Febrile seizures following measles and varicella vaccines in young children in Australia

Kristine K Macartney; Heather F Gidding; Lieu Trinh; Han Wang; Jocelynne McRae; Nigel Crawford; Michael Gold; Anne Kynaston; Christopher Blyth; Zurynski Yvonne; Elizabeth Elliott; Robert Booy; Jim Buttery; Helen Marshall; Michael Nissen; Peter Richmond; Peter B McInytre; Nicholas Wood; PAEDS (Paediatric Active Enhanced Disease Surveillance) Network

doi:10.1016/j.vaccine.2014.10.071

Febrile seizures following measles and varicella vaccines in young children in Australia

Vaccine. 2015 Mar 10;33(11):1412-7. doi: 10.1016/j.vaccine.2014.10.071. Epub 2014 Nov 7.

Authors

Kristine K Macartney¹, Heather F Gidding², Lieu Trinh³, Han Wang³, Jocelynne McRae³, Nigel Crawford⁴, Michael Gold⁵, Anne Kynaston⁶, Christopher Blyth⁷, Zurynski Yvonne⁸, Elizabeth Elliott⁸, Robert Booy⁹, Jim Buttery¹⁰, Helen Marshall⁵, Michael Nissen⁶, Peter Richmond⁷, Peter B McInytre⁹, Nicholas Wood⁹; PAEDS (Paediatric Active Enhanced Disease Surveillance) Network

Affiliations

¹ National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia. Electronic address: kristine.macartney@health.nsw.gov.au.
² National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.
³ National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia.
⁴ Murdoch Children's Research Institute, Parkville, Australia; Royal Children's Hospital, Melbourne, Australia.
⁵ Women and Children's Hospital, Adelaide, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
⁶ Royal Children's Hospital, Brisbane, Australia.
⁷ Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; University of Western Australia School of Paediatrics and Child health, Princess Margaret Hospital, Perth, Australia.
⁸ Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia; Australian Paediatric Surveillance Unit, Westmead, Australia.
⁹ National Centre for Immunization Research & Surveillance, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; Children's Hospital Westmead, Sydney, Australia.
¹⁰ Murdoch Children's Research Institute, Parkville, Australia; Paediatrics Department, The University of Melbourne, Melbourne, Australia.

PMID: 25444797
DOI: 10.1016/j.vaccine.2014.10.071

Abstract

Background: Febrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age.

Methods: All FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11-23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk.

Results: There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5-12 days post receipt of MMR1 at 12 months (RI=1.9 [95% CI: 1.3-2.9]), but not after VV at 18 months (RI=0.6 [95% CI: 0.3-1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11-23 months (95% CI=7-49 cases per 100,000) or 1 per 4167 doses.

Conclusions: Our study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.

Keywords: Febrile seizures; Measles–mumps–rubella vaccine; Risk; Vaccine safety; Varicella vaccine.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Chickenpox Vaccine / adverse effects*
Child
Child, Preschool
Female
Humans
Incidence
Infant
Male
Measles-Mumps-Rubella Vaccine / adverse effects*
Risk Factors
Seizures, Febrile / epidemiology*
Seizures, Febrile / etiology*
Vaccines, Combined

Substances

Chickenpox Vaccine
Measles-Mumps-Rubella Vaccine
Vaccines, Combined
measles, mumps, rubella, varicella vaccine