Kawasaki syndrome hospitalizations among children in Hawaii and Connecticut

OBJECTIVES: To estimate the incidence and describe recent trends of Kawasaki syndrome (KS) in 2 different areas of the United States. METHODS: Retrospective analysis of Hawaii and Connecticut State KS hospital discharge records for children younger than 5 years. RESULTS: In Hawaii, 175 KS hospitalizations for children younger than 5 years were reported during 1994 through 1997; the annual hospitalization rate per 100,000 children was 47.7. The rate for Hawaiian children younger than 1 year (83.2) was greater than that for 1- to 4-year-old children (39.0), and most hospitalizations occurred prior to age 2 years (median age, 17 months). In Connecticut, 171 KS hospitalizations for children younger than 5 years were reported during 1993 through 1996; the annual hospitalization rate per 100,000 children was 18.8, and the median age at hospitalization was 28 months. For both states, most hospitalizations were for boys. Although no clear seasonality was apparent, monthly peaks occurred in some of the years from December through March. CONCLUSIONS: Kawasaki syndrome seems to remain an endemic disease in the United States. A high KS annual hospitalization rate was seen in Hawaii, especially in children younger than 1 year, whereas in Connecticut, the KS rate was more consistent with those previously reported in the continental United States. Arch Pediatr Adolesc Med. 2000;154:804-808     

Kawasaki syndrome in Denmark

OBJECTIVE: To describe the epidemiologic characteristics of Kawasaki syndrome (KS) and to estimate national KS incidence rates among children in Denmark. METHODS: A retrospective population-based study using hospital discharge records with a KS diagnosis for children younger than 15 years selected from the Danish National Hospital Register for 1981-2004. Incidence rates were calculated using the number of KS patients and corresponding census data. RESULTS: During 1981-2004, 360 children younger than 15 years were hospitalized with KS in Denmark, with 73% younger than 5 years. In this age group, the average annual incidence of KS gradually increased from 1981 to 1999 and thereafter stabilized at 4.5 to 5.0 per 100,000 person-years. The incidence was greater for boys than for girls (RR = 1.6, 95% CI = 1.2-2.0) and was highest among infants younger than 1 year (4.5), declining with increasing age (P = 0.03). However, the age-specific decline in incidence was only observed for boys, whereas the incidence for girls remained unchanged by age. The median length of hospital stay was 12 days, and the incidence peaked in the winter months. CONCLUSIONS: Major epidemiologic characteristics identified among Danish childhood KS are consistent with those described in previous studies, such as highest incidence among young children and winter-seasonality. The KS incidence rate among children younger than 5 years in Denmark increased steadily during the early study period (coinciding with global recognition of KS) and seems to have stabilized from 1998-1999 onwards. Although the incidence among Danish children was lower than that reported for several other European countries, differences in methodology challenge definite comparisons.     

The incidence of Kawasaki syndrome in West Coast health maintenance organizations

BACKGROUND: Kawasaki syndrome (KS) causes an acute vasculitis of unknown etiology. It is a leading cause of acquired heart disease of children in Japan and the United States. METHODS: We examined the incidence of KS in a well-defined population group of children < or =6 years of age, using data collected through the Vaccine Safety Datalink (VSD) project. The VSD database contains information on >1 million children enrolled in four West Coast health maintenance organizations (HMOs). RESULTS: During 1993 through 1996 a total of 234 physician-diagnosed KS patients were reported in the 4 HMOs; 152 (65.0%) were boys and 195 (83.3%) were <5 years of age. The incidence of KS among children <5 years of age in the HMOs ranged from 9.0 to 19.1 per 100,000 person years. KS incidence was higher among boys in 3 of the sites. In the 2 sites with the highest number of KS patients, a seasonal occurrence of KS in winter and early spring was observed. Overall 226 (96.6%) of the KS patients were reported to have been hospitalized; hospitalization rates for children <5 years of age ranged from 9.0 to 16.8 per 100,000 person years. CONCLUSIONS: The incidence of KS in the HMOs was similar to that reported in other population-based studies in the United States and higher than estimates for Australia and several European countries.     

