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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the clinical outcomes of patients with a history of Kawasaki disease after exposure to SARS-CoV-2 infection or vaccination?

Findings  In this case series of 153 patients with a history of Kawasaki disease, SARS-CoV-2 infection and/or vaccination was well tolerated, with no adverse events or hospital admissions documented.

Meaning  These findings suggest that patients with history of Kawasaki disease tolerate SARS-CoV-2 infection or vaccination.


Importance  Kawasaki 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.

Objective  To describe the outcomes of patients with KD to SARS-CoV-2 infection or vaccination.

Design, Setting, and Participants  This 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.

Exposures  SARS-CoV-2 vaccination and/or infection.

Main Outcomes and Measures  Adverse events after mRNA vaccination and/or COVID-19, including clinician visits, emergency department encounters, or hospitalizations.

Results  Among 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 Relevance  These findings suggest that the mRNA vaccines may be safe and COVID-19 may not be severe for patients with a history of KD.

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Article Information

Accepted for Publication: June 23, 2022.

Published: August 12, 2022. doi:10.1001/jamanetworkopen.2022.26236

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Beckley M et al. JAMA Network Open.

Corresponding Author: Michael A. Portman, MD, 1900 Ninth Ave, Seattle, WA 98101 (michael.portman@seattlechildrens.org).

Author Contributions: Dr Portman had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Portman.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Beckley, Portman.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Beckley.

Obtained funding: Portman.

Administrative, technical, or material support: Beckley, Portman.

Supervision: All authors.

Conflict of Interest Disclosures: Ms Beckley reported receiving support from grants from the National Institutes of Health (NIH) awarded to Dr Portman during the conduct of the study. Dr Portman reported receiving grants from NIH during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by the grant R01 HL143130 from the NIH (Dr Portman).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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