FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

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

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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.

Full Text of this Article

This article has been cited by other articles:

• Dean, B. B., Lam, J., Natoli, J. L., Butler, Q., Aguilar, D., Nordyke, R. J. (2009). Review: Use of Electronic Medical Records for Health Outcomes Research: A Literature Review. Med Care Res Rev 66: 611-638 [Abstract]  
• Zupanc, M. L. (2009). Clinical Evaluation and Diagnosis of Severe Epilepsy Syndromes of Early Childhood. J Child Neurol 24: 6S-14S [Abstract]  
• Whitaker, H. J, Hocine, M. N, Farrington, C P. (2009). The methodology of self-controlled case series studies. Stat Methods Med Res 18: 7-26 [Abstract]  
• Zangwill, K. M., Eriksen, E., Lee, M., Lee, J., Marcy, S. M., Friedland, L. R., Weston, W., Howe, B., Ward, J. I. (2008). A Population-Based, Postlicensure Evaluation of the Safety of a Combination Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B, and Inactivated Poliovirus Vaccine in a Large Managed Care Organization. Pediatrics 122: e1179-e1185 [Abstract] [Full Text]  
• (2008). Update: Recommendations From the Advisory Committee on Immunization Practices (ACIP) Regarding Administration of Combination MMRV Vaccine. JAMA 299: 1765-1766 [Full Text]  
• Braun, M. M. (2008). Toward Better Vaccine Safety Data and Safer Vaccination. Pediatrics 121: 625-626 [Full Text]  
• Fry, S. R., Chen, A. Y., Daggard, G., Mukkur, T. K. S. (2008). Parenteral immunization of mice with a genetically inactivated pertussis toxin DNA vaccine induces cell-mediated immunity and protection. J Med Microbiol 57: 28-35 [Abstract] [Full Text]  
• Ward, K. N., Bryant, N. J., Andrews, N. J., Bowley, J. S., Ohrling, A., Verity, C. M., Ross, E. M., Miller, E. (2007). Risk of Serious Neurologic Disease After Immunization of Young Children in Britain and Ireland. Pediatrics 120: 314-321 [Abstract] [Full Text]  
• Miller, E, Andrews, N, Stowe, J, Grant, A, Waight, P, Taylor, B (2007). Risks of Convulsion and Aseptic Meningitis following Measles-Mumps-Rubella Vaccination in the United Kingdom. Am J Epidemiol 165: 704-709 [Abstract] [Full Text]  
• Hambidge, S. J., Glanz, J. M., France, E. K., McClure, D., Xu, S., Yamasaki, K., Jackson, L., Mullooly, J. P., Zangwill, K. M., Marcy, S. M., Black, S. B., Lewis, E. M., Shinefield, H. R., Belongia, E., Nordin, J., Chen, R. T., Shay, D. K., Davis, R. L., DeStefano, F., for the Vaccine Safety Datalink Team, (2006). Safety of Trivalent Inactivated Influenza Vaccine in Children 6 to 23 Months Old. JAMA 296: 1990-1997 [Abstract] [Full Text]  
• Cummings, P, Rivara, F P, Thompson, R S, Reid, R J (2005). Ability of parents to recall the injuries of their young children. Inj. Prev. 11: 43-47 [Abstract] [Full Text]  
• McMahon, A. W., Iskander, J., Haber, P., Chang, S., Woo, E. J., Braun, M. M., Ball, R. (2005). Adverse Events After Inactivated Influenza Vaccination Among Children Less Than 2 Years of Age: Analysis of Reports From the Vaccine Adverse Event Reporting System, 1990-2003. Pediatrics 115: 453-460 [Abstract] [Full Text]  
• Waruiru, C, Appleton, R (2004). Febrile seizures: an update. Arch. Dis. Child. 89: 751-756 [Abstract] [Full Text]  
• Vestergaard, M., Hviid, A., Madsen, K. M., Wohlfahrt, J., Thorsen, P., Schendel, D., Melbye, M., Olsen, J. (2004). MMR Vaccination and Febrile Seizures: Evaluation of Susceptible Subgroups and Long-term Prognosis. JAMA 292: 351-357 [Abstract] [Full Text]  
• Bale, J. F. JR (2004). Topical Review: Neurologic Complications of Immunization. J Child Neurol 19: 405-412 [Abstract]  
• Le Saux, N., Barrowman, N. J., Moore, D. L., Whiting, S., Scheifele, D., Halperin, S., for Members of the Canadian Paediatric Society/ He, (2003). Decrease in Hospital Admissions for Febrile Seizures and Reports of Hypotonic-Hyporesponsive Episodes Presenting to Hospital Emergency Departments Since Switching to Acellular Pertussis Vaccine in Canada: A Report From IMPACT. Pediatrics 112: e348-348 [Abstract] [Full Text]  
• (2003). MMR vaccine - how effective and how safe?. DTB 41: 25-29 [Abstract] [Full Text]  
• da Silveira, C. M., Kmetzsch, C. I., Mohrdieck, R., Sperb, A. F., Prevots, D R. (2002). The risk of aseptic meningitis associated with the Leningrad-Zagreb mumps vaccine strain following mass vaccination with measles-mumps-rubella vaccine, Rio Grande do Sul, Brazil, 1997. Int J Epidemiol 31: 978-982 [Abstract] [Full Text]  
• Greene, A. (2002). Vaccination Fears: What the School Nurse Can Do. The Journal of School Nursing 18: 31-35 [Full Text]  
• Abramson, J. S., Pickering, L. K. (2002). US Immunization Policy. JAMA 287: 505-509 [Full Text]  
• Millichap, J. G., Rathore, M. H. (2001). Increased Risk of Seizures Following DTP and MMR Vaccine Is Not Associated with Any Long-Term Adverse Consequences. AAP Grand Rounds 6: 54-55 [Full Text]  
• (2001). Seizures After Childhood Vaccinations. JWatch Infect. Diseases 2001: 4-4 [Full Text]