Severe bronchiolitis and respiratory syncytial virus among young children in Hawaii

BACKGROUND: Lower respiratory tract infections are a leading cause of hospitalization and mortality among children worldwide. Our objective was to describe the incidence and epidemiology of severe bronchiolitis, respiratory syncytial virus (RSV), and pneumonia among children in Hawaii. METHODS: Retrospective analysis of the patient-linked hospital discharge data associated with bronchiolitis, RSV, and pneumonia among Hawaii residents younger than 5 years of age during 1997 through 2004 using the Hawaii State Inpatient Database. RESULTS: During 1997 through 2004, the average annual incidence rates for bronchiolitis, RSV, and pneumonia were 3.8, 2.7, and 6.8 per 1000 children younger than 5 years, respectively. The incidence of each condition was higher for infants younger than 1 year (15.1, 9.8, and 15.9 per 1000 infants, respectively) than the incidence for children 1-4 years of age, and higher for boys compared with girls. The incidence of each condition was highest among Native Hawaiian and other Pacific Islander children compared with children of other race groups living in Hawaii. Most hospitalizations occurred during the months of October through February. Estimated median hospital charges were $4806 (bronchiolitis), $5465 (RSV) and $5240 (pneumonia), with overall average annual charges of $11.5 million. CONCLUSION: The incidence and hospitalization rates for bronchiolitis, RSV, and pneumonia among children younger than 5 years of age in Hawaii were low; the corresponding hospitalization rates were lower than those for the general U.S. population. However, the hospitalization rates for each condition among Hawaiian and other Pacific Islander children were much higher than those for other race groups or for the U.S. population.     

Kawasaki syndrome hospitalizations in Ireland, 1996 through 2000

OBJECTIVE: To describe the epidemiologic characteristics and estimate the incidence of Kawasaki syndrome (KS) among children in Ireland. METHODS: Hospital discharge records with a KS diagnosis among patients <18 years of age were examined using Ireland's Hospital In-Patient Enquiry database for 1996 through 2000. RESULTS: During the study period 265 hospitalizations associated with KS among children <18 years of age were recorded in Ireland. Of those, 194 (73%) occurred among children <5 years of age. The median age of patients at admission was 2 years. The average annual KS hospitalization rate for children <5 years of age was 15.2 per 100 000 children, and among that group the hospitalization rate was higher for infants <1 year of age than for children 1 to 4 years of age (19.7 and 16.0 per 100 000 children, respectively). Most KS hospitalizations occurred among children <5 years of age and among boys. The highest monthly number of hospitalizations occurred during the months of November through January. No deaths associated with KS were reported among hospitalized children. CONCLUSION: Hospital discharge data provide useful information on the epidemiology of KS in Ireland. The hospitalization rate for KS in Ireland is similar to rates in the United States and may be higher than those in other European countries, although the European studies differ in methodologies and time periods.     

Population-based incidence of infection with selected bacterial enteric pathogens in children younger than five years of age, 1996-1998

BACKGROUND: Previous studies of bacterial enteric infections have suggested a disproportionate disease burden for children younger than 5 years of age. OBJECTIVES: This study describes population-based incidence of culture-confirmed infections with 6 bacterial enteric pathogens in children younger than 5 years of age in the Foodborne Diseases Active Surveillance Network (FoodNet), 1996-1998. METHODS: Cases were ascertained through active laboratory-based surveillance in Minnesota, Oregon and selected counties in California, Connecticut, Georgia, Maryland and New York. RESULTS: Twenty-one percent (5218 of 24,358) of infections were in children younger than 5 years of age, but this age group made up only 7% of the total person-years of observation. Among those younger than 5 years of age, the incidence (cases per 100,000 person-years) for each pathogen was: Salmonella, 55.3; Campylobacter, 43.4; Shigella, 32.7; E. coli O157, 10.3; Yersinia enterocolitica, 7.1; Listeria monocytogenes, 0.7. Incidence varied widely among the 7 FoodNet sites. CONCLUSIONS: This study confirmed a disproportionate disease burden in young children. Investigation of risk factors specific to this age group and review and enhancement of current prevention and control strategies for children younger than 5 years of age may reduce illness.     

