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Kawasaki Disease in Germany: A Prospective, Population-based Study Adjusted for Underreporting
André Jakob1, Jane Whelan, Matthaeus Kordecki
1From the *Department of Congenital Heart Defects, Heart Center University of Freiburg, Freiburg, Germany; †Novartis Pharma BV, Amsterdam, The Netherlands; ‡Clinic and Polyclinic for Pediatrics and Adolescent Medicine, University Children's Hospital, Technische Universität Dresden, Dresden, Germany; §Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany; ¶Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian's University Munich, München, Germany; and ‖Section of Pediatric Infectious Diseases and Rheumatology, Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
Accurate Kawasaki disease (KD) incidence requires including incomplete cases. Infants under one year with incomplete KD face higher coronary aneurysm risks, highlighting the need for improved surveillance and diagnostics.
Area of Science:
- Pediatrics
- Epidemiology
- Infectious Diseases
Background:
- National Kawasaki disease (KD) incidence estimates often exclude incomplete cases.
- Retrospective registries and case reports contribute to underreporting issues in KD surveillance.
Purpose of the Study:
- To determine the incidence of KD in children under 5 years in Germany.
- To assess underreporting in the German Pediatric Surveillance Unit (ESPED).
- To analyze characteristics of complete versus incomplete KD cases.
Main Methods:
- Prospective nationwide KD surveillance study using the German Pediatric Surveillance Unit (ESPED).
- Capture-recapture methodology applied in two federal states using hospital discharge records (ICD-10 code M30.3).
- KD diagnosis (complete and incomplete) based on American Heart Association criteria (2004).
Main Results:
- Corrected KD incidence was 7.2 per 100,000 children under 5.
- Underreporting to ESPED was estimated at 37%-44%.
- Incomplete cases (20%) were younger and had significantly higher rates of coronary aneurysms (43% vs. 11%).
Conclusions:
- A significant proportion of KD cases were diagnosed using laboratory or echocardiographic criteria alone, especially in infants.
- Infants under 1 year with incomplete KD showed increased risk for coronary aneurysms.
- High underreporting rates necessitate improved surveillance strategies and diagnostic tools for Kawasaki disease.
