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Boisnard F, Manson C, Serradell L, Macina D. DTaP-IPV-HB-Hib vaccine (Hexaxim): an update 10 years after first licensure. Expert Rev Vaccines 2023; 22:1196-1213. [PMID: 37936265 DOI: 10.1080/14760584.2023.2280236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Hexaxim® is fully liquid, hexavalent, combination vaccine that provides immunization against diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B, and invasive diseases caused by Haemophilus influenzae type b. Combination vaccines such as Hexaxim reduce the number of injections needed, improving both vaccination compliance and operational efficiency. AREAS COVERED Safety and immunogenicity data were reviewed from >25 clinical trials involving approximately 7200 infants/toddlers, identified using PubMed searches to April 2023. These trials have evaluated a diverse range of primary series and booster schedules, including antibody persistence, co-administration of Hexaxim with other routine pediatric vaccines, and specific populations (born to Tdap-vaccinated women, preterm, and immunocompromised infants). Lastly, post-marketing surveillance and real-world effectiveness data were assessed. EXPERT OPINION An extensive program of clinical development prior to licensure demonstrated favorable vaccine safety and good immunogenicity of each antigen, and Hexaxim was first approved for use in 2012. In the 10 years since licensure, Hexaxim has been adopted widely, with more than 180 million doses distributed worldwide. The widespread use of this hexavalent vaccine is a crucial tool in the ongoing and future control of six pediatric infectious diseases globally.
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Olecká I, Dobiáš M, Lemrová A, Ivanová K, Fürst T, Krajsa J, Handlos P. Indeterminacy of the Diagnosis of Sudden Infant Death Syndrome Leading to Problems with the Validity of Data. Diagnostics (Basel) 2022; 12:diagnostics12071512. [PMID: 35885418 PMCID: PMC9319831 DOI: 10.3390/diagnostics12071512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022] Open
Abstract
The validity of infant mortality data is essential in assessing health care quality and in the setting of preventive measures. This study explores different diagnostic procedures used to determine the cause of death across forensic settings and thus the issue of the reduced validity of data. All records from three forensic medical departments that conducted autopsies on children aged 12 months or younger (n = 204) who died during the years 2007–2016 in Moravia were included. Differences in diagnostic procedures were found to be statistically significant. Each department works with a different set of risk factors and places different emphasis on different types of examination. The most significant differences could be observed in sudden infant death syndrome and suffocation diagnosis frequency. The validity of statistical data on the causes of infant mortality is thus significantly reduced. Therefore, the possibilities of public health and social policy interventions toward preventing sudden and unexpected infant death are extraordinarily complicated by this lack of data validity.
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Affiliation(s)
- Ivana Olecká
- Department of Christian Social Work, Sts Cyril and Methodius Faculty of Theology, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Martin Dobiáš
- Department of Forensic Medicine and Medical Law, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence:
| | - Adéla Lemrová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (A.L.); (K.I.)
| | - Kateřina Ivanová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (A.L.); (K.I.)