Rheumatic fever in children and adolescents in Hawaii

Case records of hospitalized children (age 4 to 18 years) with acute rheumatic fever on Oahu, HI, were reviewed for the 4-year period from Oct 1, 1980, to Sept 30, 1984. Ninety-eight cases met the modified Jones criteria. The overall incidence of rheumatic fever was 13.4 hospitalized children per 100,000 children per year and that for recurrent attacks was 2.5. Of the 98 with rheumatic fever, 73 had polyarthritis, 33 had carditis, and ten had chorea. Polynesian/part-Polynesian children accounted for 76 of the 98 cases. The incidence of rheumatic fever in Hawaiian/part-Hawaiian was 18.0 and for Samoan children was 206 hospitalized children per 100,000 per year. The relative risks were 7.7 and 88 times that of the white children, respectively. Rheumatic fever continues to cause significant morbidity in children in Hawaii, especially in Polynesian children.     

Population-based surveillance for childhood invasive pneumococcal disease in the era of conjugate vaccine

BACKGROUND: Heptavalent pneumococcal conjugate vaccine was licensed in the United States in February 2000 and, following national guidelines, universally distributed in Massachusetts starting in July 2000 to children younger than 2 years of age and selected children 2-5 years of age. We performed statewide surveillance for all cases of invasive pneumococcal disease (IPD) in children younger than 18 years of age to determine risk features and contribution of vaccine failure to ongoing pneumococcal invasive disease. METHODS: Massachusetts pediatric IPD cases were identified via enhanced passive surveillance of microbiology laboratory reports of pneumococcal isolates from sterile body sites of children younger than 18 years for 2 years starting in October 2001. Serotyping was performed on isolates of Streptococcus pneumoniae from normally sterile body fluid. Case demographic and clinical data (including dates of prior doses of PCV7) were collected via follow-up telephone interviews with case primary care providers and/or parents. RESULTS: Between October 1, 2001 and September 30, 2003, 191 cases of IPD were identified statewide (138 in children younger than 5 years). Annual incidence rate for IPD was 17.4 per 100,000 children younger than 5 years, representing a decline of 69% when compared with annual incidence rate of 56.9 per 100,000 from Massachusetts statewide active surveillance performed 1990-1991. In 2001-2003, 30% of cases occurred in the first year of life (36.5 per 100,000), representing a 7.8-fold increased risk compared with children older than 1 year of age. Race-specific annual incidence rates in blacks and Hispanics were 2.3-fold (95% confidence interval, 1.21-4.42) and 1.9-fold (95% confidence interval, 1.06-3.37), greater than in whites. Fifty-nine cases were reported to have underlying comorbid conditions. Serotyping was available for 136 of 191 (71%) cases younger than 18 years; of isolates available for serotyping, 40 (29%) were vaccine serotype (ST), 31 (23%) vaccine-related ST and 65 (48%) nonvaccine ST. Seven of 40 cases with IPD caused by vaccine ST received at least 3 doses of PCV7 vaccine before IPD. CONCLUSIONS: Universal administration of PCV7 to children younger than 2 years of age and selective administration to children 2-5 years of age has resulted in a significant decline in IPD in Massachusetts. Children younger than 1 year of age, African American and Hispanic children and those with recognized comorbid illnesses (malignancy, human immunodeficiency virus, immune deficiency, nephrotic syndrome, etc.) continue to remain at risk for IPD. These risk features should be considered when evaluating febrile infants and children.     

Kawasaki syndrome among American Indian and Alaska Native children, 1980 through 1995.

