En Cataluña la enfermedad de Kawasaki es más prevalente en las zonas rurales / Kawasaki disease is more prevalent in rural areas of Catalonia (Spain)

Introducción: La enfermedad de Kawasaki (EK) es una vasculitis aguda autolimitada relativamente frecuente en la infancia. La etiología de la EK es aún desconocida, aunque los datos clínicos y de laboratorio y las características epidemiológicas sugieren un origen infeccioso. Las diferencias en la incidencia entre los países se han relacionado con factores genéticos, étnicos y otros factores socioculturales y ambientales. Presentamos un estudio poblacional sobre la incidencia de la EK en Cataluña (España), centrándose en las diferencias entre los pacientes en zonas rurales y no rurales de la región. Métodos: Estudio observacional poblacional incluyendo todas las unidades pediátricas en los hospitales catalanes, entre 2004 y 2014. Recogida prospectiva de nuevos casos de EK durante 12 meses (marzo de 2013-marzo de 2014) para determinar la incidencia de la EK. El resto de los datos se recuperaron de forma retrospectiva. Se analizaron los datos de 399 pacientes durante el período de estudio de 10 años. Resultados: Entre el total de pacientes con EK, 353 (88,5%) vivían en zonas no rurales y 46 (11,5%) en zonas rurales. Se encontró una diferencia significativa (p < 0,001) entre el porcentaje de la población rural observada en los pacientes con EK (11,5%), y el esperado 5% para la población catalana. Conclusión: Este es el primer estudio poblacional que muestra diferencias significativas entre las tasas de incidencia de EK entre las zonas rurales y no rurales (AU)

Introduction: Kawasaki disease (KD) is an acute self-limited systemic vasculitis relatively common in childhood. The etiology of KD is still unknown, although clinical, laboratory and epidemiological features suggest an infectious origin or trigger. Differences on incidence between countries have been related to specific genetic factors, ethnicity, country of birth and some other sociocultural and environmental factors. We present a population-based study on incidence of KD in Catalonia (Spain), focusing on differences between patients in rural and non-rural areas of the region. Methods: Observational population-based study including all Pediatric Units in Catalan hospitals, between 2004 and 2014. A 12-month (March 2013-March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. The rest of the data was retrieved retrospectively. Results: Data from 399 patients over the 10-year study period was analyzed. Among the total KD patients, 353 (88.5%) lived in non-rural areas and 46 (11.5%) in rural areas. It was found that there is a significant difference (P < .001) between the percentage of rural population observed in patients with KD (11.5%), and the expected 5% of the Catalan population. Conclusion: This is the first population-based study showing significant differences on KD incidence rates between rural and non-rural areas (AU)

[Kawasaki disease is more prevalent in rural areas of Catalonia (Spain)]. / En Cataluña la enfermedad de Kawasaki es más prevalente en las zonas rurales.

INTRODUCTION: Kawasaki disease (KD) is an acute self-limited systemic vasculitis relatively common in childhood. The etiology of KD is still unknown, although clinical, laboratory and epidemiological features suggest an infectious origin or trigger. Differences on incidence between countries have been related to specific genetic factors, ethnicity, country of birth and some other sociocultural and environmental factors. We present a population-based study on incidence of KD in Catalonia (Spain), focusing on differences between patients in rural and non-rural areas of the region. METHODS: Observational population-based study including all Pediatric Units in Catalan hospitals, between 2004 and 2014. A 12-month (March 2013-March 2014) prospective collection of new cases of KD was carried out to determine the incidence of KD. The rest of the data was retrieved retrospectively. RESULTS: Data from 399 patients over the 10-year study period was analyzed. Among the total KD patients, 353 (88.5%) lived in non-rural areas and 46 (11.5%) in rural areas. It was found that there is a significant difference (P<.001) between the percentage of rural population observed in patients with KD (11.5%), and the expected 5% of the Catalan population. CONCLUSION: This is the first population-based study showing significant differences on KD incidence rates between rural and non-rural areas.

Revisiting the role of environmental and climate factors on the epidemiology of Kawasaki disease.

Can environmental factors, such as air-transported preformed toxins, be of key relevance to the health outcomes of poorly understood human ailments (e.g., rheumatic diseases such as vasculitides, some inflammatory diseases, or even severe childhood acquired heart diseases)? Can the physical, chemical, or biological features of air masses be linked to the emergence of diseases such as Kawasaki disease (KD), Henoch-Schönlein purpura, Takayasu's aortitis, and ANCA-associated vasculitis? These diseases surprisingly share some common epidemiological features. For example, they tend to appear as clusters of cases grouped geographically and temporarily progress in nonrandom sequences that repeat every year in a similar way. They also show concurrent trend changes within regions in countries and among different world regions. In this paper, we revisit transdisciplinary research on the role of environmental and climate factors in the epidemiology of KD as a paradigmatic example of this group of diseases. Early-warning systems based on environmental alerts, if successful, could be implemented as a way to better inform patients who are predisposed to, or at risk for, developing KD. Further research on the etiology of KD could facilitate the development of vaccines and specific medical therapies.

Tropospheric winds from northeastern China carry the etiologic agent of Kawasaki disease from its source to Japan.

Evidence indicates that the densely cultivated region of northeastern China acts as a source for the wind-borne agent of Kawasaki disease (KD). KD is an acute, coronary artery vasculitis of young children, and still a medical mystery after more than 40 y. We used residence times from simulations with the flexible particle dispersion model to pinpoint the source region for KD. Simulations were generated from locations spanning Japan from days with either high or low KD incidence. The postepidemic interval (1987-2010) and the extreme epidemics (1979, 1982, and 1986) pointed to the same source region. Results suggest a very short incubation period (<24 h) from exposure, thus making an infectious agent unlikely. Sampling campaigns over Japan during the KD season detected major differences in the microbiota of the tropospheric aerosols compared with ground aerosols, with the unexpected finding of the Candida species as the dominant fungus from aloft samples (54% of all fungal strains). These results, consistent with the Candida animal model for KD, provide support for the concept and feasibility of a windborne pathogen. A fungal toxin could be pursued as a possible etiologic agent of KD, consistent with an agricultural source, a short incubation time and synchronized outbreaks. Our study suggests that the causative agent of KD is a preformed toxin or environmental agent rather than an organism requiring replication. We propose a new paradigm whereby an idiosyncratic immune response, influenced by host genetics triggered by an environmental exposure carried on winds, results in the clinical syndrome known as acute KD.