Sudden-Onset Sensorineural Hearing Loss after Immunization: A Case-Centered Analysis
Sudden-Onset Sensorineural Hearing Loss after Immunization: A Case-Centered Analysis
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DOI：
10.1177/0194599816639043
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发表时间：
2016-07-01
影响因子：
3.4
通讯作者：
Klein, Nicola P.
中科院分区：
文献类型：
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作者：
Baxter, Roger;Lewis, Ned;Klein, Nicola P.
目的疫苗后突发性感音神经性耳聋(SSHL)的病例报道引起了人们的关注，即疫苗很少会导致听力损失。由于这一担忧，我们分析了SSHL与疫苗接种之间的关联。研究设计我们使用以病例为中心的方法，相当于病例对照设计，使用所有匹配人群的免疫日期来计算疫苗暴露，而不是抽样。设置Kaiser Permanente Northern California(KPNC)，2007-2013年。对象和方法我们在KPNC数据库中搜索2007-2013年所有首次诊断的SSHL。我们使用首次SSHL诊断前60天内任何听力或耳朵相关就诊的日期作为发病日期。只使用前9个月接种的SSHL病例，我们比较了所有KPNC成员在发病前几个危险时段的疫苗暴露与相同时间段相同时间段的暴露，性别和年龄匹配。结果在研究期间，KPNC接种了2000万种疫苗。在SSHL发病前的所有风险区间，我们没有发现与匹配的对照组相比免疫风险增加的证据。接种三价流感灭活疫苗前1周接种的优势比为0.965(95%可信区间，0.61~1.50)；破伤风、白喉和无细胞百日咳减少的优势比为0.842(0.39~1.62)；带状疱疹疫苗接种的优势比为0.454(0.08~1.53)。结论一项以病例为中心的大规模分析未发现SSHL与既往接种过TIV或其他疫苗有任何关联。
Objective Case reports of sudden sensorineural hearing loss (SSHL) following vaccines have led to concerns that vaccines may rarely cause hearing loss. Because of this concern, we analyzed for an association between SSHL and vaccinations.Study Design We used a case-centered method, equivalent to a case control design using immunization dates from all matched members of the population to calculate exposure to vaccines, rather than sampling.Setting Kaiser Permanente Northern California (KPNC), 2007 to 2013.Subjects and Methods We searched KPNC databases from 2007 to 2013 for all first-time diagnoses of SSHL. We used the date of any hearing- or ear-related visit in the 60 days prior to the first SSHL diagnosis as the onset date. Using only SSHL cases immunized in the prior 9 months, we compared the vaccine exposure in several risk intervals prior to onset with the exposure to the same vaccine during the same time period in all KPNC membership, matched to sex and age.Results During the study period, >20 million vaccines were administered at KPNC. In all risk intervals prior to onset of SSHL, we found no evidence of increased risk of immunization compared with matched controls. The odds ratios for vaccination 1 week prior to SSHL were 0.965 (95% confidence interval, 0.61-1.50) for trivalent inactivated influenza vaccine (TIV); 0.842 (0.39-1.62) for tetanus, reduced diphtheria, and reduced acellular pertussis; and 0.454 (0.08-1.53) for zoster vaccine.Conclusion A large-scale analysis applying a case-centered method did not detect any association between SSHL and previous receipt of TIV or other vaccines.