Kawasaki Disease & COVID-19 FAQ’s

Transcription of Kawasaki Disease and COVID-19 FAQ video

Recorded 07, May 2020 between Beth Avant (BA) and Adriana Tremoulet, MD (AT).

Beth Avant: Hi, I’m Beth Avant. I am a Kawasaki Disease parent and also a KD Foundation volunteer. I’m here today with Dr. Adriana Tremoulet. She’s the Associate Director of the Kawasaki Disease Research Center at UC San Diego, and she has been nice enough to answer some of these questions that all of us parents have. Hi, Dr. Tremoulet.

Dr. Adriana Tremoulet: Hi, Beth. Thank you so much for having a chance to sit down and chat.

BA: Thank you so much for chatting with us. Okay, so we have a bunch of questions that some of the parents have asked that I’d just like to go through. The first one being, really is this Kawasaki Disease? Is this Kawasaki Disease that we are seeing in the news? Is this COVID-19? What is this? Is it just mimicking it, or is it actually KD?

AT: Yeah, some excellent questions. So, we have been hearing about two different things that are happening; the first is that in areas of the world that have been hardest hit by the COVID-19 pandemic, there appear to be an increased number of cases of classic Kawasaki Disease. So, the bread and butter that all of us know of, and they seem to present with classic signs of KD. That’s the first piece of this. The second thing that‘s been seen is what is now being called PIMS, which is Pediatric Inflammatory Multiorgan Syndrome, and this is a disease that gratefully is only in a small number of children, but children are presenting very ill. They are presenting in shock to their local hospitals. Again, this is in heavily affected areas where the COVID-19 pandemic has really been present. And then these kids, in addition to the — to how they’re presenting, they also have fever, and then they have some signs that are consistent with Kawasaki Disease. So, they’ve got some red eyes, some have had rash in about 60% of the kids, abdominal pain in about another, you know, 60% as well, some swelling of the hands and feet in a fewer number of those. So, it — it does raise some concern that this is somehow linked to KD, although that exact linkage still has to be figured out.

BA: Have you seen any groups that the PIMS disorder has most affected?

AT: That’s a very interesting question. The most data that we have is actually out of London, where there are 37 cases that have been reported thus far, as of last week, and a fair number of those children are actually of African and Afro-Caribbean descent. So, that raises the question of whether this inflammatory process is somehow genetically linked. Is there a genetic predisposition in African and Afro-Caribbean children that then makes them more susceptible to the inflammatory response the body has to the trigger, which could be SARS COV-2? So, that definitely needs to be further studied, and we need to understand why that group is having such a — much higher attack rate than we would expect given the number of African and Afro-Caribbean children in the London area.

BA: So, do you think—are adults or older kids that have had KD in the past more susceptible to picking up COVID-19?

AT: So, we actually don’t have that thought, and specifically in regards to what’s going on. So, in terms of COVID-19, this is a viral illness that seems to — you know, that does effect certain populations more than others, but in terms of Kawasaki Disease — so KD is a disease where you have the genetic predisposition for getting the illness and you have to come into contact with a trigger. And it’s very likely that there are multiple triggers for Kawasaki Disease. So, if you had KD in the past, especially before COVID-19 pandemic hit, it’s most likely that the trigger — if, in fact, coronaviruses are at all associated with KD — it’s very likely that the current COVID-19 pandemic and SARS COV-2 infection was not what triggered your Kawasaki Disease. So, we really don’t have any reason to believe that the current circulating virus of SARS COV-2— that that —anybody that’s had KD in the past would have a higher chance of getting COVID-19 illness.

BA: Have you guys been — have you guys ruled out corona viruses in general from being a trigger for KD?

AT: Yeah, so coronaviruses have been evaluated in Kawasaki Disease a — a few times they’ve been considered as a possible trigger. You know, several years ago, there was a thought that coronaviruses were the trigger for KD. Our group actually here at UC San Diego at the KD Research Center, in fact found that at the time that coronaviruses were not associated with KD. In part because the way that that study had initially been done. It didn’t have the right group of children without Kawasaki Disease as a control. So, you know, coronaviruses have come up like all other sorts of viruses as possible triggers for KD, and here they are once again.

BA: Do you think that as a KD parent we should take extra precautions for our children at this time?

AT: Yeah, again, given the genetic predisposition for KD, and the fact that the majority of our families that we care for probably had a very different trigger than SARS COV-2, I really don’t think that there’s anything different that needs to be done at this time. So, really gratefully children are at low risk of even being infected with COVID-19 illness, and the new PIMS disease that’s being seen is gratefully rare. So, at this point, we have no reason to believe that parents in general, and specifically those with children that have had KD, should take any specific measures.

BA: So, these kids that are showing these symptoms that are being diagnosed with COVID-19, they’re —they did not have Kawasaki Disease to begin with, correct? Or they haven’t had it in the past?

AT: Yeah, so it’s a couple things to distinguish there. So, first of all, not all the children that have had this Pediatric Inflammatory Multiorgan Syndrome actually have tested positive for COVID-19. So, some have been positive by the PCR in the nose; others have been positive in the antibodies in the blood; and then some, even though they’re presenting exactly like the kids that were positive for COVID-19 illness, or at least shown exposure to the COVID-19 illness, have actually been negative for any signs of SARS COV-2 infection. So, that’s the first piece that’s really interesting is that it’s certainly timely in how this is showing up, and some of the kids appear to be infected with SARS COV-2, but not everybody. Then again, in terms of the KD patients, we don’t see any reason to believe that our past KD patients would be at any increased risk of this Pediatric Inflammatory disorder that‘s being seen.