| | - Tomáš Fürst
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacký University Olomouc, 779 00 Olomouc, Czech Republic;
| | - Jan Krajsa
- Department of Forensic Medicine, Faculty of Medicine, Masaryk University & St. Anne’s University Hospital Brno, 602 00 Brno, Czech Republic;
| | - Petr Handlos
- Institute of Pathology, Faculty of Medicine, University of Ostrava & University Hospital in Ostrava, 701 03 Ostrava, Czech Republic;
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Enhanced surveillance for adverse events following immunization during the 2019 typhoid conjugate vaccine campaign in Harare, Zimbabwe. Vaccine 2022; 40:3573-3580. [PMID: 35568590 PMCID: PMC10116805 DOI: 10.1016/j.vaccine.2022.04.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND During February 25-March 4, 2019, Zimbabwe's Ministry of Health and Child Care conducted an emergency campaign using 342,000 doses of typhoid conjugate vaccine (TCV) targeting individuals 6 months-15 years of age in eight high-risk suburbs of Harare and up to 45 years of age in one suburb of Harare. The campaign represented the first use of TCV in Africa outside of clinical trials. METHODS Three methods were used to capture adverse events during the campaign and for 42 days following the last dose administered: (1) active surveillance in two Harare hospitals, (2) national passive surveillance, and (3) a post-campaign coverage survey. RESULTS Thirty-nine adverse events were identified during active surveillance, including 19 seizure cases (16 were febrile), 16 hypersensitivity cases, 1 thrombocytopenia case, 1 anaphylaxis case, and two cases with two conditions. Only 21 (54%) of 39 patients were hospitalized and 38 recovered without sequelae. Attack rates per 100,000 TCV doses administered were highest for seizures (6.27) and hypersensitivity (5.02). Only 6 adverse events were reported through passive surveillance by facilities other than the two active surveillance hospitals. A total of 177 (10%) of 1,817 vaccinees surveyed reported experiencing an adverse event during the post-campaign coverage survey, of which 25 (14%) sought care. CONCLUSIONS In line with previous evaluations of TCV, enhanced adverse event monitoring during an emergency campaign supports the safety of TCV. The majority of reported events were minor or resulted in recovery without long-term sequelae. Attack rates for seizures and hypersensitivity were low compared with previous active surveillance studies conducted in Kenya and Burkina Faso. Strengthening adverse event monitoring in Zimbabwe and establishing background rates of conditions of interest in the general population may improve future safety monitoring during new vaccine introductions.
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Longley AT, Date K, Luby SP, Bhatnagar P, Bentsi-Enchill AD, Goyal V, Shimpi R, Katkar A, Yewale V, Jayaprasad N, Horng L, Kunwar A, Harvey P, Haldar P, Dutta S, Gidudu JF. Evaluation of Vaccine Safety After the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018. Clin Infect Dis 2021; 73:e927-e933. [PMID: 33502453 PMCID: PMC8366822 DOI: 10.1093/cid/ciab059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In December 2017, the World Health Organization (WHO) prequalified the first typhoid conjugate vaccine (TCV; Typbar-TCV). While no safety concerns were identified in pre- and postlicensure studies, WHO's Global Advisory Committee on Vaccine Safety recommended robust safety evaluation with large-scale TCV introductions. During July-August 2018, the Navi Mumbai Municipal Corporation (NMMC) launched the world's first public sector TCV introduction. Per administrative reports, 113 420 children 9 months-14 years old received TCV. METHODS We evaluated adverse events following immunization (AEFIs) using passive and active surveillance via (1) reports from the passive NMMC AEFI surveillance system, (2) telephone interviews with 5% of caregivers of vaccine recipients 48 hours and 7 days postvaccination, and (3) chart abstraction for adverse events of special interest (AESIs) among patients admitted to 5 hospitals using the Brighton Collaboration criteria followed by ascertainment of vaccination status. RESULTS We identified 222/113 420 (0.2%) vaccine recipients with AEFIs through the NMMC AEFI surveillance system: 211 (0.19%) experienced minor AEFIs, 2 (0.002%) severe, and 9 serious (0.008%). At 48 hours postvaccination, 1852/5605 (33%) caregivers reported ≥1 AEFI, including injection site pain (n = 1452, 26%), swelling (n = 419, 7.5%), and fever (n = 416, 7.4%). Of the 4728 interviews completed at 7 days postvaccination, the most reported AEFIs included fever (n = 200, 4%), pain (n = 52, 1%), and headache (n = 42, 1%). Among 525 hospitalized children diagnosed with an AESI, 60 were vaccinated; no AESIs were causally associated with TCV. CONCLUSIONS No unexpected safety signals were identified with TCV introduction. This provides further reassurance for the large-scale use of Typbar-TCV among children 9 months-14 years old.
