Infection, vaccination, and childhood arterial ischemic stroke

Heather J. Fullerton, Nancy K. Hills, Mitchell S V Elkind, Michael M. Dowling, Max Wintermark, Carol A. Glaser, Marilyn Tan, Michael J. Rivkin, Luigi Titomanlio, A. James Barkovich, Gabrielle A. DeVeber

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objectives: Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. Methods: The Vascular Effects of Infection in Pediatric Stroke study is an international case-control study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review. Results: Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p 0.44). Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases, vs 3% of controls, conferring a 6.3-fold increased risk of AIS (p <0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p <0.0001), undervaccination (OR 8.2, p 0.0004), black race (compared to white; OR 1.9, p 0.009), and rural residence (compared to urban; OR 3.0, p 0.0003). Conclusions: Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children.

Original languageEnglish (US)
Pages (from-to)1459-1466
Number of pages8
JournalNeurology
Volume85
Issue number17
DOIs
StatePublished - Oct 27 2015

Fingerprint

Vaccination
Stroke
Infection
Odds Ratio
Logistic Models
Interviews
Respiratory Tract Infections
Blood Vessels
Case-Control Studies
Vaccines
Pediatrics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Fullerton, H. J., Hills, N. K., Elkind, M. S. V., Dowling, M. M., Wintermark, M., Glaser, C. A., ... DeVeber, G. A. (2015). Infection, vaccination, and childhood arterial ischemic stroke. Neurology, 85(17), 1459-1466. https://doi.org/10.1212/WNL.0000000000002065

Infection, vaccination, and childhood arterial ischemic stroke. / Fullerton, Heather J.; Hills, Nancy K.; Elkind, Mitchell S V; Dowling, Michael M.; Wintermark, Max; Glaser, Carol A.; Tan, Marilyn; Rivkin, Michael J.; Titomanlio, Luigi; James Barkovich, A.; DeVeber, Gabrielle A.

In: Neurology, Vol. 85, No. 17, 27.10.2015, p. 1459-1466.

Research output: Contribution to journalArticle

Fullerton, HJ, Hills, NK, Elkind, MSV, Dowling, MM, Wintermark, M, Glaser, CA, Tan, M, Rivkin, MJ, Titomanlio, L, James Barkovich, A & DeVeber, GA 2015, 'Infection, vaccination, and childhood arterial ischemic stroke', Neurology, vol. 85, no. 17, pp. 1459-1466. https://doi.org/10.1212/WNL.0000000000002065
Fullerton HJ, Hills NK, Elkind MSV, Dowling MM, Wintermark M, Glaser CA et al. Infection, vaccination, and childhood arterial ischemic stroke. Neurology. 2015 Oct 27;85(17):1459-1466. https://doi.org/10.1212/WNL.0000000000002065
Fullerton, Heather J. ; Hills, Nancy K. ; Elkind, Mitchell S V ; Dowling, Michael M. ; Wintermark, Max ; Glaser, Carol A. ; Tan, Marilyn ; Rivkin, Michael J. ; Titomanlio, Luigi ; James Barkovich, A. ; DeVeber, Gabrielle A. / Infection, vaccination, and childhood arterial ischemic stroke. In: Neurology. 2015 ; Vol. 85, No. 17. pp. 1459-1466.
@article{d7cb4c2e0f304927b770b104fc3baaa0,
title = "Infection, vaccination, and childhood arterial ischemic stroke",
abstract = "Objectives: Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. Methods: The Vascular Effects of Infection in Pediatric Stroke study is an international case-control study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review. Results: Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p 0.44). Infection in the week prior to stroke, or interview date for controls, was reported in 18{\%} of cases, vs 3{\%} of controls, conferring a 6.3-fold increased risk of AIS (p <0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p <0.0001), undervaccination (OR 8.2, p 0.0004), black race (compared to white; OR 1.9, p 0.009), and rural residence (compared to urban; OR 3.0, p 0.0003). Conclusions: Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children.",
author = "Fullerton, {Heather J.} and Hills, {Nancy K.} and Elkind, {Mitchell S V} and Dowling, {Michael M.} and Max Wintermark and Glaser, {Carol A.} and Marilyn Tan and Rivkin, {Michael J.} and Luigi Titomanlio and {James Barkovich}, A. and DeVeber, {Gabrielle A.}",
year = "2015",
month = "10",
day = "27",
doi = "10.1212/WNL.0000000000002065",
language = "English (US)",
volume = "85",
pages = "1459--1466",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "17",

}

TY - JOUR

T1 - Infection, vaccination, and childhood arterial ischemic stroke

AU - Fullerton, Heather J.

AU - Hills, Nancy K.

AU - Elkind, Mitchell S V

AU - Dowling, Michael M.

AU - Wintermark, Max

AU - Glaser, Carol A.

AU - Tan, Marilyn

AU - Rivkin, Michael J.

AU - Titomanlio, Luigi

AU - James Barkovich, A.

AU - DeVeber, Gabrielle A.

PY - 2015/10/27

Y1 - 2015/10/27

N2 - Objectives: Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. Methods: The Vascular Effects of Infection in Pediatric Stroke study is an international case-control study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review. Results: Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p 0.44). Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases, vs 3% of controls, conferring a 6.3-fold increased risk of AIS (p <0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p <0.0001), undervaccination (OR 8.2, p 0.0004), black race (compared to white; OR 1.9, p 0.009), and rural residence (compared to urban; OR 3.0, p 0.0003). Conclusions: Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children.

AB - Objectives: Minor infection can trigger adult arterial ischemic stroke (AIS) and is common in childhood. We tested the hypotheses that infection transiently increases risk of AIS in children, regardless of stroke subtype, while vaccination against infection is protective. Methods: The Vascular Effects of Infection in Pediatric Stroke study is an international case-control study that prospectively enrolled 355 centrally confirmed cases of AIS (29 days-18 years old) and 354 stroke-free controls. To determine prior exposure to infections and vaccines, we conducted parental interviews and chart review. Results: Median (interquartile range) age was 7.6 years for cases and 9.3 for controls (p 0.44). Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases, vs 3% of controls, conferring a 6.3-fold increased risk of AIS (p <0.0001); upper respiratory infections were most common. Prevalence of preceding infection was similar across stroke subtypes: arteriopathic, cardioembolic, and idiopathic. Use of vasoactive cold medications was similarly low in both groups. Children with some/few/no routine vaccinations were at higher stroke risk than those receiving all or most (odds ratio [OR] 7.3, p 0.0002). In an age-adjusted multivariate logistic regression model, independent risk factors for AIS included infection in the prior week (OR 6.3, p <0.0001), undervaccination (OR 8.2, p 0.0004), black race (compared to white; OR 1.9, p 0.009), and rural residence (compared to urban; OR 3.0, p 0.0003). Conclusions: Infection may act as a trigger for childhood AIS, while routine vaccinations appear protective. Hence, efforts to reduce the spread of common infections might help prevent stroke in children.

UR - http://www.scopus.com/inward/record.url?scp=84945303834&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84945303834&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000002065

DO - 10.1212/WNL.0000000000002065

M3 - Article

VL - 85

SP - 1459

EP - 1466

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 17

ER -