Kawasaki Syndrome: Description of Two Outbreaks in the United States

Investigation of two outbreaks of Kawasaki syndrome (KS) in the United States in 1979 and in 1980 revealed no evidence of person-to-person transmission or of a common-source exposure among patients. Questionnaire data showed that KS was more likely to occur in children of middle and upper socioeconomic status than in those of lower status (P<0.05 and P<0.001 for the respective outbreaks) and that patients with KS had a higher incidence of an antecedent, primarily respiratory illness than did controls matched for age, sex, and race (83 per cent of patients in the first outbreak vs. 30 per cent of one control group, P<0.01, and vs. 36 per cent of another control group, P<0.02; and 56 per cent of patients in the second outbreak vs. 32 per cent of their controls, P<0.02). However, laboratory studies did not identify an etiologic agent for either KS or for the antecedent illness that may be a risk factor for KS. (N Engl J Med. 1981; 304:1568–75.) KAWASAKI syndrome (KS; also known as Kawasaki disease and mucocutaneous lymph-node syndrome) is a febrile illness of unknown origin that occurs predominantly in children under five years of age. Features of the syndrome, described first in Japan by Tomisaku Kawasaki in 1967,^1,2 include prolonged fever, conjunctival injection, oropharyngeal inflammation, peripheral changes on extremities (edema, erythema, or desquamation), rash, and lymphadenopathy. Coronary-artery aneurysms have been present in 17 to 31 per cent of cases,^{3 4 5} with an overall case-fatality ratio of 0.5 to 2.8 per cent.^2,3,6 KS appears to be most prevalent in Japan, where more than 18,000 cases were reported between.