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Affiliation(s)
- Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Pankaj Bhatnagar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Adwoa D Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Vineet Goyal
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Rahul Shimpi
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Arun Katkar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Vijay Yewale
- Dr Yewale Multi Specialty Hospital for Children, Navi Mumbai, India
| | - Niniya Jayaprasad
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Abhishek Kunwar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pauline Harvey
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Jane F Gidudu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Puente Gómez I, Verheust C, Hanssens L, Dolhain J. Safety profile of Infanrix hexa – 17 years of GSK’s passive post-marketing surveillance. Expert Rev Vaccines 2020; 19:771-779. [DOI: 10.1080/14760584.2020.1800458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
| | | | - Linda Hanssens
- GSK, Wavre, Belgium
- Miltenyi Biomedicine, Bergisch Gladbach, North Rhine-Westphalia, Germany
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A Prospective Cohort Study on the Safety of Infant Pentavalent (DTwP-HBV-Hib) and Oral Polio Vaccines in Two South Indian Districts. Pediatr Infect Dis J 2020; 39:389-396. [PMID: 32301918 PMCID: PMC7170438 DOI: 10.1097/inf.0000000000002594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Safety of pentavalent (DTwP-HBV-Hib) vaccine has been a public concern in India and other countries. This study attempted to document the association of serious adverse events following immunization (AEFI, including hospitalizations and deaths of all causes) with the 3 doses of pentavalent and oral poliovirus (OPV) vaccines. METHODS A cohort of 30,688 infants in 2 south Indian districts were enrolled and followed-up between October 2014 and May 2016, following their first vaccination with DTwP-HBV-Hib and OPV at public health facilities. During weekly follow-ups, by telephone or home visits, the serious AEFIs (hospitalizations and deaths) occurring any time after each vaccination until 4 weeks after third dose were documented. The incidence risk ratios (IRRs) of serious AEFIs in the first (days 0-6) and fourth weeks (days 21-27) after the vaccine doses were compared using the poisson regression analysis. RESULTS Of the 30,688 infants enrolled, 30,208 received their third doses of vaccines. During the 4-week periods following each vaccination, there were 365 hospitalizations and 17 deaths. Adjusted incidence risk ratio of 3 doses combined for post-vaccination serious AEFIs during the first week compared with fourth week was 0.8 [95% confidence interval: 0.6-1.0]. CONCLUSIONS There was no increased risk of a serious AEFIs during the first week after any of the 3 doses of pentavalent and OPV vaccination compared with the fourth week. In the absence of any temporal clustering, mortality and hospitalization rates observed in vaccinated infants probably reflects the natural occurrence of such events.
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Anleitung und Beratung zur Prävention des plötzlichen Kindstodes. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moro PL, Perez-Vilar S, Lewis P, Bryant-Genevier M, Kamiya H, Cano M. Safety Surveillance of Diphtheria and Tetanus Toxoids and Acellular Pertussis (DTaP) Vaccines. Pediatrics 2018; 142:peds.2017-4171. [PMID: 29866795 PMCID: PMC6476554 DOI: 10.1542/peds.2017-4171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the safety of currently licensed diphtheria-tetanus-acellular pertussis (DTaP) vaccines in the United States by using data from the Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting surveillance system. METHODS We searched VAERS for US reports of DTaP vaccinations occurring from January 1, 1991, through December 31, 2016, and received by March 17, 2017. We reviewed available medical records for all death reports and a random sample of reports classified as nondeath serious. We used Empirical Bayesian data mining to identify adverse events that were disproportionally reported after DTaP vaccination. RESULTS VAERS received 50 157 reports after DTaP vaccination; 43 984 (87.7%) of them reported concomitant administration of other vaccines, and 5627 (11.2%) were serious. Median age at vaccination was 19 months (interquartile range 35 months). The most frequently reported events were injection site erythema (12 695; 25.3%), pyrexia (9913; 19.8%), injection site swelling (7542; 15.0%), erythema (5599; 11.2%), and injection site warmth (4793; 9.6%). For 3 of the DTaP vaccines, we identified elevated values for vaccination errors using Empirical Bayesian data mining. CONCLUSIONS No new or unexpected adverse events were detected. The observed disproportionate reporting for some nonserious vaccination errors calls for better education of vaccine providers on the specific indications for each of the DTaP vaccines.
