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Previous Volume 345:656-661 August 30, 2001 Number 9 Next

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ABSTRACT

Background The administration of the diphtheria and tetanus toxoids and whole-cell pertussis (DTP) vaccine and measles, mumps, and rubella (MMR) vaccine has been associated with seizures. We studied the relation between these vaccinations and the risk of a first seizure, subsequent seizures, and neurodevelopmental disability in children.

Methods This cohort study was conducted at four large health maintenance organizations and included reviews of the medical records of children with seizures. We calculated the relative risks of febrile and nonfebrile seizures among 679,942 children after 340,386 vaccinations with DTP vaccine, 137,457 vaccinations with MMR vaccine, or no recent vaccination. Children who had febrile seizures after vaccination were followed to identify the risk of subsequent seizures and other neurologic disabilities.

Results Receipt of DTP vaccine was associated with an increased risk of febrile seizures only on the day of vaccination (adjusted relative risk, 5.70; 95 percent confidence interval, 1.98 to 16.42). Receipt of MMR vaccine was associated with an increased risk of febrile seizures 8 to 14 days after vaccination (relative risk, 2.83; 95 percent confidence interval, 1.44 to 5.55). Neither vaccination was associated with an increased risk of nonfebrile seizures. The number of febrile seizures attributable to the administration of DTP and MMR vaccines was estimated to be 6 to 9 and 25 to 34 per 100,000 children, respectively. As compared with other children with febrile seizures that were not associated with vaccination, the children who had febrile seizures after vaccination were not found to be at higher risk for subsequent seizures or neurodevelopmental disabilities.

Conclusions There are significantly elevated risks of febrile seizures after receipt of DTP vaccine or MMR vaccine, but these risks do not appear to be associated with any long-term, adverse consequences.

Source Information

From the Immunization Studies Program, Center for Health Studies, Group Health Cooperative, Seattle (W.E.B., R.L.D., R.S.T.); the Department of Biostatistics, University of Washington, Seattle (W.E.B.); the National Immunization Program, Vaccine Safety and Development Activity, Centers for Disease Control and Prevention, Atlanta (J.W.G., P.H.R., F.D., R.T.C.); the Center for Health Research, Northwest Kaiser Permanente, Portland, Oreg. (J.P.M.); the Division of Research, Kaiser Permanente of Northern California, Oakland (S.B.B., H.R.S.); the UCLA Center for Vaccine Research, Harbor–UCLA Medical Center, Torrance, Calif. (J.I.W.); and the Kaiser–UCLA Vaccine Research Group, Southern California Kaiser Permanente, Panorama City, Calif. (S.M.M.).

Other authors were Virginia Immanuel, M.P.H. (Immunization Studies Program, Center for Health Studies, Group Health Cooperative, Seattle), John A. Pearson, M.D. (Center for Health Research, Northwest Kaiser Permanente, Portland, Oreg.), Constance M. Vadheim, Ph.D. (UCLA Center for Vaccine Research, Harbor–UCLA Medical Center, Torrance, Calif.), Viviana Rebolledo, B.S. (Immunization Studies Program, Center for Health Studies, Group Health Cooperative, Seattle), Dimitri Christakis, M.D., M.P.H. (Department of Pediatrics, University of Washington, Seattle), Patti J. Benson, M.P.H. (Immunization Studies Program, Center for Health Studies, Group Health Cooperative, Seattle), and Ned Lewis, M.P.H. (Division of Research, Kaiser Permanente of Northern California, Oakland).

Address reprint requests to Dr. Davis at the Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101-1448.

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