Rheumatology International

, Volume 38, Issue 7, pp 1259–1266 | Cite as

Kawasaki disease in Spanish paediatric population and synoptic weather types: an observational study

  • Leyre Riancho-Zarrabeitia
  • Domingo F. Rasilla
  • Dominic Royé
  • Pablo Fdez-Arroyabe
  • Ana SanturtúnEmail author
Observational Research


Kawasaki disease (KD) is a vasculitis of unelucidated pathogenesis that usually occurs in paediatric patients. In this study we analyse the temporal pattern and geographical distribution of the disease in Spain, and its relationship with atmospheric circulation patterns. We performed a retrospective study in which we collected all hospital admissions due to KD in the country between 2005 and 2015 and explored their relationship with demographic and geographical characteristics. Moreover, we calculated daily surface atmospheric patterns over Spain to study the relationship between weather types (WT) and KD Admissions. The average admission rate for KD in the paediatric population was 3.90 per 100,000, with a male to female ratio of 1.56:1. The highest rate of admissions was found in the 0–4-year-old group, with an incidence of 11.7 cases per 100,000. Admissions followed an annual cyclic pattern with a peak of incidence in January (p = 0.022) and a nadir in September. There was an upwards trend in the number of KD admissions in male sex during the study period (p = 0.004). However, there were marked geographical differences in the incidence rate. Finally, the analysis of the relationship between the WT and the number of admissions by KD revealed no statistically significant association. KD admissions follow a peculiar seasonal and spatial distribution, that suggest the involvement of environmental factors in the disease; however, the absence of an association with WT should be interpreted with caution and regional studies should be done to explore this relationship.


Kawasaki disease Weather types Season Trend 


Author contributions

LR-Z and AS conceived the study, elaborated the draft manuscript and are responsible for the full content. DR and PF-A calculated the weather type data. AS and DR performed the statistical analysis. All authors gave scientific inputs and contributed to the final manuscript.


There was no specific financial support for this study.

Compliance with ethical standards

Conflict of interest

Leyre Riancho-Zarrabeitia, Domingo F. Rasilla, Dominic Royé, Pablo Fdez-Arroyabe and Ana Santurtún declare that they have no conflict of interest.