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Affiliation(s)
- Pedro L. Moro
- Immunization Safety Office, Division of Healthcare Quality Promotion CDC
| | - Silvia Perez-Vilar
- Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, 20993, MD, United States
| | - Paige Lewis
- Immunization Safety Office, Division of Healthcare Quality Promotion CDC
| | - Marthe Bryant-Genevier
- Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, 20993, MD, United States
| | - Hajime Kamiya
- Epidemiology Intelligence Service, Meningitis and Vaccine Preventable Diseases Branch, National Center for Immunization and Respiratory Diseases, CDC and Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Maria Cano
- Immunization Safety Office, Division of Healthcare Quality Promotion CDC
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Huang WT, Chen RT, Hsu YC, Glasser JW, Rhodes PH. Vaccination and unexplained sudden death risk in Taiwanese infants. Pharmacoepidemiol Drug Saf 2016; 26:17-25. [PMID: 27891698 DOI: 10.1002/pds.4141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 10/30/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE In March 1992, eight infants who had died within 36 hours of receiving whole-cell pertussis vaccine (diphtheria, tetanus, and whole-cell pertussis [DTwP]) prompted the Taiwan health authorities to suspend its use. We conducted an investigation of vaccination and sudden unexplained infant death (SUID) and repeated it more recently after Taiwan switched to acellular pertussis vaccine (diphtheria, tetanus, and acellular pertussis [DTaP]) in 2010. METHODS All SUIDs aged 31-364 days during 1990-1992 and 1996-2013 were selected from the death registration databases. The case-control investigation matched each case to two controls on clinic, sex, and birth date, whereas the follow-up self-controlled case series study compared risk of death during the 30-day post-vaccination risk periods with those in the control periods within the same case. RESULTS Sudden unexplained infant death was associated with never receiving DTwP (odds ratio 2.28, 95% confidence interval 1.25-4.15) in the case-control investigation. The odds ratios within 0-1, 2-7, 8-14, and 15-30 days of DTwP administration were 1.18, 0.26, 0.50, and 0.77. In the 1996-2013 self-controlled case series studies, this temporal shift between DTwP and SUID was consistently observed for female (incidence rate ratio 1.70, 0.75, 1.01, and 0.84) but not male or DTaP recipients. A pooled analysis showed significant risk within 2 days of receiving DTwP in female infants (incidence rate ratio 1.66, 95% confidence interval 1.05-2.60). CONCLUSIONS Being unvaccinated and recent receipt of DTwP in female infants was significantly associated with SUID; the latter was consistent with a temporal shift pattern without overall increase in risk. The currently used pertussis vaccine, DTaP, did not increase risk of SUID. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Robert T Chen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yu-Chen Hsu
- Taiwan Centers for Disease Control, Taipei, Taiwan
| | - John W Glasser
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Philip H Rhodes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Silfverdal SA, Coremans V, François N, Borys D, Cleerbout J. Safety profile of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV). Expert Rev Vaccines 2016; 16:109-121. [DOI: 10.1586/14760584.2016.1164044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Deshmukh V, Lahariya C, Krishnamurthy S, Das MK, Pandey RM, Arora NK. Taken to Health Care Provider or Not, Under-Five Children Die of Preventable Causes: Findings from Cross-Sectional Survey and Social Autopsy in Rural India. Indian J Community Med 2016; 41:108-19. [PMID: 27051085 PMCID: PMC4799633 DOI: 10.4103/0970-0218.177527] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Under-five children in India continue to die from causes that can either be treated or prevented. The data regarding causes of death, community care-seeking practices, and events prior to death are needed to guide and refine health policies for achieving national goals and targets. Materials and Methods: A cross-sectional survey covering rural areas of 16 districts from eight states across India was conducted to understand the causes of deaths and the health-seeking patterns of caregivers prior to the death of such children. Mothers of the deceased children were interviewed. The physician review process was used to assign cause of death. The qualitative data were analyzed as per standard methods, while STATA version 10 was used for analysis of quantitative data. Findings: A total of 1,488 death histories were captured through verbal autopsy. Neonatal etiologies, acute respiratory infection (ARI), and diarrhea accounted for approximately 63.1% of all deaths in the under-five age group. The causes of death in neonates showed that birth asphyxia, prematurity, and neonatal infections contributed to more than 67.5% of all neonatal deaths, while in children aged 29 days to 59 months, ARI and diarrhea accounted for 54.3% of deaths. Care providers of 52.6% of the neonates and 21.7% of infants and under-five children did not seek any medical care before the death of the child. Substantial delays in seeking care occurred at home and during transit. For those who received medical care, there was an apparent amongst in their caregivers toward private health providers. Conclusion: The deaths of neonates and postneonates taken to any health facilities highlight the need for providing equitable and high-quality health services in India. The findings could be used for policy planning and program refinement in India.
