Measles Vaccines Do Not Cause Febrile Seizures in 4- to 6-Year-Olds AAP Grand Rounds 2012;28;13 DOI: 10.1542/gr.

28-2-13

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AAP GRAND ROUNDS

Vol. 28 No. 2 | Pages 13-24 | August 2012
The authors conclude that there is no association of febrile seizure with receipt of MMRV or MMR + V in US children aged 4 to 6 years.

Mission: To provide pediatricians with timely synopses and critiques of important new studies relevant to pediatric practice, reviewing methodology, significance, and practical impact, as part of ongoing CME activity.

INFECTIOUS DISEASES

Measles Vaccines Do Not Cause Febrile Seizures in 4- to 6-Year-Olds

Source: Klein NP, Lewis E, Baxter R, et al. Measles-containing vaccines and febrile seizures in children aged 4 to 6 years. Pediatrics. 2012;129(5):809-814; doi:10.1542/peds.2011-3198
nvestigators from the Centers for PICO Disease Control and Prevention Question: Among US children aged 4 to 6 (CDC) and 7 managed care oryears, do measles-containing vaccines lead ganizations (MCOs) participating in to an increased risk of febrile seizures? the Vaccine Safety Datalink evaluated Question type: Intervention the risk of febrile seizure and mediStudy design: Retrospective cohort cally-attended fever events among US children aged 4 to 6 years in the 6 weeks following receipt of either measles-mumps-rubella-varicella vaccine (MMRV), separately administered MMR + V vaccines given on the same day, or MMR or V given alone. Study participants were children in 1 of the 7 MCOs who received 1 of these vaccines during the study period. Since rates of febrile seizure following measles-containing vaccines are increased for toddlers 12 to 23 months old, between 7 and 10 days after receipt,1,2 the primary outcome was seizure occurrence 7 to 10 days following immunization in study children. Secondary outcomes were seizure occurrence 0 to 42 days following vaccination and fever events during this same period. A post-vaccination seizure was defined as the first episode of epilepsy or convulsion in a study participant, as defined by the International Classification of Diseases, Ninth Revision (ICD-9), and was identified by review of the MCOs emergency department or hospital databases. Similarly, medically-attended outpatient fever events (fever and other physiologic disturbances of temperature regulation) were identified by reviewing outpatient visit databases. Occurrence of seizure was identified for all recipients of measles-containing or varicella vaccines aged 4 to 6 years between 2000 and 2008. Analysis of outpatient fever events was limited to study children vaccinated between 2006 and 2008, since that is the time period in which MMRV and MMR + V were being administered to this age group. Between 2006 and 2008, 86,750 children aged 4 to 6 years received MMRV. Between 2000 and 2008, 67,438 children aged 4 to 6 years received MMR + V on the same day. In the same time period, 479,311 such children received MMR alone and 80,985 INSIDE V alone. In the period 7 to 10 days Risk of Sudden Death in NCAA Athletes following vaccination, the rates of With Sickle Cell Trait seizure (per 10,000 doses) were 0.5, 0, Increasing the Accuracy of Peanut 0.2, and 0 for MMRV, MMR + V, MMR Allergy Diagnosis alone, and V alone, respectively (not Is Neuroimaging Necessary After a First Complex Febrile Seizure? significantly different). Similarly, the Dental Caries in Children With rates for the 42 days after vaccination Cleft Lip and Palate were 2.2, 1.5, 2.1, and 0.7, respectively Texting Parents to Improve Influenza (also not significantly different). Rates Immunization Rates of outpatient fever visits were not difCommunity Asthma Initiative ferent among groups. Improves Health Outcomes
The Impact of Victimization on Suicide Risk in Adolescents Risky Behaviors in Adolescents Benzodiazepine Use Safe During Lactation Back Page: Clinical Streptococcal Pharyngitis Simply (or Not) Doesnt Fly

Commentary by

Robert W. Tolan, Jr, MD, FAAP, The Childrens Hospital at Saint Peters University Hospital, New Brunswick, NJ and Drexel University College of Medicine, Philadelphia, PA
Dr Tolan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

MMRV was licensed by the Food and Drug Administration in 2005 and recommended for use at 1 to 2 years of age with a second dose at 4 to 6 years by the Advisory Committee on Immunization Practices in 2006. Careful post-licensure study suggested a possible increased risk of febrile seizures for toddlers who received MMRV.3 Subsequently, measles-containing vaccines were shown to increase the risk of febrile seizures in children aged 12 to 23 months.1,2 That risk was approximately doubled with MMRV compared to MMR + V,1,2 and translated into an additional febrile seizure for every 2,300 doses of MMRV given in place of separate vaccines.1 In view of this finding, the preference for MMRV was rescinded, although use of either approach was acceptable.4 The current study addresses concerns that an increase in risk of febrile seizure following MMRV might also occur in children aged 4 to 6 years. Such an increase was not observed. The risk of febrile seizures is lower in this population, so the finding is not surprising. It is reassuring to have the data, however, when parents raise concerns about the vaccine.

Editors Note
As the number of vaccines administered to infants, children, and adolescents has increased, the need for combination vaccines has likewise increased. Although febrile seizures are not associated with long-term sequelae, they are frightening to parents, and thus pose a theoretical barrier to MMRV vaccination which this study should remove for children 4 to 6 years old receiving the vaccine.
References
1. Klein NP, et al. Pediatrics. 2010;126(1):e1-e8; doi:10.1542/peds.2010-0665 2. Jacobsen SJ, et al. Vaccine. 2009;27(34):4656-4661; doi:10.1016/j.vaccine.2009.05.056 3. Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP). MMWR. 2008;57(10):258-260 4. Marin M, et al. MMWR Recomm Rep. 2010;59(rr3):1-12

Key words: measles-containing vaccines, fever, febrile seizures

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Measles Vaccines Do Not Cause Febrile Seizures in 4- to 6-Year-Olds AAP Grand Rounds 2012;28;13 DOI: 10.1542/gr.28-2-13

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including high resolution figures, can be found at: http://aapgrandrounds.aappublications.org/content/28/2/13 This article cites 5 articles, 2 of which you can access for free at: http://aapgrandrounds.aappublications.org/content/28/2/13#BIBL This article, along with others on similar topics, appears in the following collection(s): Infectious Diseases http://aapgrandrounds.aappublications.org/cgi/collection/infectious_dis eases_sub Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: /site/misc/Permissions.xhtml Information about ordering reprints can be found online: /site/misc/reprints.xhtml

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