Epidemiology of Kawasaki disease in Chandigarh, India (2020-2024): COVID-19 pandemic-related decline and post-pandemic resurgence.

BACKGROUND

Kawasaki disease is the leading cause of acquired heart disease in children worldwide. Previous studies from Chandigarh, India, documented a rising incidence until 2019. The COVID-19 pandemic, with its infection-control measures and emergence of multisystem inflammatory syndrome in children, disrupted established epidemiological trends. We aimed to evaluate the impact of the pandemic on incidence, clinical features, and coronary outcomes in children with Kawasaki disease in the Union Territory of Chandigarh.

METHODS

This study was conducted at the tertiary care teaching institute in North-West India, from January 2020 to December 2024. Demographic, clinical, laboratory, and echocardiographic data were collected. Population estimates were derived from national census projections, and annual incidence rates were calculated for children <5 years and <15 years. Temporal and seasonal trends were analysed using regression models and Chow tests.

FINDINGS: A total of 442 children with Kawasaki disease were diagnosed during the study period-of these, 60 (median age 40.5 months, 62% male, 63% complete, and 37% incomplete Kawasaki disease) were residents of Chandigarh. Incidence declined markedly during the pandemic (1.7 and 3.4 per 100,000 children <5 years in 2020 and 2021, respectively), followed by a rebound in 2022 (8.4) and 2023 (5.8), and a sharp rise in 2024 (13.9), the highest incidence recorded to date in Chandigarh. Coronary artery abnormalities were detected in 13% of patients, with 3.3% showing persistent lesions at 6 weeks. No deaths occurred, and seasonal patterns remained unchanged compared with 2015-2019.

INTERPRETATION: Kawasaki disease incidence in Chandigarh declined transiently during the COVID-19 pandemic but rebounded sharply post-pandemic, exceeding the highest previously reported estimates. Despite fluctuations, clinical features and coronary outcomes remained stable. These findings reinforce Kawasaki disease as an endemic childhood vasculitis in Chandigarh, India, and highlight the need for ongoing surveillance and early recognition as an important contributor to acquired heart disease burden in children.