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Affiliation(s)
| | - Chandrakant Lahariya
- Formerly, The INCLEN Trust International, New Delhi, India; Formerly, Department of Community Medicine, GR Medical College, Gwalior, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Manoj K Das
- The INCLEN Trust International, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institutes of Medical Sciences, New Delhi, India
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McCarthy NL, Gee J, Sukumaran L, Weintraub E, Duffy J, Kharbanda EO, Baxter R, Irving S, King J, Daley MF, Hechter R, McNeil MM. Vaccination and 30-Day Mortality Risk in Children, Adolescents, and Young Adults. Pediatrics 2016; 137:e20152970. [PMID: 26908690 PMCID: PMC6511986 DOI: 10.1542/peds.2015-2970] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This study evaluates the potential association of vaccination and death in the Vaccine Safety Datalink (VSD). METHODS The study cohort included individuals ages 9 to 26 years with deaths between January 1, 2005, and December 31, 2011. We implemented a case-centered method to estimate a relative risk (RR) for death in days 0 to 30 after vaccination.Deaths due to external causes (accidents, homicides, and suicides) were excluded from the primary analysis. In a secondary analysis, we included all deaths regardless of cause. A team of physicians reviewed available medical records and coroner's reports to confirm cause of death and assess the causal relationship between death and vaccination. RESULTS Of the 1100 deaths identified during the study period, 76 (7%) occurred 0 to 30 days after vaccination. The relative risks for deaths after any vaccination and influenza vaccination were significantly lower for deaths due to nonexternal causes (RR 0.57, 95% confidence interval [CI] 0.38-0.83, and RR 0.44, 95% CI 0.24-0.80, respectively) and deaths due to all causes (RR 0.72, 95% CI 0.56-0.91, and RR 0.44, 95% CI 0.28-0.65). No other individual vaccines were significantly associated with death. Among deaths reviewed, 1 cause of death was unknown, 25 deaths were due to nonexternal causes, and 34 deaths were due to external causes. The causality assessment found no evidence of a causal association between vaccination and death. CONCLUSIONS Risk of death was not increased during the 30 days after vaccination, and no deaths were found to be causally associated with vaccination.
