Kaiser Permanente Vaccine Study Center, Oakland, CA 94612, USA.
Pediatrics. 2010 Jul;126(1):e1-8. doi: 10.1542/peds.2010-0665. Epub 2010 Jun 29.
In February 2008, we alerted the Advisory Committee on Immunization Practices to preliminary evidence of a twofold increased risk of febrile seizures after the combination measles-mumps-rubella-varicella (MMRV) vaccine when compared with separate measles-mumps-rubella (MMR) and varicella vaccines. Now with data on twice as many vaccine recipients, our goal was to reexamine seizure risk after MMRV vaccine.
Using 2000-2008 Vaccine Safety Datalink data, we assessed seizures and fever visits among children aged 12 to 23 months after MMRV and separate MMR + varicella vaccines. We compared seizure risk after MMRV vaccine to that after MMR + varicella vaccines by using Poisson regression as well as with supplementary regressions that incorporated chart-review results and self-controlled analyses.
MMRV vaccine recipients (83,107) were compared with recipients of MMR + varicella vaccines (376,354). Seizure and fever significantly clustered 7 to 10 days after vaccination with all measles-containing vaccines but not after varicella vaccination alone. Seizure risk during days 7 to 10 was higher after MMRV than after MMR + varicella vaccination (relative risk: 1.98 [95% confidence interval: 1.43-2.73]). Supplementary analyses yielded similar results. The excess risk for febrile seizures 7 to 10 days after MMRV compared with separate MMR + varicella vaccination was 4.3 per 10,000 doses (95% confidence interval: 2.6-5.6).
Among 12- to 23-month-olds who received their first dose of measles-containing vaccine, fever and seizure were elevated 7 to 10 days after vaccination. Vaccination with MMRV results in 1 additional febrile seizure for every 2300 doses given instead of separate MMR + varicella vaccines. Providers who recommend MMRV should communicate to parents that it increases the risk of fever and seizure over that already associated with measles-containing vaccines.
2008 年 2 月，我们向免疫实践咨询委员会通报了初步证据，表明在接种麻疹-腮腺炎-风疹-水痘（MMRV）联合疫苗后，与分别接种麻疹-腮腺炎-风疹（MMR）和水痘疫苗相比，热性惊厥的风险增加了两倍。现在，我们有了两倍数量的疫苗接种者的数据，我们的目标是重新检查 MMRV 疫苗接种后的癫痫发作风险。
使用 2000-2008 年疫苗安全数据链接数据，我们评估了 12 至 23 个月大的儿童在接种 MMRV 和单独 MMR+水痘疫苗后发生癫痫发作和发热就诊的情况。我们使用泊松回归以及包含图表审查结果和自我对照分析的补充回归来比较 MMRV 疫苗接种后的癫痫发作风险与 MMR+水痘疫苗接种后的风险。
将 MMRV 疫苗接种者（83107 人）与 MMR+水痘疫苗接种者（376354 人）进行比较。所有含麻疹疫苗接种后 7 至 10 天，癫痫发作和发热显著聚集，但单独接种水痘疫苗则不会。接种 MMRV 疫苗后 7 至 10 天的癫痫发作风险高于 MMR+水痘疫苗（相对风险：1.98 [95%置信区间：1.43-2.73]）。补充分析得出了类似的结果。与单独接种 MMR+水痘疫苗相比，MMRV 接种后 7 至 10 天的发热性惊厥风险增加了 4.3 例/10000 剂（95%置信区间：2.6-5.6）。
在接种首剂含麻疹疫苗的 12 至 23 个月大的儿童中，接种后 7 至 10 天发热和癫痫发作的风险增加。与单独接种 MMR+水痘疫苗相比，接种 MMRV 疫苗每 2300 剂会增加 1 例发热性惊厥。推荐接种 MMRV 的医生应告知家长，接种 MMRV 会增加发热和癫痫发作的风险，超过与含麻疹疫苗相关的风险。