BA: Okay. One parent wrote in that their child was diagnosed and treated in January for Kawasaki Disease. They said that they did test for coronavirus at the time, but it came back negative. Is there any chance that that could have been a false Kawasaki Disease diagnosis?

AT: Yeah, so we too have been testing our KD patients and, you know, Kawasaki Disease has peaks and valleys throughout the year. We see it all year long. And, you know, our patients have also been negative by the nasal swab, in terms of the PCR. I think part of the question is getting to could it be that that child actually had COVID-19 at some point, but then tested negative by the nasal swab? And while that possibility exists, we still have to show that. In — it is possible that children that have had Kawasaki Disease since the start of the pandemic have had exposure to a family member that’s been sick, and therefore maybe they also developed antibodies, but it’s possible that they did not actually have the virus itself in their nose, so the PCR test would have been negative.

BA: And what about a child that was diagnosed and treated with IVIG? Did that — does that have any impact on the COVID-19 test results?

AT: Yeah, so the antibody test, because it is, in fact, something that’s contained in IVIG — because that’s what IVIG is, it’s, you know, it’s a big bag of wonderful antibodies to fight inflammation — the — the IVIG that we’re using now, and that we’ve been using since the beginning of the year, was IVIG that was processed and collected before SARS COV-2 was actually circulating in the population. So, we don’t think that IVIG contains the antibodies specifically for SARS COV-2. It may have antibodies to other coronaviruses, but specifically to SARS COV-2, we don’t think that there are antibodies in there. But, you know, that has yet to be shown. So, it — it does put a little wrinkle in the fact that if we wanted to test our patients after they got IVIG and they were antibody positive, the question is, was that child positive because he’d been exposed to COVID-19, or maybe there was something in that IVIG? I’m not quite sure that there was enough SARS COV-2 circulating last year whereby the IVIG that our children get would be positive by antibody. But again, another thing we have to probably study.

BA: I know. And I know that this is all so new and it’s just really popping up, but one — another parent said that — that COVID-19 might not be the trigger for KD, but for KD survivors, have you done any testing yet, or are you planning on doing any testing with a child who’s contracted — who’s had COVID-19 — but also had KD in the past? So, KD are more of a preexisting condition? And are you seeing any outcomes that are different?

AT: Yeah, so that has not been evaluated yet. I’m sure that, you know, as we get information from around the country and the globe that there will be children who had KD in the past who have just happened to have also had COVID-19 illness now. I’m sure that that will be the case. There currently isn’t any investigation of those kids, but not that there couldn’t be in the future as we learn more about this disease.

BA: So, now if any of us parents who had —have a KD kid come down with COVID-19, what do you suggest we do? When should we reach out to you guys directly for any sort of additional studies or information?

AT: Yeah, so we are rapidly working on a number of studies to better understand what is going on. First of all, to just even know the number of increased cases of KD that are affecting our cities that are most affected by COVID-19, as well as putting in place our Kawasaki Disease Research Center at UCSD and Rady Children’s Hospital is working in — in putting in place a system to be able to collect serum and plasma and even check antibodies —not only in the children, but even the parents of some of our children that have been recently affected by KD. Where I would suggest that people go is our website at UCSD, which is constantly now being updated. That’s where we’re going to be posting anything new that’s going on in terms of our studies and in terms of study recruitment. So, we just ask that people stay in touch and they stay updated on what we’re doing. And as well as anything that’s going on, we’ll be certainly also posting with the KD Foundation so that we can kind of keep people updated. And we‘re forever grateful to our KD families for their willingness to participate in any study that goes on, so we will certainly be reaching out to our KD families on that when we’re ready for that.

BA: Right, we’re always happy to help. And, as a KD parent, we all know that the biggest issue is the unknown about Kawasaki Disease. My son had it about 15 and a half years ago, so that was really unknown at that point, and basically before Google or before Facebook. So, I just want to ask, what — as a KD parent — what can we do to help you guys out?

AT: Yeah. That is a super important question at this time. You know, it’s very sad what is happening in those rare cases of those children with this inflammatory disorder. But I think it gives us a — a very unique opportunity that we really have to really capitalize on, which is that we as a KD community need to inform the world about what Kawasaki Disease is. So, even if it’s just posting photos, a link to the KD Foundation, the signs and symptoms, I think that that is a huge service to the world and — and hopefully it will reduce the misdiagnosis that happens in this disease. I — I see nothing but good coming out from this in terms of what we’re going to learn, not only about this rare inflammatory disorder and its possible association with Kawasaki Disease, but even just about run of the mill classic KD. I — I mean, I — I think that now that phrase is on everybody’s lips, and I’m glad to see that it’s there. So, I ask all of our families to find their voice, to find that platform and to get out the word about what KD is because we have such a great unique opportunity that we cannot miss.

BA: Great. Thank you so much for taking the time to talk to us today.

AT: Thank you so much and wishing everybody peace and health, and wishing everybody the very best.