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Affiliation(s)
- Natalie L. McCarthy
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Address correspondence to Natalie L. McCarthy, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-D26, Atlanta, GA 30333. E-mail:
| | - Julianne Gee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lakshmi Sukumaran
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Duffy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elyse O. Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Roger Baxter
- Kaiser Permanente of Northern California, Oakland, California
| | | | - Jennifer King
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; and
| | - Rulin Hechter
- Kaiser Permanente Southern California, Pasadena, California
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Gold MS, Balakrishnan MR, Amarasinghe A, MacDonald NE. An approach to death as an adverse event following immunization. Vaccine 2015; 34:212-217. [PMID: 26608326 DOI: 10.1016/j.vaccine.2015.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/29/2022]
Abstract
Co-incidental death occurring proximate to vaccination may be reported as an adverse event following immunization. Such events are particularly concerning because they may raise community and health provider concerns about the safety of the specific vaccine and often the immunization programme in general. Coincidental events need to be differentiated from vaccine reactions, such as anaphylaxis, which may very rarely result in death. In 2013, the World Health Organization (WHO) released an updated manual for the Causality Assessment of an AEFI. The purpose of this review is to apply the WHO causality methodology to death when this is reported as an AEFI. The causality assessment scheme recommends a four step process to enable classification of the AEFI and to differentiate events which are causally consistent from those that are inconsistent with immunization. However, for some events causality maybe indeterminate. Consistent causal reactions that may result in death are very rare and maybe related to the vaccine product (e.g. anaphylaxis, viscerotrophic disease), vaccine quality defect (e.g. an incompletely attenuated live vaccine agent) or an immunization error (e.g. vaccine vial contamination). Events that are inconsistent with immunizations are due to co-incidental conditions that may account for infant and childhood mortality. In countries with a high infant mortality rate the coincidental occurrence of death and immunization may occur not infrequently and a robust mechanism to obtain information from autopsy and perform an AEFI investigation and causality assessment is essential. Communication with the community and all stakeholders to maintain confidence in the immunization programme is critical.
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Affiliation(s)
- Michael S Gold
- University of Adelaide, Discipline of Paediatrics, Women's and Children's Health Network, 72 King William Road, Adelaide 5000, Australia.
| | | | | | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Canada
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Moro PL, Arana J, Cano M, Lewis P, Shimabukuro TT. Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997-2013. Clin Infect Dis 2015; 61:980-7. [PMID: 26021988 DOI: 10.1093/cid/civ423] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/14/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vaccines are among the safest medical products in use today. Hundreds of millions of vaccinations are administered in the United States each year. Serious adverse reactions are uncommon. However, temporally associated deaths can occur following vaccination. Our aim was to characterize main causes of death among reports submitted to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous vaccine safety surveillance system. METHODS We searched VAERS for US reports of death after any vaccination from 1 July 1997 through 31 December 2013. Available medical records, autopsy reports, and death certificates were reviewed to identify cause of death. RESULTS VAERS received 2149 death reports, most (n = 1469 [68.4%]) in children. Median age was 0.5 years (range, 0-100 years); males accounted for 1226 (57%) reports. The total annual number of death reports generally decreased during the latter part of the study period. Most common causes of death among 1244 child reports with available death certificates/autopsy reports included sudden infant death syndrome (n = 544 [44%]), asphyxia (n = 74 [6.0%]), septicemia (n = 61 [4.9%]), and pneumonia (n = 57 [4.6%]). Among 526 adult reports, most common causes of death included diseases of the circulatory (n = 247 [46.9%]) and respiratory systems (n = 77 [14.6%]), certain infections and parasitic diseases (n = 62 [11.8%]), and malignant neoplasms (n = 20 [3.8%]). For child death reports, 79.4% received >1 vaccine on the same day. Inactivated influenza vaccine given alone was most commonly associated with death reports in adults (51.4%). CONCLUSIONS No concerning pattern was noted among death reports submitted to VAERS during 1997-2013. The main causes of death were consistent with the most common causes of death in the US population.
