Minor Infections May Increase Stroke Risk in Children

February 13, 2014

SAN DIEGO, California — Common infections are associated with a significantly higher risk for stroke in children, and routine vaccinations appear to be protective, a new study suggests.

The National Institutes of Health (NIH)–funded study was presented here by Nancy Hills, PhD, University of California San Francisco Medical Center, at the American Stroke Association (ASA) International Stroke Conference (ISC) 2014.

"This is not something that parents have to worry about too much as minor infections are very common and stroke is very rare in children," Dr. Hills commented. "It is likely that infection is a trigger in children predisposed to stroke."

Principal investigator Heather Fullerton, MD, University of California San Francisco Medical Center, added, "Our message for the general population is that vaccinations are safe in terms of childhood stroke and rather than conferring a risk, they are actually protective.

"Our results are useful for those children who may be predisposed to stroke — for example those with congenital heart disease or sickle cell disease," Dr. Fullerton said. "These children really do need their flu jabs."

But she noted that while some of the strokes in this study did occur in children with predisposing factors, most of the cases were in previously healthy children. "We don't understand why these children have had strokes, but we are pleased that the NIH is now investing in childhood strokes and we hope to do further studies to understand more about the pathology."

Moderator of an ASA press conference on the study, Larry Goldstein, MD, Duke University, Durham, North Carolina, commented: "Stroke is 100 times less common in children than in adults, affecting about 0.05 per 1000 children and 5 per 1000 adults. But when stroke does occur in children it has a high morbidity rate, so it is important to try and figure out the risk factors."

For the study, known as Vascular effects of Infection in Pediatric Stroke (VIPS), researchers interviewed parents of 310 children who had a stroke to determine the presence and timing of any infectious illnesses before their stroke. They compared their findings with data from 289 children who hadn't experienced a stroke but had visited the doctor for an annual check-up, routine follow-up for headaches, developmental delay, or trauma.

Results showed that common infections were linked to the risk for stroke. This relationship was influenced by the time of the infection: Children with an infection in the past week had more than a 6-fold increased risk for stroke (P < .0001).

Table. Relative Risk for Stroke in Relation to Time of Infection

Endpoint Infection in Prior Week Infection in Prior Month Infection in Prior 6 Months
Increased risk for stroke vs controls 6.5 2.3 1.2

 

In total, 17% of patients with stroke were reported to have had an infection in the prior week vs 3% of controls.

Routine vaccinations were associated with a protective effect, with children reported to have had few or none of their vaccinations having a 7 times increased risk for stroke compared with those who had received all or most of their vaccinations.

In a logistic regression analysis adjusted for age, ever having received a vaccine against measles, mumps, and rubella; polio; or pneumococcus was each significantly protective against stroke.

Other analyses of the study found that infections with parvovirus B19 and different herpes viruses were also linked to a significantly greater stroke risk. Blood tests showed that 41% of stroke patients had an active herpes infection, compared with 9% of patients without stroke.

The study was supported by the NIH. Dr. Hills has disclosed no relevant financial relationships. Dr. Fullerton reports significant research grants from NIH and the American Heart Association.

International Stroke Conference (ISC) 2014. Abstracts 36, 38, 39. Presented February 12, 2014.

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