Climate Science to Solve Kawasaki Disease

Summary

In 2024, the Kawasaki Disease Research Center (KDRC) at the University of California San Diego (UCSD) and its partners committed to scaling research and data to enable better understanding of environmental triggers of Kawasaki Disease (KD) , working across six research countries where it is estimated that more than 88,000 children will be affected by the disease over the next three years. Discovering the environmental triggers for KD has the potential to accelerate the creation of algorithms to predict exposure, diagnostics, and new treatments. KD is a rare condition and the leading cause of acquired heart disease in children, but despite five decades of research, the cause remains unknown. Combining disease epidemiology with climate science, clinical medicine, aerosol science, and oceanography, KDRC and its partners will bridge clinical medicine and climate science to strengthen insights into environmental and climate-driven health consequences and inform solutions to strengthen prevention, diagnosis, and treatment.

Approach

The Kawasaki Disease Research Center (KDRC) at University of California San Diego (UCSD) and its partners commit to scaling research and data to enable better understanding of the causes and improved identification of Kawasaki Disease (KD) , working across four research countries where it is estimated that at least 88,000 children will be affected by the disease by 2027. Discovering the environmental trigger(s) for KD will accelerate creation of a diagnostic test, algorithms to predict exposure, and new treatments.

KDRC will combine earth observations and atmospheric modeling using historical, longitudinal datasets from Japan, Taiwan, South Korea, Indonesia, the Philippines, and the United States (U.S.) to identify source regions for the aerosols associated with clusters and quiet periods of Kawasaki disease cases.

Multiple lines of evidence support the hypothesis that the triggering agent of KD is a wind-borne aerosol. Atmospheric conditions relevant to aerosol transport can thus be used to identify moments of heightened risk for KD, even if the specific aerosol remains unidentified. The research team will characterize daily atmospheric conditions relevant to aerosol transport and relate them to KD incidence over the last two decades obtained from our collaborators in the four research countries that are hot spots for Kawasaki disease. For the U.S., KDRC will use data from the Pediatric Health Information Service. All of the earth observations necessary for these analyses are available from NASA’s Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2) product.

KRDC and its partners have the necessary expertise in epidemiology, climate science, and big data analysis to carry out the proposed plan. These analyses will include pinpointing source regions, and the nature of aerosols linked to spikes in numbers of children with Kawasaki disease. Identifying the source region and nature of the inhaled aerosols could lead to mitigation strategies that reduce production of the aerosol trigger(s) . We cannot change the intensity of the wind patterns that are accelerating with global warming, but we can impact what the wind carries.

Action Plan

KRDC and its partners are projecting a three-year time commitment to this project.

Year 1, Q1-2:
KRDC will work with collaborators across three countries in Asia to obtain updated datasets spanning two decades of KD cases that include date of onset, age at onset, and municipality of the patient’s primary residence.

Year 1, Q3-4.
KDRC will build models that predict peaks and quiet periods of KD incidence.

Year 2, Q1-4:
KDRC and collaborators will test and refine models that identify source regions for the aerosols associated with peaks in KD cases.
Data out of the Asia-based research countries will be analyzed to compare wind trajectories and source regions with extensive aerosol content databases maintained by the governments of each country to monitor pollutants, heavy metals, and other small molecules that are tracked by these systems.

Year 3, Q1-4:
KDRC will test these models in the United States using the patient-specific information from the administrative database (Pediatric Health Information Service) that encompasses the 48 free-standing children’s hospitals in the U.S. country and the extensive database maintained at the KDRC for San Diego County.

Background

Kawasaki disease (KD) is a pediatric vasculitis and the leading cause of acquired heart disease in children that first emerged in Japan after World War I (Pediatrics; AAP, 2000) . KD is now recognized world-wide with over 6,000 cases diagnosed each year in the U.S. (UCSD) . Although there is an effective treatment, there is no robust diagnostic test and the diagnosis is often delayed or missed. Without timely treatment, one in four children will suffer heart damage that may lead to heart attack and death. Despite five decades of research, the cause remains unknown. Work by the Kawasaki Disease Research Center (KDRC) at the University of California San Diego (UCSD) , using the Japanese dataset of >420,000 cases, has linked fluctuations in KD case numbers with atmospheric conditions including wind direction and speed suggesting an environmental trigger for this devastating disease. Until the environmental trigger(s) for KD are understood, infants and children will continue to suffer preventable heart damage due to delayed or missed diagnosis.

Progress Update

Partnership Opportunities

KDRC and its partners are seeking to unlock resources for this type of cross-discipline investigation. Combining disease epidemiology with climate science and team members from clinical medicine, aerosol science, and oceanography falls outside of the focus of most funding agencies. Additional resources can help support an interdisciplinary team to lead research and analysis and help scale this type of research that bridges clinical medicine with climate science to strengthen insights into environmental and climate-driven health consequences and inform solutions to improve diagnosis and treatment, and reduce future risks., KDRC and its partners are offering topic expertise to other organizations and interested groups, best practices for management of KD, and connection to researchers in geographies with a high burden of disease but limited research infrastructure. Notably, the models developed by KDRC and its partners for aerosol analysis, wind trajectories, and exposures to children on the ground, will be made available and can be applied to the study of respiratory conditions including infectious and immunologic diseases including asthma, bronchitis, and pneumonia that may be mediated or exacerbated by inhaled aerosols.