Risk of anaphylaxis after vaccination in children and adults
Risk of anaphylaxis after vaccination in children and adults
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DOI：
10.1016/j.jaci.2015.07.048
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发表时间：
2016-03-01
影响因子：
14.2
通讯作者：
DeStefano, Frank
中科院分区：
文献类型：
--
作者：
McNeil, Michael M.;Weintraub, Eric S.;DeStefano, Frank
背景：过敏反应是一种可能危及生命的过敏反应。疫苗接种后过敏反应的风险尚未得到很好的描述，在成人或与新的疫苗在children.Objective：我们试图估计疫苗接种后过敏反应的发病率和描述的人口统计学和临床特征的确认病例的过敏反应.Methods：使用卫生保健数据从疫苗安全数据链，我们确定了儿童和成人接种后过敏反应的发生率。我们首先确定了2009年1月至2011年12月期间有疫苗接种记录的所有患者，并使用诊断和程序代码来确定潜在的过敏反应病例。审查了潜在病例的病历。确诊病例符合布莱顿协作组对速发型过敏反应的定义，必须确定为疫苗触发。我们计算了所有疫苗联合接种后和选定的个别疫苗后过敏反应的发生率。结果：我们确定了33例确认的疫苗引发的过敏反应病例，发生在25，173，965剂疫苗后。过敏反应发生率为1.31（95% CI，0.90-1.84）/百万疫苗剂量。发病率没有显着变化的年龄，有一个非显着的女性优势。疫苗特异性率包括每百万剂灭活三价流感疫苗（10例，单独接种7，434，628剂）为1.35（95%CI，0.65-2.47），每百万剂灭活单价流感疫苗（2例，单独接种1，090，279剂）为1.83（95%CI，0.22-6.63）。发病时间30 min内8例，30 ~ 120 min内8例，2 ~ 4 h内10例，4 ~ 8 h内2例，1例次日发病，4例未记录。尽管过敏反应很罕见，但它是一种潜在的危及生命的医疗紧急情况，疫苗提供者需要做好治疗准备。
Background: Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children.Objective: We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis.Methods: Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines.Results: We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).Conclusion: Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat.