Background
COVID-19 substantially changed the epidemiology of Kawasaki disease (KD), with decreased incidence reported globally. We sought to determine its effect in Canada.
Methods
Pediatric admissions for KD (2004-2023) were identified through the Canadian Institute for Health Information. Clinical data for KD hospitalizations at the Hospital for Sick Children in Toronto (2016-June 2023) were manually reviewed.
Results
The incidence of KD was stable before the pandemic (22.5 cases/100,000 children aged 0-4 years/year, P = 0.19). There was a 30% reduction across all regions during the early pandemic period (2020-2021) (15.8 cases/100,000 children aged 0-4 years), with blunting of traditional winter peaks. In the summer of 2022, an atypical peak in the incidence of KD was observed, aligning with the Delta wave. Epidemiology returned to normal patterns in 2023-2024 (+7% vs prepandemic to 24.1 cases/100,000 children aged 0-4 years), with notable differences in Ontario and the Prairies. Patients diagnosed during the early pandemic were more likely to present with incomplete KD (odds ratio [OR] [95% confidence interval (CI)]: 4.84 [3.22-7.30], P = 0.008), respiratory symptoms (OR [95% CI]: 2.59 [1.70-7.30], P = 0.03), or abdominal symptoms (OR [95% CI]: 4.84 [3.15-7.44], P < 0.001). Those diagnosed in the late pandemic also presented with more incomplete KD (OR [95% CI]: 1.76 [1.16-2.66], P < 0.001), respiratory symptoms (OR [95% CI]: 1.70 [1.05-2.75], P < 0.001), or abdominal symptoms (OR [95% CI]: 2.53 [1.73-3.70], P < 0.001), albeit to a lesser extent, along with a shorter duration of fever before diagnosis (parameter estimate [95% CI]: −0.82 [−1.52; −0.12] days, P = 0.02) and higher odds of developing KD shock syndrome (OR [95% CI]: 4.66 [1.83-11.87], P = 0.001). Throughout the pandemic, odds of developing giant coronary aneurysms or admission to the intensive care unit remained similar.
Conclusions
The pandemic saw a substantial decrease in the incidence of KD with disrupted seasonality. Prepandemic epidemiologic patterns have returned. Patient presentations changed, but outcomes remained stable compared with the prepandemic period.
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