The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents
The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown. Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were ident...
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| Veröffentlicht in: | Pediatrics (Evanston) 2012-02, Vol.129 (2), p.248-255 |
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| creator | O'LEARY, Sean T GLANZ, Jason M BALL, Robert MCCLURE, David L AKHTAR, Aysha DALEY, Matthew F NAKASATO, Cynthia BAXTER, Roger DAVIS, Robert L IZURIETA, Hector S LIEU, Tracy A |
| description | The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown.
Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae.
ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation. |
| doi_str_mv | 10.1542/peds.2011-1111 |
| format | Article |
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Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae.
ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2011-1111</identifier><identifier>PMID: 22232308</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: American Academy of Pediatrics</publisher><subject>Adolescent ; Adverse and side effects ; Adverse drug reactions ; Biological and medical sciences ; Blood platelets ; Causes of ; Chickenpox Vaccine - adverse effects ; Chickenpox Vaccine - immunology ; Child ; Child, Preschool ; Children & youth ; Cohort Studies ; Complications and side effects ; Diphtheria-Tetanus-acellular Pertussis Vaccines - adverse effects ; Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology ; Drugs ; Female ; General aspects ; Hematologic and hematopoietic diseases ; Hepatitis A Vaccines - adverse effects ; Hepatitis A Vaccines - immunology ; Humans ; Immunization ; Infant ; Male ; Medical sciences ; Pediatrics ; Platelet diseases and coagulopathies ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Purpura, Thrombocytopenic, Idiopathic - epidemiology ; Purpura, Thrombocytopenic, Idiopathic - etiology ; Retrospective Studies ; Risk ; Risk assessment ; Thrombocytopenic purpura ; United States ; Vaccination ; Vaccination - adverse effects ; Vaccines</subject><ispartof>Pediatrics (Evanston), 2012-02, Vol.129 (2), p.248-255</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Academy of Pediatrics Feb 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c495t-dd2f3db063a8d89fbf0d322316907768625e01534b64aba44e2eb6d661b454843</citedby><cites>FETCH-LOGICAL-c495t-dd2f3db063a8d89fbf0d322316907768625e01534b64aba44e2eb6d661b454843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25481874$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22232308$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O'LEARY, Sean T</creatorcontrib><creatorcontrib>GLANZ, Jason M</creatorcontrib><creatorcontrib>BALL, Robert</creatorcontrib><creatorcontrib>MCCLURE, David L</creatorcontrib><creatorcontrib>AKHTAR, Aysha</creatorcontrib><creatorcontrib>DALEY, Matthew F</creatorcontrib><creatorcontrib>NAKASATO, Cynthia</creatorcontrib><creatorcontrib>BAXTER, Roger</creatorcontrib><creatorcontrib>DAVIS, Robert L</creatorcontrib><creatorcontrib>IZURIETA, Hector S</creatorcontrib><creatorcontrib>LIEU, Tracy A</creatorcontrib><title>The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown.
Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae.
ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.</description><subject>Adolescent</subject><subject>Adverse and side effects</subject><subject>Adverse drug reactions</subject><subject>Biological and medical sciences</subject><subject>Blood platelets</subject><subject>Causes of</subject><subject>Chickenpox Vaccine - adverse effects</subject><subject>Chickenpox Vaccine - immunology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Diphtheria-Tetanus-acellular Pertussis Vaccines - adverse effects</subject><subject>Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology</subject><subject>Drugs</subject><subject>Female</subject><subject>General aspects</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hepatitis A Vaccines - adverse effects</subject><subject>Hepatitis A Vaccines - immunology</subject><subject>Humans</subject><subject>Immunization</subject><subject>Infant</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pediatrics</subject><subject>Platelet diseases and coagulopathies</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Purpura, Thrombocytopenic, Idiopathic - epidemiology</subject><subject>Purpura, Thrombocytopenic, Idiopathic - etiology</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk assessment</subject><subject>Thrombocytopenic purpura</subject><subject>United States</subject><subject>Vaccination</subject><subject>Vaccination - adverse effects</subject><subject>Vaccines</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU2L1DAYgIMo7uzq1aMEQfbUMZ9tehwGPxYWVmQUPIU0ebuTtU1q0oL7702ZUcFccnny5nl5EHpFyZZKwd5N4PKWEUorWs4TtKGkVZVgjXyKNoRwWglC5AW6zPmBECJkw56jC8YYZ5yoDfp-OAL-4vMPHHt8M45LAHw4pjh20T7OcYLgLf68pGlJBu_6GRL-Zqz1wcw-BuwD3h_94BIEbILDOxcHyBbCnF-gZ70ZMrw831fo64f3h_2n6vbu481-d1tZ0cq5co713HWk5kY51fZdTxwverRuSdPUqmYSCJVcdLUwnRECGHS1q2vaCSmU4Ffo-jR3SvHnAnnWoy8Gw2ACxCXrlratlJLLQr75j3yISwpFTreMKaKIWMdVJ-jeDKB9sDHM8Gu2cRjgHnRR39_pHVNcteT0_fbE2xRzTtDrKfnRpEdNiV4T6TWRXhPpNVF58PpssXQjuL_4nyYFeHsGTLZm6JMJ1ud_XNmaqkbw3_VLl0k</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>O'LEARY, Sean T</creator><creator>GLANZ, Jason M</creator><creator>BALL, Robert</creator><creator>MCCLURE, David L</creator><creator>AKHTAR, Aysha</creator><creator>DALEY, Matthew F</creator><creator>NAKASATO, Cynthia</creator><creator>BAXTER, Roger</creator><creator>DAVIS, Robert L</creator><creator>IZURIETA, Hector S</creator><creator>LIEU, Tracy A</creator><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20120201</creationdate><title>The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents</title><author>O'LEARY, Sean T ; GLANZ, Jason M ; BALL, Robert ; MCCLURE, David L ; AKHTAR, Aysha ; DALEY, Matthew F ; NAKASATO, Cynthia ; BAXTER, Roger ; DAVIS, Robert L ; IZURIETA, Hector S ; LIEU, Tracy A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c495t-dd2f3db063a8d89fbf0d322316907768625e01534b64aba44e2eb6d661b454843</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adverse and side effects</topic><topic>Adverse drug reactions</topic><topic>Biological and medical sciences</topic><topic>Blood platelets</topic><topic>Causes of</topic><topic>Chickenpox Vaccine - adverse effects</topic><topic>Chickenpox Vaccine - immunology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Cohort Studies</topic><topic>Complications and side effects</topic><topic>Diphtheria-Tetanus-acellular Pertussis Vaccines - adverse effects</topic><topic>Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology</topic><topic>Drugs</topic><topic>Female</topic><topic>General aspects</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hepatitis A Vaccines - adverse effects</topic><topic>Hepatitis A Vaccines - immunology</topic><topic>Humans</topic><topic>Immunization</topic><topic>Infant</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pediatrics</topic><topic>Platelet diseases and coagulopathies</topic><topic>Prevention and actions</topic><topic>Public health. 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Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae.
ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.</abstract><cop>Elk Grove Village, IL</cop><pub>American Academy of Pediatrics</pub><pmid>22232308</pmid><doi>10.1542/peds.2011-1111</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adverse and side effects Adverse drug reactions Biological and medical sciences Blood platelets Causes of Chickenpox Vaccine - adverse effects Chickenpox Vaccine - immunology Child Child, Preschool Children & youth Cohort Studies Complications and side effects Diphtheria-Tetanus-acellular Pertussis Vaccines - adverse effects Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology Drugs Female General aspects Hematologic and hematopoietic diseases Hepatitis A Vaccines - adverse effects Hepatitis A Vaccines - immunology Humans Immunization Infant Male Medical sciences Pediatrics Platelet diseases and coagulopathies Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Purpura, Thrombocytopenic, Idiopathic - epidemiology Purpura, Thrombocytopenic, Idiopathic - etiology Retrospective Studies Risk Risk assessment Thrombocytopenic purpura United States Vaccination Vaccination - adverse effects Vaccines |
| title | The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents |
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