Advertisement

European Journal of Pediatrics

, Volume 155, Issue 4, pp 303–307 | Cite as

A case-control study of recurrent Kawasaki disease using the database of the nationwide surveys in Japan

  • Yosikazu Nakamura
  • Hiroshi Yanagawa
Infectious Diseases

Abstract

Abstract

In spite of many reports of recurrent Kawasaki disease, little information about the risk factors associated with recurrence is available. We conducted a case-control study on 150 cases of recurrent Kawasaki disease and 1173 pair-matched controls selected from the database of nationwide surveys of the same disease in Japan. Items observed were: sex, age, use of intravenous gamma globulin, and cardiac sequelae at the first episode. Sex and cardiac sequenlae did not affect the risk of recurrence. One- to 2-year-old chilren were more likely to be affected again than infants (odds ratio [OR]=1.42; 95% confidence interval [CI], 0.94–2.13), and children who were 3 years of age or older were less likely to experience a recurrence than infants (OR=0.59; 95% CI, 0.34–1.02). Intravenous gamma globulin therapy at the first episode increased the risk for recurrence of Kawasaki disease within 12 months (OR=2.66, 95% CI, 1.06–6.66). However, it did not affect recurrences 12 months after the first episode (OR=1.02; 95% CI, 0.53–1.97).

Conclusion

Patients with Kawasaki disease treated with intravenous gamma globulin are 2.66 times as likely to be affected by the disease again within 12 months as those treated without intravenous gamma globulin.

Key words

Mucocutaneous lymph node syndrome Recurrence Immunoglobulin Intravenous Case-control studies 