Informed consent

For this type of study formal consent is not required.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Dietz SM, van Stijn D, Burgner D et al (2017) Dissecting Kawasaki disease: a state-of-the-art review. Eur J Pediatr 176:995–1009CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Hara T, Nakashima Y, Sakai Y, Nishio H, Motomura Y, Yamasaki S (2016) Kawasaki disease: a matter of innate immunity. Clin Exp Immunol 186:134–143CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ha S, Seo GH, Kim KY, Kim DS (2016) Epidemiologic study on Kawasaki Disease in Korea, 2007–2014: based on health insurance review & assessment service claims. J Korean Med Sci 31:1445–1449CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Makino N, Nakamura Y, Yashiro M et al (2015) Descriptive epidemiology of Kawasaki disease in Japan, 2011–2012: from the results of the 22nd nationwide survey. J Epidemiol 25:239–245CrossRefPubMedGoogle Scholar
  5. 5.
    Rodo X, Curcoll R, Robinson M et al (2014) Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan. Proc Natl Acad Sci USA 111:7952–7957CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Rodo X, Ballester J, Cayan D et al (2011) Association of Kawasaki disease with tropospheric wind patterns. Sci Rep 1:152CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Jorquera H, Borzutzky A, Hoyos-Bachiloglu R, Garcia A (2015) Association of Kawasaki disease with tropospheric winds in Central Chile: is wind-borne desert dust a risk factor? Environ Int 78:32–38CrossRefPubMedGoogle Scholar
  8. 8.
    Singh S, Vignesh P, Burgner D (2015) The epidemiology of Kawasaki disease: a global update. Arch Dis Child 100:1084–1088CrossRefPubMedGoogle Scholar
  9. 9.
    Jenkinson AF, Collison FP (1977) An initial climatology of gales over the North sea. Synoptic climatology branch memorandum, No. 62, Meteorological Office, BracknellGoogle Scholar
  10. 10.
    Cortesi N, Trigo RM, Gonzalez-Hidalgo JC, Ramos AM (2013) Modelling monthly precipitation with circulation weather types for a dense network of stations over Iberia. Hydrol Earth Syst Sci 17:665–678CrossRefGoogle Scholar
  11. 11.
    Nadal-Romero E, Cortesi N, Gonzalez-Hidalgo JC (2013) Weather types, runoff and sediment yield in a Mediterranean mountain landscape. Earth Surf Proc Land 39:427–438CrossRefGoogle Scholar
  12. 12.
    Andrade C, Santos J, Pinto JG, Corte-Real J (2011) Large-scale atmospheric dynamics of the wet winter 2009–2010 and its impact on hydrology in Portugal. Clim Res 46:29–41CrossRefGoogle Scholar
  13. 13.
    Santurtún A, Gonzalez-Hidalgo JC, Sanchez Lorenzo A, Zarrabeitia MT (2015) Surface ozone concentration trends and its relationship with weather types in Spain (2001–2010). Atmos Environ 101:10–22CrossRefGoogle Scholar
  14. 14.
    Peña-Angulo D, Trigo RM, Cortesi N, Gonzalez-Hidalgo JC (2016) The influence of weather types on the monthly average maximum and minimum temperatures in the Iberian Peninsula. Atmos Res 178–179:217–230CrossRefGoogle Scholar
  15. 15.
    Zhao N, Cao G, Vanos JK, Vecellio D (2018) The effects of synoptic weather on influenza infection incidences: a retrospective study utilizing digital disease surveillance. Int J Biometeorol 62(1):69–84. CrossRefPubMedGoogle Scholar
  16. 16.
    Royé D, Taboada JJ, Martí A, Lorenzo MN (2016) Winter circulation weather types and hospital admissions for respiratory diseases in Galicia, Spain. Int J Biometeorol 60(4):507–520. CrossRefPubMedGoogle Scholar
  17. 17.
    Wood S (2006) On confidence intervals for generalized additive models based on penalized regression splines. Austr N Z J Stat 48:445–464. CrossRefGoogle Scholar
  18. 18.
    Hastie T, Tibshirani R (1990) Generalized additive models. CRC Press, Boca Raton. Scholar
  19. 19.
    Ye X, Wolff R, Yu W et al (2011) Ambient temperature and morbidity: a review of epidemiological evidence. Environ Health Perspect 120(1):19–28. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Jakob A, Whelan J, Kordecki M et al (2016) Kawasaki disease in Germany: a prospective, population-based study adjusted for underreporting. Pediatr Infect Dis J 35:129–134CrossRefPubMedGoogle Scholar
  21. 21.
    Pinto FF, Laranjo S, Mota CM, Brito MJ, Cruz FR (2017) Twelve years of Kawasaki Disease in Portugal: epidemiology in hospitalized children. Pediatr Infect Dis J 36:364–368CrossRefPubMedGoogle Scholar
