Oral Presentation Australian and New Zealand Stroke Organisation Conference 2025

Do Infections Increase the Risk of Paediatric Stroke? Population-Based Evidence From Victoria   (123200)

Lachlan Dalli 1 , Muideen T Olaiya 1 , Hannah J Morgan 2 3 4 , Monique F Kilkenny 1 5 , Michael Fahey 6 , Mark MacKay 4 7 , Dominique A Cadilhac 1 5 , Tzu-Yung Kuo 1 , Seana L Gall 1 8 , Hazel J Clothier 2 3 4 , Jacqueline A Boyle 9 , John Mallard 2 3 , Daneeta Hennessy 2 3 , Jim Buttery 2 3 4 10
  1. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  2. Epidemiology-informatics Group and Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  3. Centre for Health Analytics, Melbourne Children's Campus, Melbourne, Victoria, Australia
  4. Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  5. Stroke Theme, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
  6. Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
  7. Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  8. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  9. Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
  10. Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia

Introduction: Evidence on the risk of paediatric stroke following infection is limited, particularly from a population-level perspective. We aimed to determine the association between recent infections and paediatric stroke at the population-level.

Methods: A population-wide observational study was undertaken using linked data from the Vaccine Safety Health Link. All children, aged 28 days to 18 years, admitted to Victorian hospitals between 2017 and 2023 were included. Paediatric stroke was determined using state-wide hospital admissions and death registration datasets. Infections in the 60 days before admission were ascertained using notifiable infection and hospital admissions databases. Associations between infection and paediatric stroke were determined using conditional logistic regression, following 1:5 case and stroke-free control matching.

Results: Over the 7-year period, 568 paediatric strokes (63% ischemic; median age 8.2 years; 46% female) occurred among >1.4 million children (incidence: 5.7 events [95% CI 5.3–6.2] per 100,000 person-years). One in ten patients with paediatric stroke had a documented infection in the preceding 60 days, with SARS-CoV-2 virus (COVID-19; n=18), respiratory syncytial virus (RSV; n=13), pneumococcal disease (n=7), and influenza virus (n=7) the most common. Children with paediatric stroke (vs. matched controls) were more likely to have had a recent infection (adjusted odds ratio: 2.22 [95% CI: 1.41–3.49]). Particularly, recent RSV infection was associated with a 3-fold increased odds of paediatric stroke (adjusted odds ratio: 2.98 [95% CI: 1.01–8.76]).

Conclusions: A recent infection, particularly RSV, is associated with paediatric stroke. Infection control strategies may help to support the prevention of paediatric stroke.