Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada.
Canadian Center for Vaccinology, IWK Health, Nova Scotia Health, and Dalhousie University, Halifax, Nova Scotia, Canada; Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
J Pediatr. 2022 Nov;250:45-53.e3. doi: 10.1016/j.jpeds.2022.07.019. Epub 2022 Aug 7.
To estimate the risk of recurrence of adverse events following immunization (AEFIs) upon revaccination and to determine among patients with suspected vaccine allergy whether allergy skin test positivity was associated with AEFI recurrence.
This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 with AEFIs who required revaccination with the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Special Immunization Clinic physicians used guidelines to inform their recommendations. Participants were followed up after revaccination to capture AEFI recurrences. Data were transferred to a central database for descriptive analysis.
Overall, 588 participants were assessed for 627 AEFIs; 570 (91%) AEFIs occurred in children <18 years of age. AEFIs included immediate hypersensitivity (130/627; 21%), large local reactions (110/627; 18%), nonurticarial rash (51/627; 8%), seizures (26/627; 4%), and thrombocytopenia (11/627; 2%). Revaccination was recommended to 513 of 588 (87%) participants. Among participants recommended and due for revaccination during the study period, 63% (299/477) were revaccinated. AEFI recurrence was 10% (31/299) overall, 31% (15/49) for large local reactions, and 7% (5/66) for immediate hypersensitivity. No recurrence was serious. Among 92 participants with suspected vaccine allergy who underwent skin testing and were revaccinated, the negative predictive value of skin testing for AEFI recurrence was 96% (95% CI 92.5%-99.5%).
Most individuals with AEFIs were safely revaccinated. Among those with suspected vaccine allergy, skin testing may help determine the safety of revaccination.
评估再次接种疫苗后不良事件（AEFI）复发的风险，并确定在疑似疫苗过敏的患者中，过敏皮肤试验阳性是否与 AEFI 复发相关。
本前瞻性观察性研究纳入了 2013 年至 2019 年期间在加拿大特殊免疫接种门诊网络中因 AEFI 而需要接种与 AEFI 相关疫苗的患者。参与者接受了标准化评估和数据收集。特殊免疫接种门诊医生使用指南为他们的建议提供信息。在接种疫苗后对参与者进行随访，以捕捉 AEFI 的复发情况。数据被转移到中央数据库进行描述性分析。
总体而言，588 名参与者因 627 例 AEFI 接受评估；570 例（91%）AEFI 发生在<18 岁的儿童中。AEFI 包括速发型过敏反应（130/627；21%）、大局部反应（110/627；18%）、非荨麻疹性皮疹（51/627；8%）、癫痫发作（26/627；4%）和血小板减少症（11/627；2%）。588 名参与者中有 513 名（87%）被推荐接种疫苗。在研究期间建议接种疫苗且应接种疫苗的参与者中，63%（299/477）接受了接种。总体 AEFI 复发率为 10%（31/299），大局部反应的复发率为 31%（15/49），速发型过敏反应的复发率为 7%（5/66）。没有严重的复发事件。在 92 名疑似疫苗过敏的参与者中，进行了皮肤测试并进行了疫苗接种，皮肤测试对 AEFI 复发的阴性预测值为 96%（95%CI 92.5%-99.5%）。
大多数 AEFI 患者可安全地再次接种疫苗。在疑似疫苗过敏的患者中，皮肤测试可能有助于确定再次接种疫苗的安全性。