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Affiliation(s)
- Pedro L Moro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge Arana
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Cano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom T Shimabukuro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Moro PL, Jankosky C, Menschik D, Lewis P, Duffy J, Stewart B, Shimabukuro TT. Adverse events following Haemophilus influenzae type b vaccines in the Vaccine Adverse Event Reporting System, 1990-2013. J Pediatr 2015; 166:992-7. [PMID: 25598306 PMCID: PMC6500451 DOI: 10.1016/j.jpeds.2014.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/20/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To characterize adverse events (AEs) after Haemophilus influenzae type b (Hib) vaccines reported to the US Vaccine Adverse Event Reporting System (VAERS), a spontaneous reporting surveillance system. STUDY DESIGN We searched VAERS for US reports after Hib vaccines among reports received from January 1, 1990, to December 1, 2013. We reviewed a random sample of reports and accompanying medical records for reports classified as serious. All reports of death were reviewed. Physicians assigned a primary clinical category to each reviewed report. We used empirical Bayesian data mining to identify AEs that were disproportionally reported after Hib vaccines. RESULTS VAERS received 29,747 reports after Hib vaccines; 5179 (17%) were serious, including 896 reports of deaths. Median age was 6 months (range 0-1022 months). Sudden infant death syndrome was the stated cause of death in 384 (51%) of 749 death reports with autopsy/death certificate records. The most common nondeath serious AE categories were neurologic (80; 37%), other noninfectious (46; 22%) (comprising mainly constitutional signs and symptoms); and gastrointestinal (39; 18%) conditions. No new safety concerns were identified after clinical review of reports of AEs that exceeded the data mining statistical threshold. CONCLUSION Review of VAERS reports did not identify any new or unexpected safety concerns for Hib vaccines.
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Affiliation(s)
- Pedro L. Moro
- Immunization Safety Office, Centers for Disease Control and Prevention
| | | | - David Menschik
- Center for Biologics Evaluation and Research, US Food and Drug Administration
| | - Paige Lewis
- Immunization Safety Office, Centers for Disease Control and Prevention
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention
| | - Brock Stewart
- Immunization Safety Office, Centers for Disease Control and Prevention
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Law BJ, Laflèche J, Ahmadipour N, Anyoti H. Canadian Adverse Events Following Immunization Surveillance System (CAEFISS): Annual report for vaccines administered in 2012. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2014; 40:7-23. [PMID: 29769908 PMCID: PMC5868630 DOI: 10.14745/ccdr.v40is3a02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To describe the adverse event following immunization (AEFI) reporting profile for vaccines administered in Canada during 2012 and surveillance trends relative to reports for vaccines administered from 2005 through 2011. METHODS Analysis of data based on AEFI reports received by the Public Health Agency of Canada by April 30, 2013, for vaccines marketed in Canada and administered from January 1, 2005, through December 31, 2012. RESULTS The AEFI reporting rate was 10.1 per 100,000 population in Canada for vaccines administered in 2012 and was inversely proportional to age. There was a trend of declining rates from 2005 (14.8) to 2012 overall and by age group. The vast majority of reports (94%-95%) were non-serious involving reactions at or near the vaccination site, rash and febrile events. CONCLUSION Canada has a strong pharmacovigilance system for vaccines with one of the highest AEFI reporting rates in developed countries. Vaccines marketed in Canada have a very good safety profile. This report enables comparisons across jurisdictions in Canada and globally.
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Affiliation(s)
- BJ Law
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - J Laflèche
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
- Citizenship and Immigration Canada, Ottawa, ON
| | - N Ahmadipour
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - H Anyoti
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
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17
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Bonhoeffer J, Imoukhuede EB, Aldrovandi G, Bachtiar NS, Chan ES, Chang S, Chen RT, Fernandopulle R, Goldenthal KL, Heffelfinger JD, Hossain S, Jevaji I, Khamesipour A, Kochhar S, Makhene M, Malkin E, Nalin D, Prevots R, Ramasamy R, Sellers S, Vekemans J, Walker KB, Wilson P, Wong V, Zaman K, Heininger U. Template protocol for clinical trials investigating vaccines--focus on safety elements. Vaccine 2013; 31:5602-20. [PMID: 23499603 DOI: 10.1016/j.vaccine.2013.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/25/2013] [Indexed: 11/19/2022]
Abstract
This document is intended as a guide to the protocol development for trials of prophylactic vaccines. The template may serve phases I-IV clinical trials protocol development to include safety relevant information as required by the regulatory authorities and as deemed useful by the investigators. This document may also be helpful for future site strengthening efforts.
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Affiliation(s)
- Jan Bonhoeffer
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland.
