Tolerability of COVID-19 Infection and Messenger RNA Vaccination Among Patients With a History of Kawasaki Disease

Abstract

ImportanceKawasaki disease (KD) symptoms significantly overlap with multisystem inflammatory syndrome in children due to COVID-19. Patients with KD may be at risk for adverse outcomes from exposure to SARS-CoV-2 infection or vaccination.ObjectiveTo describe the outcomes of patients with KD to SARS-CoV-2 infection or vaccination.Design, Setting, and ParticipantsThis case series evaluated 2 cohorts using an existing KD database and reviewed individual electronic medical records for the period spanning January 1, 2020, through January 31, 2022, via electronic medical records that include Washington state immunization records. Vaccine cohort inclusion criteria consisted of being 21 years or younger at immunization and receiving 1 or more BNT162b2 (Pfizer-BioNTech) or messenger RNA (mRNA)–1273 (Moderna) vaccine doses. The COVID-19 cohort included patients 21 years or younger with positive polymerase chain reaction or nuclear capsid IgG findings for SARS-CoV-2. Participants included 826 patients from a preexisting KD database. One hundred fifty-three patients received at least 1 BNT162b2 or mRNA-1273 vaccine dose and were included in the mRNA vaccine cohort. Thirty-seven patients had positive test results for SARS-CoV-2 and were included in the COVID-19 cohort.ExposuresSARS-CoV-2 vaccination and/or infection.Main Outcomes and MeasuresAdverse events after mRNA vaccination and/or COVID-19, including clinician visits, emergency department encounters, or hospitalizations.ResultsAmong the 153 patients included in the mRNA vaccination cohort (mean [SD] age, 13.0 [4.3] years; 94 male [61.4%]), the BNT162b2 vaccine was provided for 143 (93.5%), and the remaining 10 (6.5%) received mRNA-1273 or a combination of both. Among patients in the vaccine cohort, 129 (84.3%) were fully vaccinated or received a third-dose booster. No clinically severe adverse events occurred, and there were no reports of vaccine-related hospitalizations or outpatient visits. The COVID-19 cohort included 37 patients (mean [SD] age, 11.0 [5.5] years; 22 male [59.5%]). No patients required hospitalization due to COVID-19. The most common symptoms included low-grade fever, fatigue, cough, and myalgia with resolution within a few days. Two patients, aged 9 and 19 years, had extended cough and fatigue for 3 to 4 weeks. One patient developed COVID-19 within 6 weeks of receiving intravenous immunoglobulin for KD.Conclusions and RelevanceThese findings suggest that the mRNA vaccines may be safe and COVID-19 may not be severe for patients with a history of KD.

Echocardiography and laboratory outcomes of COVID-19 in children with a history of Kawasaki disease: a preliminary observation

“…Less is known about outcomes of COVID-19 in children with a history of Kawasaki disease. In a study which used electronic medical records obtained from Washington State, in the United States, COVID-19 did not result in higher rates of hospitalization or severe disease in 37 patients with a history of Kawasaki disease ( 7 ). However, this study did not include echocardiographic or laboratory data.…”

Emerging Insights Into the Pathophysiology of Multisystem Inflammatory Syndrome Associated With COVID-19 in Children

“…In contrast, a report from Seattle noted that patients with a prior history of KD did not have adverse outcomes when either infected with SARS-CoV-2 or vaccinated with mRNA COVID-19 vaccines. 82 …”

Profiling humoral responses to COVID-19 immunization in Kawasaki disease using SARS-CoV-2 variant protein microarrays

“…However, in a large cohort study on KD patients who were administered with two mRNA vaccines, BNT162b2 or mRNA-1273, it has been shown that mRNA vaccines may be safe and tolerable, and also, infection with COVID-19 might not be severe for individuals with a history of KD. 24 Still, limited information exists, and immune responses of KD patients against COVID-19 immunization are unclear.…”