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BMC Pediatrics

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Open Access 01-12-2018 | Research article

Risk of seizures after immunization in children with epilepsy: a risk interval analysis

Authors: Karina A. Top, Paula Brna, Lingyun Ye, Bruce Smith

Published in: BMC Pediatrics | Issue 1/2018

Abstract

Background

In children with epilepsy, fever and infection can trigger seizures. Immunization can also induce inflammation and fever, which could theoretically trigger a seizure. The risk of seizure after immunization in children with pre-existing epilepsy is not known. The study objective was to determine the risk of medically attended seizure after immunization in children with epilepsy < 7 years of age.

Methods

We conducted a retrospective study of children < 7 years of age with epilepsy in Nova Scotia, Canada from 2010 to 2014. Hospitalizations, emergency visits, unscheduled clinic visits, and telephone calls for seizures were extracted from medical records. Immunization records were obtained from family physicians and Public Health with informed consent. We conducted a risk interval analysis to estimate the relative risk (RR) of seizure during risk periods 0–14, 0–2, and 5–14 days post-immunization versus a control period 21–83 days post-immunization.

Results

There were 302 children with epilepsy who were eligible for the study. Immunization records were retrieved on 147 patients (49%), of whom 80 (54%) had one or more immunizations between the epilepsy diagnosis date and age 7 years. These 80 children had 161 immunization visits and 197 medically attended seizures. Children with immunizations had more seizures than either those with no immunizations or those with no records (mean 2.5 versus 0.7 versus 0.9, p < 0.001). The risk of medically attended seizure was not increased 0–14 days after any vaccine (RR = 1.1, 95% confidence interval (CI): 0.5–2.8) or 0–2 days after inactivated vaccines (RR = 0.9, 95% CI: 0.1–7.1) versus 21–83 days post-immunization. No seizure events occurred 5–14 days after live vaccines.

Conclusions

Children with epilepsy do not appear to be at increased risk of medically attended seizure following immunization. These findings suggest that immunization is safe in children with epilepsy, with benefits outweighing risks.

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Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, Lee BW, Lolekha S, Peltola H, Ruff TA, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86:140–6.CrossRefPubMed

Callreus T. Perceptions of vaccine safety in a global context. Acta Paediatr. 2010;99:166–71.PubMed

Friedman MJ, Sharieff GQ. Seizures in children. Pediatr Clin N Am. 2006;53:257–77.CrossRef

Wiebe S, Bellhouse DR, Fallahay C, Eliasziw M. Burden of epilepsy: the Ontario health survey. Can J Neurol Sci. 1999;26:263–70.CrossRefPubMed

Kozyrskyj AL, Prasad AN. The burden of seizures in Manitoba children: a population-based study. Can J Neurol Sci. 2004;31:48–52.CrossRefPubMed

Prasad AN, Sang X, Corbett BA, Burneo JG. Prevalence of childhood epilepsy in Canada. Can J Neurol Sci. 2011;38:719–22.CrossRefPubMed

Armstrong PK, Dowse GK, Effler PV, Carcione D, Blyth CC, Richmond PC, Geelhoed GC, Mascaro F, Scully M, Weeramanthri TS. Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine. BMJ Open. 2011;1:e000016.CrossRefPubMedPubMedCentral

Tse A, Tseng HF, Greene SK, Vellozzi C, Lee GM, Group VSDRCAIW. Signal identification and evaluation for risk of febrile seizures in children following trivalent inactivated influenza vaccine in the Vaccine Safety Datalink project, 2010-2011. Vaccine. 2012;30:2024–31.

Barlow WE, Davis RL, Glasser JW, Rhodes PH, Thompson RS, Mullooly JP, Black SB, Shinefield HR, Ward JI, Marcy SM, et al. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. N Engl J Med. 2001;345:656–61.CrossRefPubMed

10.

MacDonald SE, Dover DC, Simmonds KA, Svenson LW. Risk of febrile seizures after first dose of measles-mumps-rubella-varicella vaccine: a population-based cohort study. CMAJ. 2014;186:824–9.CrossRefPubMedPubMedCentral

11.

IOM (Institute of Medicine). Measles, mumps, and rubella vaccine. In: Stratton K, Ford A, Rusch E, Wright Clayton E, editors. Adverse effects of vaccines: evidence and causality. Washington, DC: The National Academies Press; 2012.

12.

