Interactions of infection history with vaccine immune responses in pediatric patients with Kawasaki disease

Abstract

We aimed to assess the influence of infection history in pediatric patients with Kawasaki disease (KD) on vaccine immune responses in the convalescence stage. In this study, a total of 298 pediatric patients who were diagnosed with KD between January 2021 and December 2024 and completed follow-up were included. They were assigned to a high infection burden group (n = 152) and a low infection burden group (n = 146). All pediatric patients underwent immunization with measles-mumps-rubella (MMR), hepatitis B, or varicella vaccine at least 11 months after treatment with intravenous immunoglobulin, and completed serological tests within 1-3 months after vaccination. Antibody levels were measured via enzyme-linked immunosorbent assay, and the positive conversion rates and geometric mean titers (GMTs) were calculated. Compared with the low infection burden group, the high infection burden group had a significantly lower positive conversion rate (82.2% vs. 93.2%, p = 0.006) and GMT (320 IU/ml vs. 540 IU/ml, p = 0.010) of measles antibody. High infection burden was independently associated with a higher likelihood of immunization failure in multivariate logistic regression analysis (odds ratio [OR] = 2.35, 95% confidence interval [CI]: 1.20-4.62, p = 0.013). Quartile-stratified analysis indicated that the measles antibody level declined significantly with increasing infection frequency (p for trend = 0.003). A history of high infection burden was associated with lower vaccine-induced immune responses. In particular, frequent respiratory tract infection can significantly weaken the vaccine-induced immune responses in the convalescence stage.