  22. 22.
    Hall GC, Tulloh LE, Tulloh RM (2016) Kawasaki disease incidence in children and adolescents: an observational study in primary care. Br J Gen Pract 66:e271–e276PubMedCentralGoogle Scholar
  23. 23.
    Cimaz R, Fanti E, Mauro A, Voller F, Rusconi F (2017) Epidemiology of Kawasaki disease in Italy: surveillance from national hospitalization records. Eur J Pediatr 176:1061–1065CrossRefPubMedGoogle Scholar
  24. 24.
    Kawasaki T (2014) Kawasaki disease. Int J Rheum Dis 17:597–600. CrossRefPubMedGoogle Scholar
  25. 25.
    Tacke CE, Breunis WB, Pereira RR, Breur JM, Kuipers IM, Kuijpers TW (2014) Five years of Kawasaki disease in the Netherlands: a national surveillance study. Pediatr Infect Dis J 33:793–797CrossRefPubMedGoogle Scholar
  26. 26.
    Burgner D, Harnden A (2005) Kawasaki disease: what is the epidemiology telling us about the etiology? Int J Infect Dis 9(4):185–194CrossRefPubMedGoogle Scholar
  27. 27.
    Sanchez-Manubens J, Anton J, Bou R, Iglesias E, Calzada-Hernandez J (2016) Incidence, epidemiology and clinical features of Kawasaki disease in Catalonia, Spain. Clin Exp Rheumatol 34:S139–S144PubMedGoogle Scholar
  28. 28.
    Manlhiot C, Mueller B, O’Shea S et al (2018) Environmental epidemiology of Kawasaki disease: Linking disease etiology, pathogenesis and global distribution. PLoS One 13(2):e0191087. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Burns JC, Herzog L, Fabri O et al (2013) Seasonality of Kawasaki disease: a global perspective. PLoS One 8(9):e74529. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Singh S, Bhattad S (2016) Kawasaki disease incidence at Chandigarh, North India, during 2009–2014. Rheumatol Int 36(10):1391–1397. CrossRefPubMedGoogle Scholar
  31. 31.
    Burns JC, Cayan DR, Tong G et al (2005) Seasonality and temporal clustering of Kawasaki syndrome. Epidemiology 16:220–225CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Uehara R, Belay ED (2012) Epidemiology of Kawasaki disease in Asia, Europe, and the United States. J Epidemiol 22(2):79–85. CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Makino N, Nakamura Y, Yashiro M et al (2018) Epidemiological observations of Kawasaki disease in Japan, 2013–2014. Pediatr Int. CrossRefPubMedGoogle Scholar
  34. 34.
    Saundankar J, Yim D, Itotoh B et al (2014) The epidemiology and clinical features of Kawasaki disease in Australia. Pediatrics 133(4):e1009–e1014. CrossRefPubMedGoogle Scholar
  35. 35.
    Mauro A, Fabi M, Da, Frè et al (2016) Kawasaki disease: an epidemiological study in central Italy. Pediatr Rheumatol Online 14:22. CrossRefGoogle Scholar
  36. 36.
    Negral L, Moreno-Grau S, Querol X et al (2012) Weak pressure gradient over the Iberian Peninsula and African dust outbreaks: a new dust long-transport scenario. Bull Am Meteor Soc 93:1125–1132CrossRefGoogle Scholar
  37. 37.
    Gaetani M, Pasqui M (2012) Synoptic patterns associated with extreme dust events in the Mediterranean Basin. Reg Environ Change 14:1847–1860. CrossRefGoogle Scholar
  38. 38.
    Stafoggia M, Zauli-Sajani S, Pey J et al (2016) Desert dust outbreaks in Southern Europe: contribution to daily PM(10) concentrations and short-term associations with mortality and hospital admissions. Environ Health Perspect 124:413–419PubMedCrossRefGoogle Scholar
  39. 39.
    Martinez RM, del Castillo MF, Borque AC et al (2003) Incidence and clinical characteristics of Kawasaki’s disease. An Pediatr (Barc) 59:323–327CrossRefGoogle Scholar
  40. 40.
    Jiao F, Jindal AK, Pandiarajan V et al (2017) The emergence of Kawasaki disease in India and China. Glob Cardiol Sci Pract 3 e201721.
  41. 41.
    Du ZD, Zhao D, Du J et al (2007) Epidemiologic study on Kawasaki disease in Beijing from 2000 through 2004. Pediatr Infect Dis J 26(5):449–51CrossRefPubMedGoogle Scholar
  42. 42.
    INE (2015) Encuesta de MOrbilidad Hopitalaria. Metodología. Accessed 20 May 2018

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Rheumatology UnitHospital SierrallanaTorrelavegaSpain
  2. 2.Geography DepartmentUniversity of CantabriaSantanderSpain
  3. 3.Department of GeographyUniversity of Santiago de CompostelaSantiago de CompostelaSpain
  4. 4.Unit of Legal Medicine, Pharmacology and Physiology DepartmentUniversity of CantabriaSantanderSpain

Personalised recommendations