Top Karina A, Brna Paula, Ye Lingyun, Smith Bruce
Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada.
BMC Pediatr. 2018 Apr 11;18(1):134. doi: 10.1186/s12887-018-1112-0.
In children with epilepsy, fever and infection can trigger seizures. Immunization can also induce inflammation and fever, which could theoretically trigger a seizure. The risk of seizure after immunization in children with pre-existing epilepsy is not known. The study objective was to determine the risk of medically attended seizure after immunization in children with epilepsy < 7 years of age.
We conducted a retrospective study of children < 7 years of age with epilepsy in Nova Scotia, Canada from 2010 to 2014. Hospitalizations, emergency visits, unscheduled clinic visits, and telephone calls for seizures were extracted from medical records. Immunization records were obtained from family physicians and Public Health with informed consent. We conducted a risk interval analysis to estimate the relative risk (RR) of seizure during risk periods 0-14, 0-2, and 5-14 days post-immunization versus a control period 21-83 days post-immunization.
There were 302 children with epilepsy who were eligible for the study. Immunization records were retrieved on 147 patients (49%), of whom 80 (54%) had one or more immunizations between the epilepsy diagnosis date and age 7 years. These 80 children had 161 immunization visits and 197 medically attended seizures. Children with immunizations had more seizures than either those with no immunizations or those with no records (mean 2.5 versus 0.7 versus 0.9, p < 0.001). The risk of medically attended seizure was not increased 0-14 days after any vaccine (RR = 1.1, 95% confidence interval (CI): 0.5-2.8) or 0-2 days after inactivated vaccines (RR = 0.9, 95% CI: 0.1-7.1) versus 21-83 days post-immunization. No seizure events occurred 5-14 days after live vaccines.
Children with epilepsy do not appear to be at increased risk of medically attended seizure following immunization. These findings suggest that immunization is safe in children with epilepsy, with benefits outweighing risks.
在癫痫患儿中，发热和感染可引发癫痫发作。免疫接种也可诱发炎症和发热，理论上可能引发癫痫发作。已有癫痫的儿童免疫接种后癫痫发作的风险尚不清楚。本研究的目的是确定7岁以下癫痫患儿免疫接种后就医癫痫发作的风险。
我们对2010年至2014年加拿大新斯科舍省7岁以下的癫痫患儿进行了一项回顾性研究。从医疗记录中提取住院、急诊就诊、非预约门诊就诊以及癫痫发作的电话记录。在获得知情同意后，从家庭医生和公共卫生部门获取免疫接种记录。我们进行了风险区间分析，以估计免疫接种后0至14天、0至2天和5至14天风险期内癫痫发作的相对风险（RR）与免疫接种后21至83天对照期的相对风险。
有302名癫痫患儿符合研究条件。检索到147名患者（49%）的免疫接种记录，其中80名（54%）在癫痫诊断日期至7岁之间进行了一次或多次免疫接种。这80名儿童有161次免疫接种就诊和197次就医癫痫发作。接种疫苗的儿童比未接种疫苗或无记录的儿童癫痫发作更多（平均2.5次对0.7次对0.9次，p<0.001）。与免疫接种后21至83天相比，任何疫苗接种后0至14天（RR=1.1，95%置信区间（CI）：0.5至2.8）或灭活疫苗接种后0至2天（RR=0.9，95%CI：0.1至7.1）就医癫痫发作的风险并未增加。活疫苗接种后5至14天未发生癫痫发作事件。
癫痫患儿免疫接种后就医癫痫发作的风险似乎并未增加。这些发现表明，癫痫患儿免疫接种是安全的，益处大于风险。
