Placing the risk of seizures with pediatric vaccines in a clinical context.
Placing the risk of seizures with pediatric vaccines in a clinical context.
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DOI：
10.2165/00148581-200305110-00001
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发表时间：
2003-01-01
期刊：
影响因子：
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通讯作者：
Barlow, William
中科院分区：
文献类型：
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作者：
Davis, Robert L;Barlow, William
在这篇综述中，我们讨论了常用的儿童疫苗，如白喉-破伤风-全细胞百日咳（DTP）和麻疹-腮腺炎-风疹（MMR）之间的关系，以及非发热性和发热性惊厥的风险。我们总结了来自疫苗安全性数据链研究和其他研究的数据，这些研究表明DTP和MMR疫苗与短暂增加的热性惊厥风险相关，并分别导致每10万名免疫儿童中5-9和25-34例额外的热性惊厥。DTP和MMR似乎不会增加非热性惊厥的风险。我们讨论了疫苗和癫痫发作研究中的一些方法学挑战。由于没有足够的比较组可以用于研究接种后很长时间的癫痫发作，因此癫痫发作研究仅限于接种后不久的急性事件。此外，虽然疫苗接种后的癫痫发作令父母和医生都感到担忧，但对这些儿童神经发育结果的观察性研究尤其存在问题。我们讨论了这些研究是如何被热性惊厥易感性的自然史和热性惊厥儿童可能经历的越来越多的诊断审查所混淆的。然而，目前的数据表明，儿童热性惊厥不经历长期的负面影响。最后，我们讨论了专门设计，以协助医生在管理与惊厥的个人或家族史的儿童接种疫苗的新诊所的创建。来自这些诊所的数据表明，接种疫苗对有癫痫发作个人或家族史的儿童是安全的，但统计能力有限。最后，我们讨论了新疫苗的引入，并注意到，即使广泛使用，我们也需要很多年才能了解这些新许可产品的罕见事件风险。
In this review we discuss the relationship between commonly administered childhood vaccines such as diphtheria-tetanus-whole cell pertussis (DTP) and measles-mumps-rubella (MMR), and the risk of nonfebrile and febrile seizure. We summarize data from the Vaccine Safety Datalink Study and other studies that suggest that DTP and MMR vaccine are associated with a transiently increased risk of febrile seizures, and cause between 5-9 and 25-34 additional extra febrile seizures per 100 000 immunized children, respectively. DTP and MMR do not appear to increase the risk of nonfebrile seizures. We discuss some methodologic challenges in studies of vaccines and seizures. Because there is no adequate comparison group that would allow for the study of seizures long after vaccination, studies of seizures are limited to acute events shortly following vaccination. Additionally, while seizures following vaccination are worrisome to parents and physicians alike, observational studies of the neurodevelopmental outcomes of these children are particularly problematic. We discuss how such studies are confounded by the natural history of predisposition to febrile seizures and by the increased diagnostic scrutiny that children with febrile seizures might undergo. Nevertheless, current data suggest that children with febrile seizures do not experience long-term negative effects.Finally, we discuss the creation of new clinics designed specifically to assist physicians in managing the vaccination of children with a personal or family history of seizures. Data from these clinics suggest that vaccination is safe for children with a personal or family history of seizures, but statistical power has been limited. We conclude by discussing the introduction of new vaccines, and note that, even with widespread use, it will take many years before we can be knowledgeable about the risk of rare events with these newly licensed products.