BACKGROUND: Kawasaki syndrome (KS) is a leading cause of acquired heart disease among US children, but the epidemiologic features of KS among American Indian and Alaska Native (AI/AN) children have not been described. METHODS: We examined Indian Health Service computerized records of hospital discharges for AI/AN children <18 years of age with KS during 1980 through 1995. RESULTS: During 1980 through 1995, 85 AI/AN children were reported with a hospitalization for KS; 10 of the children had an additional KS hospitalization record within 5 months. The average annual KS hospitalization rate for children <5 years of age, based on first KS hospitalization only, was 4.3 cases per 100000 children; the rate for children age <1 year (n = 21) was 8.6 per 100000 and for children ages 1 to 4 years was 3.6 per 100000. The annual rates for children < 5 years of age ranged from 0 to 8.5 per 100000 children. KS hospitalizations for children peaked in January and February; 50.6% of the children were hospitalized during January through April. The overall median length of hospital stay was 4 days (range, 1 to 29 days); the median duration decreased from 8 days from 1980 through 1982 to 4 days from 1993 through 1995. CONCLUSIONS: The overall annual hospitalization rate of KS among AI/AN children <5 years of age was slightly lower than rates for several majority white populations in the United States. (4.6 to 15.2 cases per 100000) and much lower than rates for blacks and Asians/Pacific Islanders.     

Kawasaki syndrome clusters in Harris County, Texas, and eastern North Carolina. A high endemic rate and a new environmental risk factor

Sixty-one cases of Kawasaki syndrome (KS) occurred in Harris County, Texas, during the three-year period from January 1982 through December 1984. Fifty-five (90%) of these 61 patients were under 5 years old, for an annual endemic rate in children under 5 years old of 9.1 cases per 100,000 per year. To our knowledge this is the highest endemic rate reported to date in the continental United States. Between Aug 26 and Sept 19, 1984, seven children with KS were hospitalized in Harris County. The seven children were between 5 months and 5 years old. The number of cases in this cluster was unusual for late summer, which is generally a low-incidence season for KS in Harris County. More important, a case-control study of these children revealed that they resided significantly closer to a bayou or drainage ditch than did randomly selected matched control subjects. A similar association with drainage ditches or creeks was observed in a subsequent cluster of 13 cases of KS in seven eastern North Carolina counties. To our knowledge, this is the first report of a possible association between KS and residing near water.     

Hemolytic uremic syndrome epidemiology: a population-based study in King County, Washington, 1971 to 1980

We conducted a retrospective, population-based study of the hemolytic uremic syndrome of childhood in King County, Washington. The average annual incidence of hemolytic uremic syndrome between 1971 and 1980, inclusive, was 1.16 cases per 100,000 children younger than 15 years of age and increased during the decade and into the early 1980s. The highest annual incidence was in children less than 3 years of age (3.02 per 100,000 children) and was equal in black and white children. No demographic risk factors were associated with the incidence of this disease including population density, median family income, crowding in housing units, percentage of households with public water supply, and percentage of households with public sewers. Our data suggest that this disease is common, endemic, and increasing in incidence in King County, Washington.     

Incidence of symptomatic vitamin D deficiency

A survey of West Midlands paediatricians in 2001 identified 24 cases of symptomatic vitamin D deficiency in children less than 5 years of age. The overall incidence was 7.5 per 100,000 children per year with notable differences in incidence per ethnic group.     

Epidemiology of invasive Kingella kingae infections in 2 distinct pediatric populations cohabiting in one geographic area

The annual incidence of invasive Kingella kingae infection in children younger than 4 years of age was significantly higher in westernized Jews than in indigent Bedouins living side by side in southern Israel (12.21/100,000 and 5.83/100,000, respectively, (P < 0.05). One K. kingae clone was overrepresented among isolates from Jewish children, suggesting that differences in bacterial pathogenicity may contribute to the morbidity excess detected in this population group.     

Incidence of symptomatic vitamin D deficiency.

