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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Published inPediatrics (Evanston) Vol. 129; no. 2; p. 248
Main Authors O'Leary, Sean T, Glanz, Jason M, McClure, David L, Akhtar, Aysha, Daley, Matthew F, Nakasato, Cynthia, Baxter, Roger, Davis, Robert L, Izurieta, Hector S, Lieu, Tracy A, Ball, Robert
Format Journal Article
LanguageEnglish
Published United States 01.02.2012
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Abstract 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.
AbstractList 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.
Author O'Leary, Sean T
Ball, Robert
Davis, Robert L
Izurieta, Hector S
McClure, David L
Baxter, Roger
Lieu, Tracy A
Akhtar, Aysha
Daley, Matthew F
Nakasato, Cynthia
Glanz, Jason M
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  organization: Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. sean.o'leary@childrenscolorado.org
– sequence: 2
  givenname: Jason M
  surname: Glanz
  fullname: Glanz, Jason M
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Snippet The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown. Using data from 5 managed...
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StartPage 248
SubjectTerms Adolescent
Chickenpox Vaccine - adverse effects
Chickenpox Vaccine - immunology
Child
Child, Preschool
Cohort Studies
Diphtheria-Tetanus-acellular Pertussis Vaccines - adverse effects
Diphtheria-Tetanus-acellular Pertussis Vaccines - immunology
Female
Hepatitis A Vaccines - adverse effects
Hepatitis A Vaccines - immunology
Humans
Infant
Male
Purpura, Thrombocytopenic, Idiopathic - epidemiology
Purpura, Thrombocytopenic, Idiopathic - etiology
Retrospective Studies
Risk
United States
Vaccination - adverse effects
Title The risk of immune thrombocytopenic purpura after vaccination in children and adolescents
URI https://www.ncbi.nlm.nih.gov/pubmed/22232308
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