Clustering and climate associations of Kawasaki Disease in San Diego County suggest environmental triggers

• Published in: Scientific reports Vol. 8; no. 1; pp. 16140 - 9
• Main Authors: Rypdal, Martin, Rypdal, Veronika, Burney, Jennifer A., Cayan, Daniel, Bainto, Emelia, Skochko, Shannon, Tremoulet, Adriana H., Creamean, Jessie, Shimizu, Chisato, Kim, Jihoon, Burns, Jane C.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 12-11-2018; Nature Publishing Group; Nature Research
• Subjects: 38; 38/39; 631/250; 692/308/3187; 704/106/35/823; 704/172/4081; Air temperature; Atmospheric circulation; California - epidemiology; Cardiology: 771; Cardiovascular diseases; Children; Climate; Clinical medical disciplines: 750; Cluster Analysis; Coronary artery disease; Data processing; Environmental factors; Environmental Monitoring; Etiology; Gene expression; Heart diseases; Humanities and Social Sciences; Humans; Incidence; Kardiologi: 771; Kawasaki disease; Klinisk medisinske fag: 750; Medical disciplines: 700; Medisinske Fag: 700; Monte Carlo Method; Mucocutaneous lymph node syndrome; Mucocutaneous Lymph Node Syndrome - epidemiology; multidisciplinary; Prospective Studies; Science; Science (multidisciplinary); Seasonal variations; Temperature; VDP; Weather; California; Spatio-temporal Clustering; Secondary Season; Pediatric Acquired Heart Disease; Environmental Triggers; Kawasaki Disease
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-018-33124-4

Kawasaki Disease (KD) is the most common cause of pediatric acquired heart disease, but its etiology remains unknown. We examined 1164 cases of KD treated at a regional children’s hospital in San Diego over a period of 15 years and uncovered novel structure to disease incidence. KD cases showed a well-defined seasonal variability, but also clustered temporally at much shorter time scales (days to weeks), and spatiotemporally on time scales of up to 10 days and spatial scales of 10–100 km. Temporal clusters of KD cases were associated with strongly significant regional-scale air temperature anomalies and consistent larger-scale atmospheric circulation patterns. Gene expression analysis further revealed a natural partitioning of KD patients into distinct groups based on their gene expression pattern, and that the different groups were associated with certain clinical characteristics that also exhibit temporal autocorrelation. Our data suggest that one or more environmental triggers exist, and that episodic exposures are modulated at least in part by regional weather conditions. We propose that characterization of the environmental factors that trigger KD in genetically susceptible children should focus on aerosols inhaled by patients who share common disease characteristics.