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Time interval of measles vaccination in patients with Kawasaki disease treated with additional intravenous immune globulin

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Abstract

A standard treatment with a dose of 2 g/kg of intravenous immune globulin (IVIG) is sometimes ineffective in some patients with Kawasaki disease (KD), who are commonly treated with additional IVIG. An interval of 6 to 7 months in Japan and 11 months in the United States is recommended before vaccination against measles after IVIG treatment for KD, but it is not known how long after treatment with additional IVIG. We studied the persistence of measles antibody titers in six episodes of KD in five patients without history of measles infection or vaccination, 4 to 28 months of age, after additional infusion of IVIG. The total dose was 4 g/kg in five episodes and 6 g/kg in one episode. Enzyme immunoassay antibody titers against measles were still positive (≥400) in all patients tested 3 months after additional infusion of IVIG and positive in one patient and equivocal (≥200 and <400) in three patients after 6 months, but negative (<200) in all after 9 months following infusion. Neutralization test antibody titers against measles were still positive (≥1:4) in all patients 3 months after additional infusion of IVIG, but only one after 6 months, and negative (<1:4) in all after 9 months following infusion. Conclusion: we suggest that an appropriate interval between infusion of 4 g/kg of intravenous immune globulin and measles vaccination be 9 months. The 11-month interval recommended in the United States for 2 g/kg may be longer than necessary.

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Abbreviations

EIA :

enzyme immunoassay

HI :

hemagglutination inhibition

IVIG :

intravenous immune globulin

KD :

Kawasaki disease

NT :

neutralization test

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Acknowledgements

We are grateful to Dr. Tetsuo Nakayama, Laboratory of Viral Infection, Kitasato Institute for Life Sciences at Kitasato University and Dr. Mitio Inokuti, Argonne National Laboratory for critical reading of an earlier manuscript. We are indebted to Dr. Tomoyoshi Sonobe, Department of Pediatrics, Japanese Red Cross Medical Center and Dr. Kiyohiko Kato, Department of Pediatrics, Yamanashi Medical University for permitting us to reproduce data. We wish to thank SRL Inc., Tokyo, Japan for the measurement of measles antibody and pharmaceutical companies as follows for information on immune globulin products: Teijin Ltd., Tokyo, Japan (Mr. Yuji Noguchi); Mitsubishi Pharma Corp., Osaka, Japan; Nihon Pharmaceutical Co., Ltd., Tokyo, Japan; Bayer Yakuhin Ltd., Osaka, Japan (Mrs. Yuki Niko).

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  1. Masaru Miura

    Present address: Keio-Northwestern Clinic, Suite 140, 1701 East Woodfield Road, Schaumburg, IL 60173, USA

Authors and Affiliations

  1. Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan

    Masaru Miura

  2. Department of Pediatrics, Saitama Municipal Hospital, Saitama, Japan

    Yasuki Katada

  3. Department of Pediatrics, Yokohama Municipal Citizens’ Hospital, Yokohama, Japan

    Jun Ishihara

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  1. Masaru Miura
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  2. Yasuki Katada
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  3. Jun Ishihara
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Correspondence to Masaru Miura.

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Miura, M., Katada, Y. & Ishihara, J. Time interval of measles vaccination in patients with Kawasaki disease treated with additional intravenous immune globulin. Eur J Pediatr 163, 25–29 (2004). https://doi.org/10.1007/s00431-003-1335-3

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  • DOI: https://doi.org/10.1007/s00431-003-1335-3

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