A survey of West Midlands paediatricians in 2001 identified 24 cases of symptomatic vitamin D deficiency in children less than 5 years of age. The overall incidence was 7.5 per 100,000 children per year with notable differences in incidence per ethnic group.     

Incidence of invasive pneumococcal disease in Sydney children, 1991-96

OBJECTIVE: Few data are available on invasive disease due to Streptococcus pneumoniae in representative Australian childhood populations. This study aimed to determine the age-specific incidence of invasive pneumococcal disease in Sydney children. METHODOLOGY: Population-based prospective study where isolates of Streptococcus pneumoniae from normally sterile sites were identified through an established laboratory surveillance network. Isolates came from children aged under 15 years living within the boundaries of Central, Eastern. Southern, Western and South-western Sydney Area Health Services from 1 July 1991 to 30 June 1996. RESULTS: Invasive pneumococcal disease was identified in 320 children during a 5-year period, of whom 193 (60%) were under 2 years of age. The incidence per 100,000 children was 12.7 per 100,000 (95% CI: 11.4-14.2/100,000) under 15 years; 31.7 (95% CI 28.1-35.7) under 5 years, and 45.5 (95% CI 38.9-53.3) under 2 years. The incidence of pneumococcal meningitis in children aged under 2 years was 10.5 per 100,000 (95% CI: 7.4-14.5/100,000). CONCLUSIONS: The incidence of childhood invasive pneumococcal disease in Sydney was stable during 1991-96 and comparable to rates reported from other industrialized countries. There was no evidence of any change in pneumococcal disease incidence with reduction in invasive Haemophilus influenzae type b (Hib) disease following introduction of Hib immunization.     

1997～2001年四川省川崎病流行病学调查

目的了解四川省川崎病(KD)的发病率和流行病学特点。方法按日本川崎病研究中心提供的川崎病诊断标准、问卷表格和调查方法,对四川省内设有儿科病床的医院进行问卷调查。收集1997年1月1日～2001 年12月31日的川崎病患儿住院资料。结果调查全省212所医院,调查表回收率达到91．5％,全省共报告了KD 患儿1811例,符合川崎病诊断标准1511例。1997～2001年<5岁儿童患病率分别为4．26／10万、5．21／10万、8．57／ 10万、7．70／10万、9．81／10万,5年平均发病率为7．06％。男女之比为1．66:1,发病高峰为1～2岁,17．0％的川崎病患儿有心脏冠脉损伤。典型病例占94．6％,使用静脉丙种球蛋白(IVIG)治疗者占70．9％。结论 1997～2001年四川省5年川崎病的发病率低于日本,与国内其他地区KD流行病学资料相比,发病率高于江苏、陕西和广东,低于北京,有逐年增高趋势。     

Resurgence of pertussis in Europe

BACKGROUND: A resurgence of pertussis has been observed in Canada, the United States and Australia since the 1980s, but inconsistent data are currently available for Europe. The objective of this paper is to describe the epidemiology of pertussis in Western European countries to discuss future vaccination strategies. METHODS: The European Community funded a network for the epidemiologic surveillance of measles and pertussis in 1998. Sixteen European countries provided national surveillance data for pertussis for the period 1998-2002 in a standard format. Data were pooled and analyzed to describe incidence rates by age group, seasonality, proportion of hospitalized patients and deaths among notified cases. RESULTS: Children younger than 1 year had the highest incidence during the entire period. Rates in the older than 14 years age group increased by 115% during the study period. Northern countries showed the highest incidence figures in all age groups. Among children younger than 1 year, 70% were admitted into hospital. Children younger than 6 months of age and those not vaccinated were most likely to be hospitalized. Thirty-two deaths were reported, 87% of which were in children younger than 6 months of age. CONCLUSIONS: Pertussis is far from being controlled in Europe. Whereas the incidence in children younger than 1 year was high but remained stable, rates in adults doubled in 5 years.     

Pediatric hospitalizations for bicycle-related injuries.

