{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:58:54Z","timestamp":1790913534358,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":258,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2025,1]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n This study examined nationwide variation in tuberculosis (TB) screening and infliximab (IFX) use in the management of Kawasaki disease (KD) in Japan. Immunosuppressive agents such as IFX, which is used to treat refractory KD, may elevate the risk of TB infection. Although guidance exists for IFX use in KD patients, standardized protocols for TB screening, particularly regarding test selection and timing, are lacking.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A nationwide, cross\u2010sectional web\u2010based survey was conducted from October 2023 to February 2025. Eligible respondents were physicians involved in the care of KD patients at institutions with at least two full\u2010time pediatricians or clinics staffed by pediatricians or internists. The questionnaire covered four domains: respondent characteristics; TB screening practices prior to IFX administration; clinical decisions regarding IFX use in patients with active, past, or suspected TB; and preferences between originator and biosimilar IFX products.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 2000 invited physicians, 871 responded (response rate: 43.6%). Chest X\u2010rays and interferon\u2010gamma release assays (IGRAs) were frequently used before IFX administration, while the use of other tests varied. The timing of TB testing differed according to region, hospital type, and physician experience. Physicians in urban areas and university hospitals more often conducted early IGRA testing. The decision to administer IFX to patients with TB history also varied, with younger physicians and those at tertiary centers more likely to perform such administration.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Clinical practices regarding TB screening and IFX use in KD patients vary widely. While national guidance exists, our findings underscore the need for more detailed and uniformly implemented protocols to ensure safe and consistent care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ped.70202","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T08:13:36Z","timestamp":1758010416000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variation in tuberculosis screening and infliximab use in Kawasaki disease in Japan"],"prefix":"10.1111","volume":"67","author":[{"given":"Koji","family":"Yokoyama","sequence":"first","affiliation":[{"name":"Department of Pediatrics Japanese Red Cross Wakayama Medical Center Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsukazu","family":"Mamada","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Japanese Red Cross Wakayama Medical Center Wakayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2021.673554"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011110"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003974"},{"key":"e_1_2_10_5_1","unstructured":"MoriM MiuraM TakeiS.Guidelines for the use of infliximab in acute\u2010phase Kawasaki disease unresponsive to conventional therapy.2016."},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.55001"},{"key":"e_1_2_10_8_1","first-page":"630","article-title":"New international efforts in childhood tuberculosis: proceedings from the 2002 workshop on childhood tuberculosis, Montreal, Canada, 6\u20137 October 2002","volume":"8","author":"Wells CD","year":"2004","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_10_9_1","unstructured":"WHO Guidelines Approved by the Guidelines Review Committee.Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. World Health Organization Geneva; 2014."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000023204"},{"key":"e_1_2_10_11_1","article-title":"Treatment of latent tuberculosis infection in a Kawasaki disease patient receiving anti\u2010tumor necrosis factor alpha (TNF\u03b1) therapy","volume":"16","author":"Yokoyama K","year":"2024","journal-title":"Cureus"},{"key":"e_1_2_10_12_1","unstructured":"HarigaiM.Guidelines for the use of TNF inhibitors in the treatment of rheumatoid arthritis (RA).2024."},{"key":"e_1_2_10_13_1","unstructured":"Ministry of Health Labour and Welfare hotiT.Summary of the 2023 Annual Report of the Tuberculosis Surveillance in Japan.2024."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/926836"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.14034"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2020-012576"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011426"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.02.014"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/amajethics.2018.1007"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2012-04-425744"}],"container-title":["Pediatrics International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70202","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ped.70202","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ped.70202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:44:11Z","timestamp":1790912651000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ped.70202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/ped.70202"],"URL":"https:\/\/doi.org\/10.1111\/ped.70202","archive":["Portico"],"relation":{},"ISSN":["1328-8067","1442-200X"],"issn-type":[{"value":"1328-8067","type":"print"},{"value":"1442-200X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2025-04-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70202"}}