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Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country

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A Correction to this article was published on 23 June 2021

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Abstract

Data on Kawasaki disease from tropical countries are scarce. Hence, this population-based study aims to determine the epidemiology, clinical characteristics, and outcome of Kawasaki disease in children enrolled in the Kawasaki disease registry between 2006 and 2019 in Southern Malaysia. Diagnosis of Kawasaki disease was made using standard criteria. Primary outcome measure was a coronary artery aneurysm. Multivariable logistic regression was used to analyze the associated risk factors for coronary artery aneurysm. There were 661 Kawasaki disease, with 27% incomplete and 11% atypical presentations. Male-to-female ratio was 2:1, and median age of diagnosis was 1.4 years (interquartile range 9 to 32 months). Incidence in children of less than 5 years was 14.8 (95% confidence interval [CI]: 13.6 to 16.0) per 100,000 population, higher in males (19/100,000) and Chinese (22/100,000), with a gradual increase from 5.7/100,000 in 2006 to 19.6/100,000 in 2019, p < 0.001. Incidence in children between 5 and 9 years old was 1.3 (95% CI: 0.9 to 1.6) per 100,000 population and remained stable over time. There was a seasonal pattern with peak incidence during the rainy season. Out of 625 intravenous immunoglobulins (IVIG)-treated Kawasaki disease, 7.4% were resistant, and 9% had coronary artery aneurysms. Atypical presentation, male sex, late diagnosis, and IVIG resistance were independent risk factors for coronary artery aneurysms.

Conclusions: Despite the tropical climate, Kawasaki disease epidemiology is similar to non-tropic regions with seasonal patterns and a rising incidence. Atypical presentation, male sex, late diagnosis, and IVIG resistance were significantly associated with coronary artery aneurysms.

What is Known:

• Kawasaki disease predominantly occurs in males, children less than 5 years old, and the Asian population.

• Male sex, late diagnosis, incomplete Kawasaki disease, and IVIG resistance were associated with coronary artery aneurysms.

What is New:

• In multi-ethnic Asian countries such as Malaysia, ethnic Chinese have a higher prevalence of Kawasaki disease compared to other ethnicities.

• Kawasaki disease with atypical presentation can occur in both complete and incomplete Kawasaki disease and is significantly associated with a coronary artery aneurysm.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Change history

Abbreviations

IVIG:

Intravenous immunoglobulin

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Acknowledgements

We would like to thank the Director-General of Health Malaysia for his permission to publish this article and Rasyidah Nizam for this manuscript’s graphics.

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Authors and Affiliations

  1. Department of Pediatrics, Hospital Sultanah Aminah, Ministry of Health Malaysia, Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor DT, Malaysia

    Mohd Nizam Mat Bah, Emieliyuza Yusnita Alias, Hasliza Razak, Mohd Hanafi Sapian, Fang Han Foo & Nisah Abdullah

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  1. Mohd Nizam Mat Bah
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Contributions

MNMB contributed to the study conception and design, carried out the echocardiogram, wrote the first draft, performed data analysis and revised the manuscript. MHS contributed to the study conception and design, carried out the echocardiogram and performed data collection. FFH contributed in the study conception and  design, and performed data collection. HR contributed in the study design, data analysis, reviewed and revised the manuscript. EYA contributed in the study design, critically reviewed and revised the manuscript. NA contributed in the study design and critically reviewed the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mohd Nizam Mat Bah.

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Ethics approval

All procedures performed in studies involving human participants were following the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was registered with the National Malaysian Research Registry with the identification number NMRR-19-2549-50342. It was approved by the Ministry of Health Research and Ethics Committee.

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Malaysian Ministry of Health Research and Ethics Committee waived the written informed consent.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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The original online version of this article was revised: The Ethical committee mentioned under Materials and methods has been updated.

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Mat Bah, M.N., Alias, E.Y., Razak, H. et al. Epidemiology, clinical characteristics, and immediate outcome of Kawasaki disease: a population-based study from a tropical country. Eur J Pediatr 180, 2599–2606 (2021). https://doi.org/10.1007/s00431-021-04135-7

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