OBJECTIVES: To determine the incidence of bicycle-related injury hospitalizations among children and adolescents 20 years of age and younger and to examine the associated use of healthcare resources. DESIGN: Nationally representative data from the 2003 Healthcare Cost and Utilization Project's Kids' Inpatient Database (KID). OUTCOME MEASURES: National estimates of hospitalization for bicycle-related injuries according to patient demographics, type of injury, total hospital charges, and length of hospital stay. RESULTS: In 2003, an estimated 10,700 children were hospitalized for a bicycle-related injury in the USA. Inpatient charges totaled nearly $200 million with a mean charge of $18,654 per hospitalization. The national rate was 12.7 hospitalizations per 100,000 children. Young adolescents aged 10-13 years accounted for the highest percentage of cases (36.6%) followed by children aged 6-9 years (25.1%). Most patients were male (76.7%) and resided in an urban area (94.4%). A head injury was diagnosed in one out of three hospitalized bicyclists; 30% were due to a motor vehicle collision. CONCLUSIONS: Pediatric bicycle-related hospitalizations are a significant public health problem. The morbidity and mortality among children and the economic costs to society are large. The patient characteristics and injury types identified by this study should be used to develop targeted prevention strategies.     

Epidemiology of childhood type I diabetes in Crete, 1990-2001

AIM: To study the epidemiological patterns of childhood-onset type I diabetes in Crete, Greece. METHODS: The incidence (new cases per 100,000 per year) from 1990 to 2001 was determined in the population of Crete < or = 14 y of age. RESULTS: A total of 89 cases was ascertained. The standardized annual incidence rate was 6.1 per 100,000 population [95% confidence interval (95% CI) 4.9-7.5]. Incidence rates were higher in children 10-14 y of age, boys and residents of urban areas (6.8, 6.7 and 6.6 per 100,000, respectively). Incidence rates were higher [relative risk (RR) 1.46, 95% CI 0.956-2.24] during the 6 y period 1996-2001 (7.2, 95% CI 5.4-9.4) than during the 6 y period 1990-1995 (4.9, 95% CI 3.4-6.9). This increase was more prominent in residents of urban areas and 10-14-y-old children. CONCLUSIONS: Although an increase was noted during the period 1990-2001, the childhood type I diabetes incidence rates in Crete remain among the lowest both in Europe and in the Mediterranean islands.     

Elimination of racial differences in invasive pneumococcal disease in young children after introduction of the conjugate pneumococcal vaccine

BACKGROUND: Racial differences in the epidemiology of invasive pneumococcal disease (IPD) have been widely recognized, but the impact of conjugate pneumococcal vaccine (PCV) introduction in 2000 on these differences has not been extensively studied. METHODS: IPD episodes in 5 Tennessee counties from January 1995 through December 2002 were collected prospectively using the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance system (ABCs). Trained nurses collected clinical data, and antibiotic susceptibility testing was performed on available isolates. RESULTS: Before vaccine licensure, IPD rates were highest in children younger than 2 years and in blacks. The disparity in IPD rates between blacks and whites younger than 2 years of age substantially diminished after PCV introduction. In 1999, the IPD rate in black children younger than 2 years was 340.2 per 100,000, representing 176.5 more events per 100,000 than in white children (P < 0.001). In 2002, this rate had decreased 83% to 57.4 per 100,000, similar to the rate in white children (39.6 per 100,000; P = 0.31). Before vaccine licensure, a higher percentage of isolates from whites were antibiotic-nonsusceptible. In 2002, the proportion of antibiotic-nonsusceptible pneumococcal isolates was similar in whites and blacks of all ages for the first time during the study period (P > 0.05 for separate comparisons of penicillin, cephalosporin and erythromycin nonsusceptibility). These changes occurred despite a lower PCV vaccination coverage in Tennessee in blacks than in whites (31.2% versus 47.6%). CONCLUSIONS: With conjugate pneumococcal vaccine introduction in Tennessee, racial differences in the incidence rates of IPD have largely been eliminated, particularly in young children.