[EXPERT REACTION] COVID-19 and the possible link with Kawasaki disease in children

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While there are no Kawasaki cases detected among children infected by COVID-19 in the country, some children who tested positive for COVID-19 in the UK, France, Italy, Spain, and the US have reported to display overlapping symptoms of severe COVID-19, toxic shock syndrome and Kawasaki disease. We asked experts to comment about the links between COVID-19 and Kawasaki disease, a multi-system inflammatory syndrome which primarily affects children under the age of five.


Associate Prof. Dr Chan Yoke Fun, Virologist & Senior Lecturer at the Department of Medical Microbiology, Faculty of Medicine, University of Malaya, said:

“We know very little about the COVID-19 epidemiology in children. Over 20 COVID-19 studies were reviewed in this paper. Clinical manifestations of children’s COVID-19 cases were generally less severe than those of adult patients, but children are just as susceptible to infection. Current data suggest a milder course of disease in young children, though some with radiological abnormalities. Children have a better prognosis than adults, and deaths were extremely rare. Children more often have gastrointestinal symptoms compared with adults. 

“Malaysia reported that 317 children under 12 were tested positive for COVID-19, with 112 under four years of age, while 22 were infants. So far no cases of Kawasaki disease syndrome have been recorded. Kawasaki disease is an acute febrile illness of unknown cause was discovered more than 60 years ago and affects mainly children younger than 5 years old. Read more about Kawasaki disease here: https://www.cdc.gov/kawasaki/index.html.

“Clinical signs include fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips, and throat. There had been some old studies on another coronavirus, NL63 which cause mild respiratory syndromes and showed that NL63 infection was not associated with Kawasaki syndrome. 

“Kawasaki disease has been reported in Italy, UK and USA recently amongst children with COVID-19 but remains rare. Prompt diagnosis and treatment will prevent heart problem. Early discovery and treatment usually allow patients to go on to lead a normal life. Intravenous immunoglobulin, aspirin and steroids have been used. A detailed treatment guideline is available here.”

Dato’ Dr Amar-Singh HSS, Senior Consultant Paediatrician, said:

“The classical non-COVID-19 Kawasaki disease is an uncommon disease that usually affects very young children. It a ‘vasculitis’ in that it affects the blood vessels in the body with inflammation. The biggest concern is aneurysms that develop in the coronary arteries (blood vessels supplying the heart muscle with oxygen). Kawasaki disease is usually diagnosed by a prolonged fever, a rash, lymph node enlargement, redness of the conjunctiva, red lips/tongue, swelling/redness of the hands/feet and coronary artery aneurysms.

“The first warnings came from the National Health Service of the UK at the end of April that described increasing numbers of very ill children with a ‘multi-system inflammatory state’. Now reports have appeared from other parts of Europe and the USA. All these children were either positive for COVID-19 or had serological markers (antibodies) to show that they had been infected. The overall numbers of children with this severe Kawasaki-like disease are still small (the risk of this happening in infected children is very small) but it is of concern.  It tells us that some very young children may be vulnerable to COVID-19 and stress the need for all of us to work together to limit its spread in any community. 

“We need to continue to maintain our focus on stopping COVID-19 spread by safe physical distancing, avoid touching faces, mask-wearing, preventing crowding, limit physical contact and talking, keep hands clean at all times, keep surfaces clean at all times. We also need to get a better idea of the risk of this severe Kawasaki-like disease (more data) before we consider opening our school, kindergartens, nurseries and child care centres.”

Disclaimer: These comments were complied to provide journalists with a range of expert perspectives on the subject. The views expressed here are the personal opinions of the experts. They do not necessarily reflect the views of the Science Media Centre or any other organisation unless specifically stated. 
Bionotes of experts

Datuk Dr Amar-Singh HSS is a senior Consultant Paediatrician. He is an individual member of the Malaysian Health Coalition. He has served at the Hospital Raja Permaisuri Bainun, Ipoh for more than 35 years prior to retiring as Head of the Paediatric Department and Head of the Clinical Research Centre Perak in 2018. During his tenure, he was responsible for Paediatric & Research services in the state of Perak. Dr Amar also sits as the Advisor of the National Early Childhood Intervention Council. He is a Senior Fellow of the Galen Centre for Health and Social Policy and a recipient of the Outstanding Asian Paediatrician Award 2012 as well as 2016 SENIA Advocacy Award. As a senior paediatrician, he has a long standing interest in health and development issues pertaining to children with disability and facing abuse, as well as disadvantaged & marginalised communities (particularly in the Orang Asli/Indigenous People). He often writes on the development of the health sector and has a series of editorials on these and other health issues in several Malaysian media outlets.

Associate Professor Dr Chan Yoke Fun is a virologist focused on the epidemiology and pathogenesis of enterovirus A71, an emerging virus that causes severe neurological disease. She leads a laboratory with research interests in epidemiology and pathogenesis of emerging viruses such as enterovirus A71, chikungunya, and respiratory viruses. With more than 20 years of research experience, she has over 80 publications, and has been involved in many research programs and grants at both national and international levels. Dr. Chan also served as an Associate Editor of BMC Infectious Diseases and guest editor in PLOS Neglected Tropical Diseases. She has multiple joint publications with collaborators from Asia, Europe, and the USA. Her studies have led to a better understanding of how viruses spread and infect humans. 

 **All previous posts about COVID-19 here: https://sciencemediacentremalaysia.com/tag/covid-19/

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