Is Kawasaki disease really a risk, and what can you do?

With some children going back to school after half term, many parents are concerned that they may catch coronavirus or bring it back home and spread it to the rest of the household. Thankfully sending your children back to school at this stage is a choice, and parents can make a decision that is right for their own family’s health situation.

Most children only get very mild symptoms of coronavirus and some get no symptoms at all. However, there is a very small number of children at the moment, who encounter serious and significant health problems, known as Multisystem Inflammatory Syndrome in Children (MIS-C), which is associated with COVID-19. This reaction is very similar to Kawasaki disease (and sometimes simply referred to as Kawasaki) or toxic shock syndrome. MIS-C can occur up to 4-6 weeks after exposure to a virus or bacterial infection, and cases have been found in the US, France, Italy and some in the UK. Whilst still incredibly rare, MIS-C is potentially very serious, and if suspected you must dash to the hospital. Very sadly a small number of children have died from this and one of my little clients had a similar scare but thankfully is OK now.

Why Does MIS-C Occur?

No one knows exactly why MIS-C occurs, and it is thought to be an inappropriate immune and inflammatory response to infection. With Kawasaki, genetics and the environment seem to be factors. It is thought that breastfed babies have a lower risk from Kawasaki, and those kids with mothers who smoke have a higher risk. It generally happens to children under the age of 5 and boys seem to be slightly more susceptible than girls. But obviously, MIS-C may have a completely different mechanism. There seem to have been significantly more cases of MIS-C in the US, compared with the UK, where it is very rare still.

Usually most cases of Kawasaki occur in the thick of winter when infections are at their peak, but this spike in MIS-C has happened later on, and in line with COVID-19 prevalence, which is making people wonder if COVID-19 could be the trigger.

However, not all children admitted to hospital recently with MIS-C have tested positive for COVID-19, so as you can see, there is considerable uncertainty.

Source: CDC

What is the treatment?

With a novel disease, it’s often hard to know what to do. However, doctors seem to be taking a similar approach to Kawasaki, since it presents in such a similar way. This means adopting a broad anti-inflammatory approach, and typically in hospital it is treated with Intravenous Immunoglobulin (IVIG) which counteracts the Oxidative Stress triggered by the cytokine storm. IVIG has been in very short supply in the UK, so let’s hope more is available going forward.

What Role Does The Immune System Play?

We have all become increasingly aware of the importance of the role of innate immunity in the fight against infections over the past few months. The Coronavirus pandemic has shown us that the same virus can affect people differently in both severity & symptoms, whereas before COVID-19, this phenomenon was less well documented. Part of this is obviously down to different virus strains, but there seems to be something more going on.

Evidence is mounting that a person’s underlying nutrition & metabolic health are very important factors for severity & duration of a viral or bacterial infection & whether this has long-term knock-on effects. Since a child’s immune system is maturing & developing during the early years, this is where some core nutrients are needed to form a healthy immune response both in the short & long term.

We see kids in our clinic who have significant changes in their personality or decline in their health after an infection & we work closely with paediatricians, neurologists and child psychiatrists to bring down the post-viral & bacterial inflammatory cytokine cascade that can trigger these problems – it is pretty far reaching and we support kids with a range of post-infection conditions, including type 1 diabetes, juvenile arthritis, chronic fatigue, PANDAS as well as kids with Kawasaki.

What nutrients can help?

Even though the definition of MIS-C is relatively new, I have previously been supporting Kawasaki kids, and the similarity is interesting. Obviously, this is general research on inflammation, oxidative stress and Kawasaki, and not necessarily specific to MIS-C which is still a very new phenomenon!

Vitamin D – kids who have low levels of Vitamin D are more likely to get a Kawasaki reaction – so this means it’s extra important for your kids to get lots of lovely sunshine over the summer; eat plenty of oily fish, eggs & shiitake mushrooms & as per the government advice take at (very) least 400iu of a Vitamin D supplement every day.

Omega 3 – if essential fatty acids are low, then a child is more likely to have an inflammatory response to an infection – again think oily fish like salmon, sardines, mackerel & trout as well as walnuts, flax, chia & hemp. Kids need 2-3 portion of oily fish a week. If they are fish-phobes or plant-powered, then they need topping up with an omega 3 supplement.

Zinc – again a critical immune mineral found to be helpful in both COVID-19 & Kawasaki – find it in meat, pulses, nuts & seeds, eggs, milk and wholegrains. This is often added to children’s immune support supplements and can also be taken separately.

Antioxidants are key – oxidative stress is the biggest issue with MIS-C and this damage to the cells needs to be repaired with antioxidants. Think Vitamin A, C & E to counteract oxidative stress as well as piling your kids’ plates with lots of brightly coloured fruits & veg. Natural foods and spices which help to reduce systemic inflammation include blueberries, blackberries and elderberries, cherries, green veggies, turmeric, saffron, ginger, cinnamon, rosemary and sage. There is evidence that a mix of antioxidants to include Resveratrol and Quercetin antioxidants are helpful too, especially after an infection.

Wrap-up

Above all, remember that this is incredibly rare. Your risk profile seems to be lower in the UK versus the US, But I hope these are helpful tips so you can send your kids back to school with confidence that you are giving them the immunity support they need to keep the bugs at bay. Mine are cetainly going back. Remember My NatureDoc clinical team are here to support you if your child is going through a tough time with post-infection related inflammatory health challenges.

References

• Severe Vitamin D Deficiency in Patients With Kawasaki Disease: A Potential Role in the Risk to Develop Heart Vascular Abnormalities?
• Breastfeeding and Vitamin D Supplementation Reduce the Risk of Kawasaki Disease in a German Population-Based Case-Control Study
• Breastfeeding and Risk of Kawasaki Disease: A Nationwide Longitudinal Survey in Japan
• Early Childhood Exposure to Maternal Smoking and Kawasaki Disease: A Longitudinal Survey in Japan
• Effects of Omega-3 Fatty Acids on Immune Cells
• Oxidative stress and Kawasaki disease: how is oxidative stress involved from the acute stage to the chronic stage?
• Does Vitamin C Improve Endothelial Function in Patients With Kawasaki Disease?
• Anti-inflammatory Effect of Resveratrol in Human Coronary Arterial Endothelial Cells via Induction of Autophagy: Implication for the Treatment of Kawasaki Disease
• Quercetin Inhibits Inflammasome Activation by Interfering With ASC Oligomerization and Prevents Interleukin-1 Mediated Mouse Vasculitis