最新の論文から
Kawasaki Disease and Vasculitis associated with Immunizations.
Author information
- 1
- Pediatrics Residency Program, University at Buffalo, State University of New York (SUNY).
- 2
- Division of Pediatric Infectious Diseases, University at Buffalo, State University of New York (SUNY).
Abstract
The etiology and pathogenesis of Kawasaki Disease (KD) remain poorly understood. Amongst the diverse infectious and environmental factors examined to be triggers for, or be associated with KD, are immunizations. In this report, we first describe a Caucasian female who presented with classic KD shortly after receiving her routine 4 month vaccination series. Prior published case reports and large epidemiological studies, which explore potential associations between immunizations and KD and other vasculitides, are then comprehensively reviewed. The methodologic challenges which complicate analysis in this area are also considered. This article is protected by copyright. All rights reserved.
論文無料で読めます。日本の症例報告も参照しています。
オフィット氏のロタテックでは治験中に川崎病がプラセボの5倍発症していました。が、市場後調査では有意な上昇はなかったという結論になっています。（メルクですから調査の信頼性は劣ります）
Notably, KD was found at higher rates in those receiving RotaTeq (RV5; Merck, Whitehouse Station, NJ, USA) in the 42 days after vaccination compared with placebo, in phase 3 of clinical trials: unadjusted RR, 4.9 (5/36,150 vs 1/35,536).
この論文の結論は、ワクチン接種が、個々の小児で川崎病を含む血管炎と関連している可能性はあるかもしれない、特に新しく導入されたワクチンでは調査していくことが重要。
The current patient's first presentation after vaccination, with widespread rash and edema, was consistent with vasculitis; her second met the criteria for KD, and the prompt response to IVIG corroborated this diagnosis. The rapidity of symptoms after the second round of vaccinations suggested the possibility of antigen sensitization with her previous exposure and an immune‐mediated phenomenon. It is worth noting that the patient's personal contacts all lacked any illnesses around the time of diagnosis, and there were no other KD cases in the present hospital for 4 weeks before or after. Given an absence of issues after the 6 month immunizations when Rotarix was omitted, we suspect that this vaccine was the precipitating agent; nevertheless, an independent or combined effect with a concomitantly received immunization remains possible. In conclusion, vaccines may potentially be associated with vasculitides, including KD, in individual children, and ongoing, systematic surveillance of such events is warranted, particularly for newer immunizations.
