Congratulations on a "Kawasaki Disease (KD) enriched" issue (July 2009).
Two key messages emerged from the article by Singh and Kawasaki(1).
Firstly, that the problem of KD in India has grown exponentially in the
last decade. Whether, as hypothesized by Kushner, et al.(2) India
will follow the Western model (an old disease being diagnosed more
frequently now) or the Japanese model (a new disease probably caused by
the introduction of an agent in a susceptible population), the load of KD
promises to be large in the near future. Secondly, treatment of KD is
costly and the cost of sequelae (in the form of morbidity/mortality to a
productive population) even larger. Not only is IVIG costlier than the per
capita income of India, its usage is limited by non-uniform availability
in time/place and that it is a biological product with finite resource.
It therefore behooves the Indian Academy of Pediatrics
(IAP) to build their embankments before the tide rises any further. A
multi pronged approach is needed:
(a) Setting up a national registry for the
disease (at centers of excellence such as PGI, Chandigarh) would be a
first step. Our experience with setting up a registry in Mumbai over 6
years ago(3) has shown that this has been a suitable way to create
awareness about this entity, educate the primary pediatricians / parents
and serve as a repository for cases.
(b) Liaising with researchers to identify
lower cost treatment regimes is the next priority. Our reliance on
imported knowledge is likely to be misplaced as has been seen in other
diseases such as juvenile arthritis where patients who fail first line
therapy often land up as therapeutic orphans for want of the costly
biologicals.
(c) Working in tandem with cardiologists/echo
cardiographers to standardize and diagnose coronary anomalies better and
create a sense of involvement in them to transition these cases into
adulthood.
(d) To appraise the health planners and
political bodies about this entity which otherwise the lay person
identifies better as a two wheeler of the same name.
I therefore earnestly appeal to the IAP to heed this
clarion call.
References
1. Singh S, Kawasaki T. Kawasaki disease – An Indian
perspective. Indian Pediatr 2009; 46: 563-572.
2. Kushner HI, Macnee R, Burns JC. Impressions of
Kawasaki syndrome in India. Indian Pediatr 2006; 43: 939-942.
3. Khubchandani RP, Khemani C. Kawasaki disease
registries reap results – experience in Mumbai. Indian J Pediatr 2006; 73:
545.
