National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Sydney, Australia;
Children's Hospital Westmead Clinical School and.
Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-2120.
Febrile seizures (FSs) are a common pediatric condition caused by a sudden rise in temperature, affecting 3% to 5% of children aged ≤6 years. Although vaccination can cause FSs, little is known on whether FSs occurring in the time soon after vaccination (vaccine-proximate febrile seizures [VP-FSs] differ clinically from non-vaccine-proximate febrile seizures [NVP-FSs]). We compared the clinical profile and outcomes of VP-FS to NVP-FS.
Prospective cohort study of children aged ≤6 years presenting with their first FS at 1 of 5 Australian pediatric hospitals between May 2013 and June 2014. Clinical features, management, and outcomes were compared between VP-FS and NVP-FS.
Of 1022 first FS cases (median age 19.8 months; interquartile range 13.6-27.6), 67 (6%) were VP-FSs. When comparing VP-FS to NVP-FS, there was no increased risk of prolonged (>1 day) hospitalization (odds ratio [OR] 1.61; 95% confidence interval [95% CI] 0.84-3.10), ICU admission (OR 0.72; 95% CI 0.10-5.48), seizure duration >15 minutes (OR 1.47; 95% CI 0.73-2.98), repeat FS within 24 hours (OR 0.80; 95% CI 0.34-1.89), or requirement for antiepileptic treatment on discharge (OR 1.81; 95% CI 0.41-8.02). VP-FS patients with a laboratory-confirmed infection (12%) were more likely to have a prolonged admission compared with those without.
VP-FS accounted for a small proportion of all FS hospital presentations. There was no difference in outcomes of VP-FS compared with NVP-FS. This is reassuring data for clinicians and parents of children who experience FS after vaccination and can help guide decisions on revaccination.
热性惊厥（FS）是一种常见的儿科疾病，由体温突然升高引起，影响 3%至 5%的 6 岁以下儿童。虽然疫苗接种会引起 FS，但对于接种后不久发生的 FS（疫苗相关热性惊厥[VP-FS]）与非疫苗相关热性惊厥[NVP-FS]在临床上是否不同知之甚少。我们比较了 VP-FS 与 NVP-FS 的临床特征和结局。
2013 年 5 月至 2014 年 6 月期间，在澳大利亚的 5 家儿科医院，对首次出现 FS 的 1022 名 6 岁以下儿童进行前瞻性队列研究。比较 VP-FS 和 NVP-FS 之间的临床特征、管理和结局。
在 1022 例首次 FS 病例中（中位年龄 19.8 个月；四分位距 13.6-27.6），67 例（6%）为 VP-FS。与 NVP-FS 相比，VP-FS 患者住院时间延长（>1 天）的风险没有增加（比值比[OR]1.61；95%置信区间[95%CI]0.84-3.10），入住 ICU（OR 0.72；95%CI 0.10-5.48），癫痫发作持续时间>15 分钟（OR 1.47；95%CI 0.73-2.98），24 小时内再次发生 FS（OR 0.80；95%CI 0.34-1.89），或出院时需要抗癫痫治疗（OR 1.81；95%CI 0.41-8.02）的风险也没有增加。实验室确诊感染的 VP-FS 患者（12%）比无感染的患者更有可能延长住院时间。
VP-FS 占所有 FS 住院患者的比例较小。与 NVP-FS 相比，VP-FS 的结局没有差异。这为接种疫苗后出现 FS 的儿童的临床医生和家长提供了令人安心的数据，并有助于指导重新接种疫苗的决策。