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Choe YJ, Kim JH, Son HJ, Bae GR, Lee DH. Sudden death in the first 2 years of life following immunization in the Republic of Korea. Pediatr Int 2012; 54:905-10. [PMID: 22783912 DOI: 10.1111/j.1442-200x.2012.03697.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because the peak age for incidence of sudden deaths in infancy temporally coincides with the age of infant primary immunization, some have raised the question as to whether immunization is a risk factor for sudden death in infancy. Recent occurrence of two sudden deaths in infants in Korea has renewed concerns about the causal association between immunization and sudden deaths in infants. METHODS We carried out a retrospective review of data from the Korea Centers for Disease Control and Prevention Adverse Events Following Immunization Surveillance System and Vaccine Compensation programs. RESULTS From 1994 to 2011, a total of 45 cases of sudden deaths in the first 2 years of life following immunization were reported in Korea. The causes of death were classified as follows: infectious diseases (n= 13); accidental injuries (n= 7); congenital abnormalities (n= 2); and malignancy (n= 1). Of 20 sudden deaths in infancy, nine deaths met Brighton Collaboration case definition level I and II, and therefore were classified as possible sudden infant death syndrome cases. Hepatitis B vaccine (n= 13) was the most frequent vaccine with temporal association with sudden deaths in the first 2 years of life. CONCLUSION Few sudden deaths in the first 2 years of life following immunization have been reported, despite the use of universal immunization in Korea. The majority of deaths in infancy did not meet case definition for sudden infant death syndrome. Encouraging investigators to perform thorough investigation, including postmortem autopsy and death scene examination, may promote data comparability and provide guidance on decision-making in the vaccine-safety monitoring and response system in Korea.
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Affiliation(s)
- Young June Choe
- Division of Vaccine Preventable Disease Control and National Immunization Program, Korea Centers for Disease Control and Prevention, Seoul, Korea.
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Wasilewska J, Sienkiewicz-Szłapka E, Kuźbida E, Jarmołowska B, Kaczmarski M, Kostyra E. The exogenous opioid peptides and DPPIV serum activity in infants with apnoea expressed as apparent life threatening events (ALTE). Neuropeptides 2011; 45:189-95. [PMID: 21334743 DOI: 10.1016/j.npep.2011.01.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 12/22/2010] [Accepted: 01/22/2011] [Indexed: 11/29/2022]
Abstract
Casein-derived peptides have been suggested to play a role in sudden infant death syndrome (SIDS). In this study, we have determined the content of bovine β-casomorphin-7 (bBCM-7) and the activity of dipeptidyl peptidase-IV (DPPIV) in sera of infants with apparent life threatening events (ALTE syndromes, 'near miss SIDS'). We have found that the sera of some infants after an apnoea event contained more β-casomorphin-7 than that of the healthy infants in the same age. In all the children after an apnoea event, however, a lowered DPPIV was detected. We suspect that the low activity of that peptidase may be responsible for opioid-induced respiratory depression, induced by bBCM-7 in the general circulation.
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Affiliation(s)
- Jolanta Wasilewska
- Department of Paediatrics, Gastroenterology and Allergic Diseases, The Medical University of Białystok, Poland
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Traversa G, Spila-Alegiani S, Bianchi C, Ciofi degli Atti M, Frova L, Massari M, Raschetti R, Salmaso S, Scalia Tomba G. Sudden unexpected deaths and vaccinations during the first two years of life in Italy: a case series study. PLoS One 2011; 6:e16363. [PMID: 21298113 PMCID: PMC3027668 DOI: 10.1371/journal.pone.0016363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 12/24/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy. METHODOLOGY/PRINCIPAL FINDINGS The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999-2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1-23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0-1, 0-7, and 0-14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0-7 and 0-14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined. CONCLUSIONS The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age.
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Affiliation(s)
- Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Stefania Spila-Alegiani
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
- * E-mail:
| | - Clara Bianchi
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | | | - Luisa Frova
- Italian National Institute of Statistics (ISTAT), Rome, Italy
| | - Marco Massari
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Roberto Raschetti
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Stefania Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
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22
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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