Huang WT, Gargiullo PM, Broder KR, Weintraub ES, Iskander JK, Klein NP, Baggs JM, Vaccine Safety Datalink Team. Lack of association between acellular pertussis vaccine and seizures in early childhood. Pediatrics. 2010;126:263–9.

13.

Verbeek NE, Jansen FE, Vermeer-de Bondt PE, de Kovel CG, van Kempen MJ, Lindhout D, Knoers NV, van der Maas NA, Brilstra EH. Etiologies for seizures around the time of vaccination. Pediatrics. 2014;134:658–66.CrossRefPubMed

14.

Ward KN, Bryant NJ, Andrews NJ, Bowley JS, Ohrling A, Verity CM, Ross EM, Miller E. Risk of serious neurologic disease after immunization of young children in Britain and Ireland. Pediatrics. 2007;120:314–21.CrossRefPubMed

15.

IOM (Institute of Medicine): The childhood immunization schedule and safety: Stakeholder concerns, scientific evidence, and future studies. In. Washington, DC: The National Academies Press; 2013.

16.

Pruna D, Balestri P, Zamponi N, Grosso S, Gobbi G, Romeo A, Franzoni E, Osti M, Capovilla G, Longhi R, et al. Epilepsy and vaccinations: Italian guidelines. Epilepsia. 2013;54(Suppl 7):13–22.CrossRefPubMed

17.

Population by year, by province and territory. [http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo02a-eng.htm]. Accessed 9 Apr 2018.

18.

Camfield CS, Camfield PR, Gordon K, Wirrell E, Dooley JM. Incidence of epilepsy in childhood and adolescence: a population-based study in Nova Scotia from 1977 to 1985. Epilepsia. 1996;37:19–23.CrossRefPubMed

19.

Glanz JM, McClure DL, Xu S, Hambidge SJ, Lee M, Kolczak MS, Kleinman K, Mullooly JP, France EK. Four different study designs to evaluate vaccine safety were equally validated with contrasting limitations. J Clin Epidemiol. 2006;59:808–18.CrossRefPubMed

20.

Arnheim-Dahlstrom L, Hallgren J, Weibull CE, Sparen P. Risk of presentation to hospital with epileptic seizures after vaccination with monovalent AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine (Pandemrix): self controlled case series study. BMJ. 2012;345:e7594.

21.

Verbeek NE, van der Maas NA, Sonsma AC, Ippel E, Vermeer-de Bondt PE, Hagebeuk E, Jansen FE, Geesink HH, Braun KP, de Louw A, et al. Effect of vaccinations on seizure risk and disease course in Dravet syndrome. Neurology. 2015;85:596–603.CrossRefPubMed

22.

Tro-Baumann B, von Spiczak S, Lotte J, Bast T, Haberlandt E, Sassen R, Freund A, Leiz S, Stephani U, Boor R, et al. A retrospective study of the relation between vaccination and occurrence of seizures in Dravet syndrome. Epilepsia. 2011;52:175–8.CrossRefPubMed

23.

Klein NP, Lewis E, Baxter R, Weintraub E, Glanz J, Naleway A, Jackson LA, Nordin J, Lieu T, Belongia EA, et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics. 2012;129:809–14.CrossRefPubMed

24.

National Advisory Committee on Immunization. Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2016–2017. In: Canadian Immunization Guide. Ottawa: Public Health Agency of Canada; 2016. p. 1–60.

25.

Public Health Agency of Canada. Vaccine coverage in Canadian children: Results from the 2013 childhood National Immunization Coverage Survey (cNICS). Ottawa: Public Health Agency of Canada; 2016.

26.

Pandolfi E, Carloni E, Marino MG, Ciofi degli Atti ML, Gesualdo F, Romano M, Giannattasio A, Guarino A, Carloni R, Borgia P, et al. Immunization coverage and timeliness of vaccination in Italian children with chronic diseases. Vaccine. 2012;30:5172–8.CrossRefPubMed

27.

Tillmann BU, Tillmann HC, Heininger U, Lutschg J, Weber P. Acceptance and timeliness of standard vaccination in children with chronic neurological deficits in North-Western Switzerland. Eur J Pediatr. 2005;164:320–5.CrossRefPubMed

Title: Risk of seizures after immunization in children with epilepsy: a risk interval analysis
Authors: Karina A. Top
Paula Brna
Lingyun Ye
Bruce Smith
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-018-1112-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Risk of seizures after immunization in children with epilepsy: a risk interval analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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