Department of Pediatrics and
Duke Human Vaccine Institute, School of Medicine, Duke University, Durham, North Carolina.
Pediatrics. 2020 Mar;145(3). doi: 10.1542/peds.2019-1909. Epub 2020 Feb 6.
Administering inactivated influenza vaccine (IIV), 13-valent pneumococcal conjugate vaccine (PCV13), and diphtheria-tetanus-acellular pertussis (DTaP) vaccine together has been associated with increased risk for febrile seizure after vaccination. We assessed the effect of administering IIV at a separate visit from PCV13 and DTaP on postvaccination fever.
In 2017-2018, children aged 12 to 16 months were randomly assigned to receive study vaccines simultaneously or sequentially. They had 2 study visits 2 weeks apart; nonstudy vaccines were permitted at visit 1. The simultaneous group received PCV13, DTaP, and quadrivalent IIV (IIV4) at visit 1 and no vaccines at visit 2. The sequential group received PCV13 and DTaP at visit 1 and IIV4 at visit 2. Participants were monitored for fever (≥38°C) and antipyretic use during the 8 days after visits.
There were 110 children randomly assigned to the simultaneous group and 111 children to the sequential group; 90% received ≥1 nonstudy vaccine at visit 1. Similar proportions of children experienced fever on days 1 to 2 after visits 1 and 2 combined (simultaneous [8.1%] versus sequential [9.3%]; adjusted relative risk = 0.87 [95% confidence interval 0.36-2.10]). During days 1 to 2 after visit 1, more children in the simultaneous group received antipyretics (37.4% vs 22.4%; = .020).
In our study, delaying IIV4 administration by 2 weeks in children receiving DTaP and PCV13 did not reduce fever occurrence after vaccination. Reevaluating this strategy to prevent fever using an IIV4 with a different composition in a future influenza season may be considered.
同时接种灭活流感疫苗（IIV）、13 价肺炎球菌结合疫苗（PCV13）和无细胞百白破疫苗（DTaP）与接种后发热性惊厥的风险增加有关。我们评估了在接种 PCV13 和 DTaP 之外的时间接种 IIV 对疫苗接种后发热的影响。
在 2017-2018 年，12 至 16 月龄儿童被随机分配接受研究疫苗同时或序贯接种。他们在 2 周内进行 2 次研究就诊；就诊 1 时允许接种非研究疫苗。同时组在就诊 1 时接种 PCV13、DTaP 和四价 IIV（IIV4），就诊 2 时不接种疫苗。序贯组在就诊 1 时接种 PCV13 和 DTaP，就诊 2 时接种 IIV4。在就诊后 8 天内监测参与者的发热（≥38°C）和退热药物使用情况。
110 名儿童被随机分配到同时组，111 名儿童被分配到序贯组；90%的儿童在就诊 1 时接种了≥1 种非研究疫苗。就诊 1 和 2 后 2 天合并发热的儿童比例相似（同时组 8.1%，序贯组 9.3%；调整后相对风险=0.87[95%置信区间 0.36-2.10]）。就诊 1 后第 1 天至第 2 天，同时组接受退热药物的儿童比例更高（37.4%比 22.4%；P=0.020）。
在我们的研究中，在接受 DTaP 和 PCV13 接种的儿童中，将 IIV4 的接种时间推迟 2 周并未降低疫苗接种后的发热发生率。在未来的流感季节，使用不同成分的 IIV4 重新评估这种预防发热的策略可能是值得考虑的。
