Kawasaki disease and immunisation

ADR adverse drug reaction AHA American Heart Association ALTalanine transaminases aspartate transaminase BCG Bacillus Calmette, Guérin (vaccine)CAAs coronary artery aneurysms CMRA cardiac magnetic resonance angiography CRPC-reactive protein DTP diphtheria, tetanus, pertussis DTaP,diphtheria-tetanus, acellular pertussis EBV Epstein Barr Virus ESR erythrocyte sedimentation rate GGT gamma-glutamyl transferase HHV human herpes virus Hib Haemophilus influenza type bHPFhigh powered fields heat shock protein IVIG Intravenous gamma globulin JMoH Japanese Ministry of Health KD Kawasaki diseaseLADleft anterior descending left ventricular MRI magnetic resonance imagingMSCTmulti, slice computed tomography PAN polyarteritis nodosa PCV pneumococcal conjugate vaccinePCRpolymerase chain reaction RCA right coronary artery RMSF Rocky Mountain Spotted Fever RTPE,recurrent toxin, mediated perineal erythemas JIA systemic juvenile idiopathic arthritis SPECT single-photon emission computed tomography TSS toxic shock syndrome TST tuberculin skin test WBC white blood cells

Kawasaki disease (KD), is a systemic vasculitis of infancy and childhood affecting medium-sized muscular arteries [1]. It causes potentially life-threatening changes in the coronary arteries of some children and is the most common cause of pediatric-acquired heart disease in high-income countries [2], [3].

The systematic review “Kawasaki disease and Immunisation” in the same volume of this journal summarises the published data on KD as a possible adverse event following immunisation (AEFI) [4]. Although a temporal relationship is observed, evidence for an increased risk or causal association is lacking. Harmonised and active surveillance using a widely applicable case definition is important to address whether new or current vaccines are associated with increased KD activity.

The literature review further highlighted that there is no uniformly accepted case definition of KD, nor is there a single unifying definition broadly applicable across surveillance, epidemiological, genetic, clinical or intervention studies [4].

A standardised case definition allowing for different levels of diagnostic certainty in different settings would add value to individual studies by facilitating data interpretation and comparability and promoting the scientific understanding of potential AEFI. Harmonised and active surveillance for possible KD in relation to established and new immunisations is most valuable in the paediatric population for several reasons. First, the age of KD peak incidence in children is less than 6 years of age. This is the age when many routine childhood immunisations are administered [5], [6]. Second, many infectious diseases may present with clinical features similar to KD, so that misclassification is possible [7], [8], [9], [10], [11], [12], [13]. Third, KD is a comparatively rare disease with an incidence rate (in children less than 5 years of age) ranging from approximately 5–20 in many settings such as the UK, US and Europe, to 80–200 per 100,000 in Japan, Korea and Taiwan [5], [14]. Thus, robust risk estimates require large population-based observational studies, or the ability to perform meaningful meta-analysis of multiple smaller studies.

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