How should I get vaccinated against Kawasaki disease?

Lele has Kawasaki disease and has been in the hospital for seven or eight days. Today is the day Lele is discharged from the hospital. I should be very happy, but I found that Lele's mother looked anxious. I walked over and asked, "Lele's mother, is there anything I can help you with?" "Pharmacist Wang, please help me take a look. The discharge summary given by the doctor said that I can't get vaccinated for 11 months. Can you explain to me why the interval is so long?"

For babies with Kawasaki disease, do all vaccines need to be postponed for 11 months? If you want to get vaccinated, what should you pay attention to? Let the pharmacist answer your questions!

What is Kawasaki disease?

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis in children. The disease was first described by Japanese doctor Kawasaki Tomi in 1967. The cause and pathogenesis are still unknown. It mainly occurs in children under 5 years old. The main clinical features of Kawasaki disease include fever, rash, conjunctival congestion of both eyes, dry and red lips, bayberry tongue, hard swelling of hands and feet, periungual peeling, lymphadenopathy, etc. Some children may have heart involvement, the most common of which is coronary artery dilatation. The treatment principle of Kawasaki disease is mainly to reduce inflammatory response and prevent thrombosis. The main therapeutic drugs are intravenous human immunoglobulin (IVIG) and aspirin.

Factors affecting vaccination in children with Kawasaki disease

The cause of Kawasaki disease is still unknown. There may be some infectious factors in the disease process, which triggers an abnormal immune response. IVIG and aspirin are required for treatment. Therefore, whether children with Kawasaki disease can be vaccinated needs to be considered from the perspective of safety and effectiveness:

(1) Is it safe for children with Kawasaki disease to be vaccinated given their special immune status? How long after contracting Kawasaki disease can they be vaccinated?

(2) Can vaccination after administration of excessive doses of IVIG induce an effective immune response?

(3) For children with coronary artery disease who take aspirin for a long time, what precautions should be taken during vaccination?

How long after having Kawasaki disease can I get vaccinated?

Some parents worry that vaccination will induce Kawasaki disease or cause a relapse of Kawasaki disease that has already been cured, but there is currently no scientific evidence that vaccination will induce Kawasaki disease, so babies who have had Kawasaki disease can still be vaccinated. Since Kawasaki disease itself is an abnormal immune response, there is currently no consensus on how long after contracting Kawasaki disease you can get vaccinated, and it needs to be determined based on the child's own condition. The general recommendation is to wait 6-12 months after recovery from Kawasaki disease before getting vaccinated, and before getting vaccinated, you need to take your child to check myocardial enzyme spectrum, electrocardiogram, humoral immunity, etc. to ensure that heart function and immune status are normal.

How long after receiving IVIG can children with Kawasaki disease be vaccinated?

IVIG is mainly prepared from healthy human plasma, so it contains certain antibodies that prevent diseases. These antibodies can combine with the antigens in the vaccine and interfere with the body's normal immune response to the vaccine.

Since people have generally experienced measles vaccination or natural infection with measles, IVIG contains a certain amount of measles antibodies. At present, it is clearly recommended, based on the recommendation of the American Academy of Pediatrics in 1994, that after receiving a large dose of IVIG (2g/kg), the interval between vaccination with measles, mumps, and rubella (mixed attenuated live vaccine for measles, rubella, and mumps) and varicella vaccine is 11 months [1]. Only when the measles, mumps, and varicella antibodies in IVIG are almost consumed can the measles, mumps, and varicella vaccines be administered.

For inactivated vaccines other than measles and varicella, in theory they can be administered directly, but for some live attenuated vaccines, such as Japanese encephalitis vaccine and live attenuated hepatitis A vaccine, it is recommended to be administered at least 3 months later.

Vaccination recommendations for children with Kawasaki disease who are taking aspirin long term

Children with Kawasaki disease who also have coronary artery disease should continue to take low-dose antiplatelet drugs such as aspirin to prevent ischemic heart disease and thrombosis until coronary artery dilation is reversed. Because children who use aspirin are at risk of developing Reye's syndrome (a serious, life-threatening disease that often occurs when children take aspirin for viral infections such as influenza or varicella), it is recommended that children who take aspirin for a long time receive an influenza vaccine every year; if children with Kawasaki disease who do not have a history of varicella are to be vaccinated, they should wait 2 days after aspirin is discontinued before receiving the vaccine [2]. It is recommended that aspirin be used with caution or other antiplatelet drugs be used within 6 weeks after influenza symptoms or influenza or varicella vaccination [3].

References

[1] Hall, Caroline B; Granoff, Dan M; Halsey, Neal A, et al. Recommended Timing of routine measles immunization for Children who have recently received. Pediatrics,1994,93(4):682-685

[2] Jiao Fuyong, Gao Chenna, Wang Juyan, et al. Research consensus on Kawasaki disease and vaccination [J]. Chinese Journal of Maternal and Child Health Research, 2019, 30(2): 137-141

[3] Cardiovascular Group, Pediatric Branch, Chinese Medical Association. Clinical treatment recommendations for coronary artery lesions in Kawasaki disease[J]. Chinese Journal of Pediatrics, 2020.58(9):718-724.