The incidence of Kawasaki disease after vaccination within the UK pre‐school National Immunisation Programme: an observational THIN database study

Hall, Gillian; Tulloh, Robert; Tulloh, Louise

doi:10.1002/pds.4108

Cited by 7 publications

(4 citation statements)

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“…Several studies have evaluated the role vaccination may play in triggering KD via robust stimulation of the innate and adaptive arms of the immune system. However, there is currently no evidence to suggest that vaccine administration is associated with development of KD [17][18][19][20].…”

Section: Vaccine Exposure Theorymentioning

confidence: 99%

Kawasaki Disease: an Update

2020

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Purpose of Review Provide the most recent updates on the epidemiology, pathogenesis, and treatment advances in Kawasaki disease. Recent Findings Treatment advances in complex, IVIG-refractory cases of Kawasaki disease. Multisystem inflammatory syndrome, a newly reported inflammatory condition with Kawasaki-like features and an association with the 2019 Coronavirus (COVID-19). Summary Kawasaki disease (KD) is a rare systemic inflammatory disease that predominately affects children less than 5 years of age. Pathogenesis of KD remains unknown; the leading theory is that an unknown stimulus triggers an immune-mediated inflammatory cascade in a genetically susceptible child. Classic KD is a clinical diagnosis based on set criteria and excluding other similar clinical entities. Patients who do not fulfill complete diagnostic criteria for KD are often referred to as atypical (or incomplete) KD. The most feared complication of KD is coronary artery abnormality development, and patients with atypical KD are also at risk. Administration of intravenous immunoglobulin (IVIG) and aspirin has greatly reduced the incidence of coronary lesions in affected children. Several other immune-modulating therapies have recently been utilized in complex or refractory cases. Keywords Kawasaki disease. Kawasaki review. Kawasaki treatment. Kawasaki workup. Kawasaki differential. Kawasaki diagnosis. Multi system inflammatory syndrome. Kawasaki-like disease Pathogenesis Genetics Although poorly understood, the predilection for children of East Asian and Pacific Islander descent, even with transmigration, This article is part of the Topical Collection on Vasculitis * Eileen Rife

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Section: Vaccine Exposure Theorymentioning

confidence: 99%

Kawasaki Disease: an Update

2020

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“…Risk periods were defined as the biologically plausible time frame after exposure when that outcome might be expected to occur if it was caused by the vaccine ( Table 1). The risk periods and preexposure periods were outcome-specific based on the literature 4,6,18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] or, when no relevant data were available, clinical experience. For convulsions, paresthesia, and GBS, a second-risk period was defined either because of these reflected different types of outcome (such as febrile and other seizures) or because the most appropriate period was not clear from the literature.…”

Section: Risk Periodsmentioning

confidence: 99%

Observational safety study of specific outcomes after trivalent cell culture seasonal influenza vaccination (Optaflu^®) among adults in THIN database of electronic UK primary healthcare records

Hall¹,

Davies

Karim

et al. 2017

Pharmacoepidemiology and Drug

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Purpose: To investigate the safety of trivalent seasonal influenza vaccine (TIVc) (Optaflu ® ), the first cell culture seasonal trivalent influenza vaccine available in Europe.Methods: Codes and unstructured text in adult electronic healthcare records (The Health Improvement Network) were searched for a TIVc brand name or batch number and possible outcomes within a 3 month pre-to 6 month post-TIVc exposure study period (2012)(2013)(2014)(2015). The outcomes were severe allergic reactions, Bell's palsy, convulsions, demyelination, paresthesia, noninfectious encephalitis, neuritis (optic and brachial), vasculitis, inflammatory bowel disease, and thrombocytopenia. Risk periods were defined based on biologically plausible time frame postvaccination when an outcome caused by the vaccine might be expected to occur. Possible outcomes were adjudicated against outcome specific case definitions and a date of onset assigned by using electronic and other medical records. Observed (risk period) to expected (outside risk and preexposure periods) rate ratios, postexposure incidence, and plots of time from exposure to outcome were reported.Results: Sixteen of 1011 events from 4578 exposures fulfilled a primary case definition and had a date of onset during the study period. Three were in observed time. The observed-toexpected rate ratios were (3.3, 95% CI 0.3, 31.7) for convulsions and (1.5, 95% CI 0.2, 14.9) for thrombocytopenia with 1 outcome each in observed time. There was 1 incident inflammatory bowel disease in observed, but none in expected, time. Conclusion:The small sample size restricts interpretation; however, no hypothesis of an increased risk of a study outcome was generated. Adjudication of events against case definitions to reduce misclassification of onset and outcomes allowed use of precise risk periods.

