Vaccination in Children with Kawasaki Disease Treated with Biological Drugs

Kawasaki disease (KD) is an acute febrile illness that primarily affects children under five years of age and can lead to coronary artery aneurysms if left untreated. High-dose intravenous immunoglobulin (IVIg) is the standard treatment. However, approximately 10%–20% of patients are refractory to this therapy and require additional treatments, including biologic agents such as infliximab, etanercept, or anakinra. As the use of these biologic agents has increased in recent years, concerns have been raised that biologics may suppress immune responses, potentially compromising the safety and immunogenicity of subsequent vaccinations, particularly live-attenuated vaccines. This study outlines the principles of vaccination in children with KD who have received biologic therapy. Key factors such as pharmacokinetics, mechanisms of action, and the duration of immunosuppressive effects should be considered when determining the optimal timing for vaccination. In patients with KD, biologics are typically administered once, often following IVIg, which may reduce the risk of vaccine-related adverse events while still allowing for adequate antibody responses. Further research is needed to establish evidence-based guidelines for safe and effective immunization in these patients.