Vaccines and Kawasaki disease

ABSTRACT

The distinctive immune system characteristics of children with Kawasaki disease (KD) could suggest that they respond in a particular way to all antigenic stimulations, including those due to vaccines. Moreover, treatment of KD is mainly based on immunomodulatory therapy. These factors suggest that vaccines and KD may interact in several ways. These interactions could be of clinical relevance because KD is a disease of younger children who receive most of the vaccines recommended for infectious disease prevention. This paper shows that available evidence does not support an association between KD development and vaccine administration. Moreover, it highlights that administration of routine vaccines is mandatory even in children with KD and all efforts must be made to ensure the highest degree of protection against vaccine-preventable diseases for these patients. However, studies are needed to clarify currently unsolved issues, especially issues related to immunologic interference induced by intravenous immunoglobulin and biological drugs.

KEYWORD:

• Aspirin
• biological drugs
• Kawasaki disease
• intravenous immunoglobulin
• immunosuppressive therapy

Financial & competing interests disclosure

This review was supported by a grant obtained from the Italian Ministry of Health (Bando Giovani Ricercatori 2009 GR-2009-1596786). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• KD is an acute, self-limited vasculitis that mainly occurs in children aged 6 months to 5 years. Its etiology is unknown, and it is diagnosed based on clinical findings.

• Standard therapies for KD consist of IVIG and aspirin; in some cases, depending on the cardiac involvement, and the response to first-line therapies, corticosteroids, antiplatelet therapies, biological agents, and immunosuppressive therapies can be used.

• Available epidemiological evidence excludes the possibility that vaccine administration may be associated with KD development.

• Few studies have analyzed the relationship between therapies for KD and timing of vaccination.

• Most authors recommend a delay of several months (6 to 11 in different guidelines) after IVIG before administering measles- and V-containing vaccines (i.e., MMR, MMRV, and V vaccines) because the immunologic response to the vaccine may be reduced by the high titres of specific antibodies against measles and V present in IVIG. On the other hand, inactivated vaccines, live attenuated oral vaccine (e.g. those for rotavirus, typhoid, and polio, in the countries in which it is still administered), live intranasal influenza vaccine, BCG vaccine, and yellow fever vaccine can be administered during or at any time after IVIG.

• Inactivated influenza vaccine is recommended in patients receiving aspirin therapy due to the risk of Reye syndrome caused by influenza; because of the potential risk of Reye syndrome induced by the attenuated VZ virus of the vaccine, V-containing vaccines should be administered 2 days after suspension of aspirin, which should be temporarily replaced with clopidogrel for 6 weeks after V vaccine administration.

• In children with KD who are treated with immunosuppressive drugs, inactivated and recombinant vaccines can be given regardless of therapy. Live attenuated vaccines not inhibited by IVIG should be administered one month after steroids are withdrawn and 3 months after biologicals are withdrawn.