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“… DTaP/IPV/Haemophilus B conjugate vaccine (Hib or HIBV)/PCV [ 41 ]. DTaP/IPV/Hib; meningitis C; PCV [ 41 ]. DTaP/IPV; MMR [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

“… DTaP-IPV/Hib and PCV13 [ 42 ]. Hib; meningitis C; PCV; MMR [ 41 ]. Measles/rubella (MR), varicella, pneumococcal [ 43 ].…”

Section: Introductionmentioning

confidence: 99%

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

Ricke,

Smith

2024

Life

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Background: Vasculitis diseases include Kawasaki disease (KD), Kawasaki disease shock syndrome (KDSS), Multisystem Inflammatory Syndrome (MIS), Henoch–Schönlein purpura (HS), or IgA vasculitis, and additional vasculitis diseases. These diseases are often preceded by infections or immunizations. Disease incidence rates are higher in children than in adults. These diseases have been extensively studied, but understanding of the disease etiology remains to be established. Objective: Many studies have failed to demonstrate an association between vasculitis diseases and vaccination; this study examines possible associations. Methods: Herein, the Vaccine Adverse Event Reporting System (VAERS) database is retrospectively examined for associations between vasculitis diseases and immunizations. Results: For some vaccines, the number of rare cases of KD, MIS, and HS are higher than the background rates. These rare cases are predicted to occur in individuals with (1) genetic risk factors with (2) antibody titer levels above the primary immune response level. Herein, the model of humoral immune response antibodies bound to antigens (pathogen or vaccine) creating immune complexes is proposed. These immune complexes are proposed to bind Fc receptors on immune cells and platelets, resulting in cell activation and the release of inflammatory molecules including histamine and serotonin. Immune complexes and inflammatory molecules including serotonin and histamine likely trigger vasculitis. Elevated serotonin and possibly histamine drive initial vasoconstrictions, disrupting blood flow. Increased blood flow pressure from cardiac capillary vasoconstrictions is predicted to trigger coronary artery aneurysms (CAA) or lesions (CAL) in some patients. For KDSS and MIS patients, these cardiac capillary vasoconstrictions are predicted to result in ischemia followed by ventricular dysfunction. Ongoing ischemia can result in long-term cardiac damage. Cases associated with pathogens are likely to have persistent infections triggering disease onset. Conclusion: The proposed model of immune complexes driving disease initial disease etiology by Fc receptor activation of immune cells and platelets, resulting in elevated histamine and serotonin levels, is testable and is consistent with disease symptoms and current treatments.

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The incidence of Kawasaki disease after vaccination within the UK pre‐school National Immunisation Programme: an observational THIN database study

Abstract: There were few cases of Kawasaki disease in the risk period after any NIP vaccination combination. The incidence rates will aid in the interpretation of clinical trials and post-marketing surveillance of new vaccines. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 7 publications

References 16 publications

Kawasaki Disease: an Update

Kawasaki Disease: an Update

Observational safety study of specific outcomes after trivalent cell culture seasonal influenza vaccination (Optaflu^®) among adults in THIN database of electronic UK primary healthcare records

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

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The incidence of Kawasaki disease after vaccination within the UK pre‐school National Immunisation Programme: an observational THIN database study

Abstract: There were few cases of Kawasaki disease in the risk period after any NIP vaccination combination. The incidence rates will aid in the interpretation of clinical trials and post-marketing surveillance of new vaccines. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 7 publications

References 16 publications

Kawasaki Disease: an Update

Kawasaki Disease: an Update

Observational safety study of specific outcomes after trivalent cell culture seasonal influenza vaccination (Optaflu®) among adults in THIN database of electronic UK primary healthcare records

VAERS Vasculitis Adverse Events Retrospective Study: Etiology Model of Immune Complexes Activating Fc Receptors in Kawasaki Disease and Multisystem Inflammatory Syndromes

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Observational safety study of specific outcomes after trivalent cell culture seasonal influenza vaccination (Optaflu^®) among adults in THIN database of electronic UK primary healthcare records