Did the COVID-19 pandemic change the Kawasaki disease phenotype? Observations from the International Kawasaki Disease Registry

Authors

• Geetha Raghuveer, Children's Mercy Hospital, University of Missouri Kansas City, Gillham Road, Kansas City, MO, 240164108, USA. graghuveer@cmh.edu.
• Milo Coffee, Children's Mercy Hospital, University of Missouri Kansas City, Gillham Road, Kansas City, MO, 240164108, USA.
• Nagib Dahdah, Division of Pediatric Cardiology, CHU Sainte-Justine, Universite de Montreal, Laval, QC, Canada.
• Ashraf S. Harahsheh, Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
• Audrey Dionne, Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
• Michael A. Portman, Seattle Children's Research Institute, Seattle, WA, USA.
• Todd T. Nowlen, Phoenix Children's, Phoenix, AZ, USA.
• Joseph J. Pagano, Department of Pediatrics, University of Alberta / Stollery Children's Hospital, Edmonton, AB, Canada.
• Megan Gunsaulus, Nationwide Children's Hospital, Columbus, OH, USA.
• Melissa Wehrmann, Children's Nebraska, Omaha, NE, USA.
• Seda Tierney, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
• Marianna Fabi, Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bolognachu, Bologna, Italy.
• Simon Lee, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
• Jacqueline Szmuszkovicz, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
• Sean M. Lang, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
• Deepika Thacker, Nemours Children's Health, Wilmington, DE, USA.
• Matthew D. Elias, Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
• Jane C. Burns, University of California, San Diego, CA, USA.
• Marco Antonio Yamazaki-Nakashimada, Instituto Nacional de Pediatria, Mexico City, Mexico.
• Kevin C
• Harris, BC Children's Hospital, Vancouver, BC, Canada.
• Supriya S. Jain, New York Medical College-Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA.
• Nina Butris, Department of Pediatrics, Research Institute, SickKids Hospital, University of Toronto, Toronto, ON, Canada.
• Cedric Manlhiot, Department of Pediatrics, Research Institute, SickKids Hospital, University of Toronto, Toronto, ON, Canada.
• Brian W. McCrindle, Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada.

Document Type

Journal Article

Publication Date

2-21-2026

Journal

Pediatric cardiology

DOI

10.1007/s00246-026-04201-7

Keywords

COVID-19; Cardiac; Children; Coronary artery aneurysm; Kawasaki Disease

Abstract

We sought to determine if the COVID-19 pandemic was associated with changes in Kawasaki disease (KD) phenotype and cardiac manifestations. Patients hospitalized with acute KD and enrolled into the International KD Registry were categorized into time periods based on admission date: during the pandemic (January 1, 2020 - September 30, 2022, 33 months) and after the pandemic (October 1, 2022 - September 30, 2025, 36 months). Only patients with verified KD diagnoses as per American Heart Association criteria with no evidence of preceding COVID-19 exposure were included. Demographics, clinical features, management, and cardiac manifestations were compared between time periods. From across 45 sites, 726 during pandemic and 813 after pandemic KD patients were included. During pandemic patients were younger (median 2.6 vs. 3.3 years; p < 0.001), more commonly had incomplete KD (15 vs. 9%; p < 0.001), were less likely to have cough (34 vs. 43%; p < 0.001) and sore throat (15 vs. 22%; p < 0.001), and there were no significant differences in immunomodulatory treatments received. Left ventricular ejection fraction was normal and maximal coronary artery Z scores (median, interquartile range 25-75%, 1.38 [0.77, 2.30] vs. 1.41[0.42, 2.37]; p = 0.08) were similar, including coronary artery aneurysm Z score categories. During the pandemic, KD patients were younger, more likely to present as incomplete KD, and less likely to have respiratory symptoms, with no differences in immunomodulatory treatments received. Cardiac manifestations were however similar. These findings suggest that the COVID-19 pandemic had minimal impact on KD phenotype especially cardiac manifestations.

APA Citation

Raghuveer, Geetha; Coffee, Milo; Dahdah, Nagib; Harahsheh, Ashraf S.; Dionne, Audrey; Portman, Michael A.; Nowlen, Todd T.; Pagano, Joseph J.; Gunsaulus, Megan; Wehrmann, Melissa; Tierney, Seda; Fabi, Marianna; Lee, Simon; Szmuszkovicz, Jacqueline; Lang, Sean M.; Thacker, Deepika; Elias, Matthew D.; Burns, Jane C.; Yamazaki-Nakashimada, Marco Antonio; C, Kevin; Harris; Jain, Supriya S.; Butris, Nina; Manlhiot, Cedric; and McCrindle, Brian W., "Did the COVID-19 pandemic change the Kawasaki disease phenotype? Observations from the International Kawasaki Disease Registry" (2026). GW Authored Works. Paper 8684.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8684

Department

Pediatrics