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

Abstract

A standard treatment with a dose of 2 g/kg of intravenous immune globulin (i.v.IG) is sometimes ineffective in some patients with Kawasaki disease (KD), who are commonly treated with additional i.v.IG. An interval of 6 to 7 months in Japan and 11 months in the United States is recommended before vaccination against measles after i.v.IG treatment for KD, but it is not known how long after treatment with additional i.v.IG. 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 i.v.IG. 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 (> or =400) in all patients tested 3 months after additional infusion of i.v.IG and positive in one patient and equivocal (> or =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 (> or =1:4) in all patients 3 months after additional infusion of i.v.IG, but only one after 6 months, and negative (<1:4) in all after 9 months following infusion. 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.