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Common infection linked to ischemic stroke in children
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SAN DIEGO — Recent infection was associated with increased risk for childhood ischemic stroke in the VIPS trial.
Routine vaccinations, however, appear to be protective against the development of stroke, researcher Nancy K. Hills, PhD, of the University of California, San Francisco, said during a press briefing at the International Stroke Conference.
Hills and colleagues conducted the prospective, case-control VIPS study to confirm findings from a previous study presented at ISC 2012 that linked acute minor infection with childhood arterial ischemic stroke (OR=3.9; 95% CI, 2-7.4). The target enrollment is 350 cases of childhood arterial ischemic stroke and 350 unmatched controls recruited from routine clinic visits or urgent visits for trauma. Participants are aged between 28 days and 18 years. The researchers interviewed parents to determine the presence and timing of recent infections, vaccination history and demographics.
Nancy K. Hills
Focus on minor infections
The researchers asked parents about a number of “common childhood infections as well as some of the more serious infections.” Hills said they were “mostly interested in the minor infections, because we know that meningitis [for example] is likely to cause stroke in children.”
At ISC, Hills said data are available for 310 cases (median age, 7.5 years; 57% boys) and 289 controls (median age, 8.2 years; 53% boys).
According to preliminary results, an infection within 1 week before stroke conferred a 6.5-fold increased risk for childhood arterial ischemic stroke (cases, 17%; controls, 3%; P<.0001).
The most common type of infections reported in the week before stroke (for cases) or parental interview (for controls) were upper respiratory infections (cases, 8%; controls, 2.4%).
“We don’t feel that there’s any particular type of infection that may predispose a child to stroke,” she said at the press conference. “It is also important to point out that while childhood infections are common, pediatric stroke is rare and is likely multifactorial. Thus, common infections potentially act as a trigger in children who are already susceptible to stroke because of other underlying conditions, such as congenital heart disease.”
Vaccinations linked to lower stroke risk
Children who were reported to have had some, few or no vaccinations were at elevated risk for arterial ischemic stroke compared with those who had all or most of their vaccinations (OR=6.72; 95% CI, 2.3-19.6), the researchers found. Children were “about seven times as likely to have a stroke” if they were not vaccinated, Hills said.
Vaccination for measles-mumps-rubella, polio or pneumococcus was significantly protective against stroke, according to logistic regression adjusted for age. Also, in general, cases were under-vaccinated compared with controls, Hills said.
The VIPS researchers presented other similar research at the conference. One study suggested a role for parvovirus B19 in increased risk for childhood arterial ischemic stroke. The researchers took serum samples from 162 cases and 36 controls in the VIPS study. Viral pathogen DNA was detected in 9.2% of cases vs. 0% of controls. Of the 14 cases with viral pathogen DNA, 10 had parvovirus B19. A second study suggested that acute exposure to herpes virus may contribute to risk for childhood arterial ischemic stroke. The researchers conducted serologic analysis on 141 cases and 44 controls. They found acute herpes infection in 41% of cases vs. 9% of controls (P<.0001). After adjustment for age, herpes exposure remained a predictor of childhood arterial ischemic stroke (OR=9; 95% CI, 3.1-38.7). The most commonly identified virus was herpes simplex virus 1. – by Erik Swain
For more information:
Fullerton HJ. Abstract 38.
Hills NK. Abstract 39.
Luna JM. Abstract 36. All presented at: International Stroke Conference 2014; Feb. 12-14, 2014; San Diego.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Ralph L. Sacco, MD, MS, FAHA, FAAN
This abstract is important because we are thinking more and more about stroke in children. We know there are some signs out there that stroke may be becoming more frequent in younger people. There is a growing body of evidence on infection and inflammation as it relates to adults and now in children. The VIPS trial is a well-designed, large study that is specifically focusing on stroke in children. Both this abstract, which talks about infection by history and some other abstracts presented at this meeting looking at serology are showing some pretty convincing findings that infection may play a role in stroke risk in children.
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