.
Burns added that the disease may be caused by a virus, pollutant, microbial aerosol, or all of the above. Once verified, the findings could have a major impact on research and prevention of Kawasaki disease, a condition that affects as many as 6,000 children each year.
Jun 17 JAMA Netw Open abstract
Jun 17 UCSD press release
US fungal deaths rose in the first 2 years of the COVID-19 pandemic
US deaths from fungal infections rose in the first 2 years of the COVID-19 pandemic compared with previous years, with the increase driven mainly by COVID-19–associated fungal deaths, researchers reported yesterday in Clinical Infectious Diseases.
Using data from the US National Vital Statistics System covering 2018 through 2021, researchers with the Centers for Disease Control and Prevention and the National Center for Health Statistics identified and examined numbers and age-adjusted rates (per 100,000 population) of fungal deaths by pathogen, COVID-19 association, demographics, and year. A total of 22,700 fungal deaths occurred over the study period.
The number and age-adjusted rates of fungal deaths was similar in 2018 (4,746) and 2019 (4,833) (rate during both years, 1.2 per 100,000 population) but increased to 5,922 in 2020 (rate, 1.5) and to 7,199 in 2021 (1.8).
Of the 13,121 fungal deaths that occurred during 2020-21, 2,868 (21.9%) were COVID-19–associated, and, of those deaths, COVID-19 was the most frequent underlying cause in 2,596 (90.5%). Compared with non-COVID-19–associated fungal deaths, COVID-19–associated fungal deaths more frequently involved Candida (27.1% vs 23.7%) and Aspergillus (23.3% vs 14.5%) and less frequently involved other fungal pathogens.
For COVID-19–associated fungal deaths, age-adjusted death rates per 100,000 population were higher for people who were American Indian/Alaska Native (1.3), Hispanic (0.7), and Black (0.6) compared with White (0.2) and Asian (0.3) persons. Observed death rates from Aspergillus infections were approximately twice as high in the Pacific census division (0.4) compared with most other divisions.
“Our analysis demonstrates the substantial burden of fungal infections in the United States and highlights an increase in fungal deaths during the first two years of COVID-19 pandemic,” the study authors wrote. “These data might help increase clinician awareness and support public health planning.”
They concluded, “Detailed public health surveillance for fungal infections, involving geographically and demographically diverse patient populations, might help better characterize disease epidemiology and guide ongoing efforts to prevent fungal infections among disproportionately affected populations.”
Jun 19 Clin Infect Dis abstract