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Is influenza vaccination associated with nephrotic syndrome relapse in children? A multicenter prospective study
Shingo Ishimori1, Tomoko Horinouchi2, Junya Fujimura3
1Department of Pediatrics, Takatsuki General Hospital, 1‑3‑13 Kosobe‑cho, Takatsuki, 569‑1192, Japan. shingo-i0324os@live.jp.
Insights
Influenza vaccination does not directly cause nephrotic syndrome (NS) relapses in children. However, children with prior NS relapses may experience increased disease activity after flu shots.
Area of Science:
- Pediatric Nephrology
- Immunology
- Vaccinology
Background:
- Previous studies indicate general immunizations do not trigger pediatric idiopathic nephrotic syndrome (NS) relapses.
- However, specific data on influenza (flu) virus vaccines and their association with NS relapses in children are lacking.
Purpose of the Study:
- To investigate the association between inactivated influenza virus vaccination and nephrotic syndrome (NS) relapse rates in children.
- To determine if flu vaccination exacerbates NS activity in pediatric patients.
Main Methods:
- A multicenter prospective study involving children with NS who received inactivated flu vaccines.
- Defined vaccination day as day 0; compared relapse rates in the 30-day post-vaccination period to a 180-day pre-vaccination period.
- Exacerbation defined as increased NS relapses or initiation of new immunosuppressants post-vaccination.
Main Results:
- No significant difference in NS relapse rates was observed between the pre-vaccination and 0-30 day post-vaccination periods (p=0.95).
- A low exacerbation rate (7.4%) was noted in children without prior NS relapses.
- Children with at least one NS relapse in the 6 months prior to vaccination showed a significant increase in exacerbation rates (44.4%, p=0.01).
Conclusions:
- Influenza vaccination does not appear to directly precipitate NS relapses in children.
- Flu vaccination may potentially increase NS disease activity in children with a history of relapses within the preceding six months.
Background:
Prospective research of children receiving heterogeneous vaccines has shown that immunization is not associated with pediatric idiopathic nephrotic syndrome (NS) relapses. However, prospective data concentrating only on influenza (flu) virus vaccines are not available.
Methods:
This multicenter prospective study was conducted in children with NS who received inactivated flu vaccines from June 2017 to July 2018. The day of flu vaccination was defined as day 0, and the period between prevaccination and postvaccination days was defined as - X to + Y (period from day - 180 to 0 as the precontrolled period). The primary outcome was the NS relapse rate from day 0 to + 30 as a direct association with vaccination compared with those in the precontrolled period. Exacerbation was defined as children experiencing more NS relapses after vaccination compared with those in the precontrolled period, or children starting any new immunosuppressants due to NS relapse after vaccination.
Results:
Sixty-three children were included. Relapse rates were not significantly different between the precontrolled period and 0 to + 30 periods (0.38 vs. 0.19 times/person-year, p = 0.95). Although the exacerbation rate during the 0 to + 180 period in children without NS relapse in the precontrolled period was very low (4/54 [7.4 %]), children with at least one NS relapse in the precontrolled period showed a remarkable increase in the rate (4/9 [44.4%]; p = 0.01).
Conclusions:
Flu vaccination did not significantly precipitate the direct relapse of NS in children. However, it might increase the disease activity in children with at least one NS relapse within a half year before vaccination. A higher resolution version of the Graphical abstract is available as Supplementary information.
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