Macartney Kristine K, Gidding Heather F, Trinh Lieu, Wang Han, McRae Jocelynne, Crawford Nigel, Gold Michael, Kynaston Anne, Blyth Christopher, Yvonne Zurynski, Elliott Elizabeth, Booy Robert, Buttery Jim, Marshall Helen, Nissen Michael, Richmond Peter, McInytre Peter B, Wood Nicholas
National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia.
National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.
Vaccine. 2015 Mar 10;33(11):1412-7. doi: 10.1016/j.vaccine.2014.10.071. Epub 2014 Nov 7.
Febrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age.
All FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11-23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk.
There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5-12 days post receipt of MMR1 at 12 months (RI=1.9 [95% CI: 1.3-2.9]), but not after VV at 18 months (RI=0.6 [95% CI: 0.3-1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11-23 months (95% CI=7-49 cases per 100,000) or 1 per 4167 doses.
Our study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.
热性惊厥（FS）在儿童期很常见，发病率在第二年达到峰值，此时会接种含麻疹和水痘的疫苗。本研究旨在探讨在计划将MMRV作为18月龄含麻疹疫苗的第二剂之前，分别接种MMR和单价水痘疫苗（VV）后FS的疫苗归因风险。
从参与PAEDS（儿科主动强化疾病监测）的五家澳大利亚三级儿科医院的急诊科（ED）和住院数据库中识别出2012年1月1日至2013年4月30日期间年龄＜5岁儿童的所有FS病例。免疫接种记录从澳大利亚儿童免疫登记册（ACIR）获取。使用自控病例系列（SCCS）方法确定11至23月龄儿童接种MMR第1剂（MMR1）和VV后FS的相对发病率（RI），并用于计算归因风险。
1761名儿童中有2013次FS发作。FS的高峰年龄为18个月。在12个月接种MMR1后5至12天，FS风险显著增加（RI = 1.9 [95% CI：1.3 - 2.9]），但在18个月接种VV后未增加（RI = 0.6 [95% CI：0.3 - 1.2]）。每100,000名11至23月龄接种疫苗儿童中，MMR1接种后FS的估计年度超额病例数为24例（95% CI =每100,000例7 - 49例）或每4167剂1例。
我们的研究检测到12个月接种MMR1疫苗后FS风险预期增加，但18个月接种单价水痘疫苗与FS风险增加无关。这为评估2013年7月在澳大利亚作为18月龄含麻疹疫苗的第二剂引入的MMRV接种后FS风险提供了基线数据。
