KD has been described in children of all races and ethnic backgrounds but is clearly overrepresented among Japanese and Japanese American children. In Japan and among Japanese residents of Hawaii, the annual incidence is approximately 200/100,000 children below five years of age (3). Over 185,000 children have been diagnosed with KD in Japan and more than 8000 new Japanese cases were recognized in 2001 (4). This means that approximately one in every 150 children in Japan will suffer from KD. In the continental United States, incidence estimates for KD vary from 15 to 18.8 per 100,000 children below five years of age (5,6). Using hospital discharge databases, the Centers for Disease Control and Prevention estimated that 4248 children below five years of age were diagnosed and treated in the United States in the year 2000 at a cost of $51 million (7). The variation of KD incidence among different ethnic groups is likely related to host genetic factors that influence disease susceptibility (8,9).

The etiology of KD remains unknown, although an infectious cause is suspected, based on seasonality and clustering of cases and the similarity of clinical signs to other

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