Abbreviations

OR

odds ratio

CI

confidence interval

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bell DM, Morens DM, Holman RC, Hurwitz ES, Hunter MK (1983) Kawasaki syndrome in the United States. Am J Dis Child 137:211–214PubMedGoogle Scholar
  2. 2.
    Breslow NE, Day NE (1980) Statistical methods in cancer research: vol 1. the analysis of case-control studies. International Agency for Research on Cancer. Lyon, pp 247–279Google Scholar
  3. 3.
    Chen CY, Wu JR (1989) Relapse of Kawasaki disease: a case report. Kao Hsiung 1 Hsueh Ko Hsueh Tsa Chih 5:189–193Google Scholar
  4. 4.
    Dean AG, Melish ME, Hicks R, Palumbo NE (1982) An epidemic of Kawasaki syndrome in Hawaii. J Pediatr 100:552–557PubMedGoogle Scholar
  5. 5.
    Furusho K, Kamiya T, Nakano H, et al (1984) High-dose intravenous gammaglobulin for Kawasaki disease. Lancet II:1155–1158Google Scholar
  6. 6.
    Harada K (1991) Intravenous gammaglobulin treatment in Kawasaki disease. Acta Paediatr Jpn 33:805–810PubMedGoogle Scholar
  7. 7.
    Ichida F, Fatica NS, O'Loughlin JE, et al (1989) Epidemiologic aspects of Kawasaki disease in a Manhattan hospital. Pediatrics 84:235–241PubMedGoogle Scholar
  8. 8.
    Kawasaki T (1967) Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children. Arerugi 16:178–222PubMedGoogle Scholar
  9. 9.
    Keren G, Passwell J, Cohen BE (1986) Recurrent mucocutaneous lymph node syndrome (Kawasaki disease): a report of three cases. J Med 17:365–371PubMedGoogle Scholar
  10. 10.
    Kikuta H, Matsumoto S, Yanase Y, Kawasaki T, Mizuno F, Osato T (1990) Recurrence of Kawasaki disease and Epstein-Barr virus infection [letter]. J Infect Dis 162:1215PubMedGoogle Scholar
  11. 11.
    Kleinbaum DG, Kupper LL, Morgenstern H (1982) Epidemiologic research Principles and quantitative methods. Van Nostrand Reinhold, New York:194–241Google Scholar
  12. 12.
    Leung DYM, Burns JC, Newburger JW, Geha RS (1987) Reversal of lymphocyte activation in vivo in the Kawasaki syndrome by intravenous gammaglobulin. J Clin Invest 79:468–472PubMedGoogle Scholar
  13. 13.
    Mason WH, Takahashi M, Schneider T (1993) Recurrence of Kawasaki disease in a large urban cohort in the United States. In: Takahashi M, Taubert K (eds) (1993) Proceedings of the Fourth International Symposium on Kawasaki Disease; 1–4 December 1991, Wailae. Am Heart Assoc. Dallas, pp 21–26Google Scholar
  14. 4.
    Meade RH, Brandt L (1982) Manifestations of Kawasaki disease in New England outbreak of 1980. J Pediatr 100:558–562PubMedGoogle Scholar
  15. 15.
    Melish ME, Hicks RM, Larson EJ (1976) Mucocutaneous lymph node syndrome in the United States. Am J Dis Child 130:599–607PubMedGoogle Scholar
  16. 16.
    Morens DM, Anderson LJ, Hurwitz ES (1980) National surveillance of Kawasaki disease. Pediatrics 65:21–25PubMedGoogle Scholar
  17. 17.
    Morikawa Y, Ohashi Y, Harada K, et al (1994) A multicenter, randomized, controlled trial of intravenous gamma globulin theray in children with acute Kawasaki disease. Acta Paediatr Jpn 36:347–354PubMedGoogle Scholar
  18. 18.
    Nakamura Y, Fujita Y, Nagai M, et al (1991) Cardiac sequelae of Kawasaki disease in Japan: statistical analysis. Pediatrics 88:1144–1147PubMedGoogle Scholar
  19. 19.
    Nakamura Y, Yanagawa H, Kawasaki T (1992) Mortality among children with Kawasaki disease in Japan. N Engl J Med 326:1246–1249PubMedGoogle Scholar
  20. 20.
    Nakamura Y, Hirose K, Yanagawa H, Kato H, Kawasaki T (1994) Incidence rate of recurrent Kawasaki disease in Japan. Acta Paediatr 84:1061–1064Google Scholar
  21. 21.
    Newburger JW, Takahashi M, Burns JC, et al (1986) The treatment of Kawasaki syndrome with intravenous gamma globulin. N Engl J Med 315:341–347PubMedGoogle Scholar
  22. 22.
    Newburger JW, Takahashi M, Beiser AS, et al (1991) A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 324:1633–1639PubMedGoogle Scholar
  23. 23.
    Omakoku BA, Chow S, Rao M (1980) Kawasaki disease. NY State J Med 80:1948–1949Google Scholar
  24. 24.
    Rothman KJ (1986) Modern epidemiology. Little, Brown and Company, Boston, pp 84–89Google Scholar
  25. 25.
    SAS Institute Inc (1991) SAS technical report P-217 SAS/STAT software: the PHREG procedure: version 6. SAS Institute Inc., CaryGoogle Scholar
  26. 26.
    Vargo TA, Huhta JC, Moore WH, Person DA, Edwards MS (1986) Recurrent Kawasaki disease. Pediatr Cardiol 6:199–202PubMedGoogle Scholar
  27. 27.
    Yanagawa H (1993) Epidemiological pictures of Kawasaki disease in Japan. In: Takahashi M, Taubert K (eds) Proceedings of the Fourth International Symposium on Kawasaki Disease: 1–4 December 1991, Wailae. Am Heart Assoc, Dallas, pp 1–5Google Scholar
  28. 28.
    Yanagawa H, Kawasaki T, Shigematsu I (1987) Nationwide survey on Kawasaki disease in Japan. Pediatrics 80:58–62PubMedGoogle Scholar
  29. 29.
    Yanagawa H, Nakamura Y, Yashiro M, et al (1988) A nationwide incidence survey of Kawasaki disease in 1985–1986 in Japan. J Infect Dis 158:1296–1301PubMedGoogle Scholar
  30. 30.
    Yanagawa H, Yashiro M, Nakamura Y, Kawasaki T, Kato H (1995) Epidemiologic pictures of Kawasaki disease in Japan; from the nationwide incidence survey in 1991 and 1992. Pediatrics 95:475–479PubMedGoogle Scholar
  31. 31.
    Yanagihara R, Todd JK (1980) Acute febrile mucocutaneous lymph node syndrome. Am J Dis Child 134:603–614PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Yosikazu Nakamura
    • 1
  • Hiroshi Yanagawa
    • 1
  1. 1.Department of Public HealthJichi Medical SchoolMinamikawachi, TochigiJapan

Personalised recommendations