Introduction: Timely treatment of Kawasaki disease (KD) reduces the likelihood of coronary artery aneurysms (CAAs).
The Bacille Calmette–Guérin (BCG) vaccine for tuberculosis prevention reportedly reactivates inoculation
site inflammation (BCG-itis) during acute KD. BCG-itis is advocated by the Japan KD guidelines to aid in
the diagnosis when KD is suspected. Data on the diagnostic utility of this finding remain limited however,
particularly in KAWARABI Middle-East-North-Africa (MENA) populations.
Objective: To evaluate the utility of BCG-itis in enhancing KD recognition among providers in Arab countries.
Methods: A multicentre, cross-sectional, survey-based study assessed BCG vaccination policies across Arab
countries and evaluated clinical recognition of BCG-itis in KD. MENA physicians involved in KD
management were invited to participate via KAWARABI investigators’ professional networks and pediatric
societies. Data collected through an online questionnaire captured respondents’ demographics, specialty,
practice location, BCG vaccination policies, clinical experience with BCG-itis, and awareness of its
diagnostic value. Descriptive statistics summarized responses and trends. Ethical approval was obtained,
and electronic informed consent was secured.
Results: Of 418 respondents, 409 consented to participate, and 356 (87%) reported experience managing KD in
13 countries (Figure 1). Respondents’ top specialties were pediatrics (203/356; 57%), pediatric cardiology
(74/356; 21%), and pediatric rheumatology/immunology (25/356; 7%). Of 356 respondents 234 (66%) had
≥ 10 years of experience. Universal BCG vaccination was reported in countries by 338/356 (95%) of
respondents, with stable or improving coverage over the last 5 years. When suspecting KD, 179/356
(50%) of respondents routinely examined the BCG inoculation site. BCG-itis was observed by 115/356 (32%), predominantly in children under five years of age, especially infants (42/115 (37%), and was most commonly associated with complete KD (70/115 (61%). When asked about response to intravenous immunoglobulin, 126/356 (35%) reported favorable response to a single dose and 3% reported resistance. Most respondents were uncertain about associations with CAAs (264/356 (74%), sex, rash, or COVID-19–related KD/MIS-C.
Discussion: This 356 strong poll confirms BCG-itis in KD diagnosis. Inconsistent assessment of BCG site in acute KD
can be improved in the vastly vaccinated MENA population. Future educational initiatives regarding utility of BCG-itis in KD are warranted, fulfilling one of KAWARABI’s missions.