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Hawken S, Ducharme R, Fell DB, Oron AP, Wilson K. Effects of sex and birth weight on non-specific health services use following whole-cell pertussis vaccination: a self-controlled case series analysis. Hum Vaccin Immunother 2019; 15:2399-2404. [PMID: 30829106 PMCID: PMC6816393 DOI: 10.1080/21645515.2019.1586029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 12/02/2022] Open
Abstract
Previous studies from low-resource countries have highlighted concerns surrounding non-specific effects of whole-cell pertussis vaccination, particularly in females. We sought to examine the effects of sex and birth weight on health services utilization following first exposure to whole-cell pertussis vaccine. Using a self-controlled case series design and by calculating relative incidence ratios (RIRs), we compared the relative incidence of emergency department visits and/or hospital admissions between sexes and between birth weight quintiles. Females had a higher relative incidence of events following vaccination compared to males (RIR = 1.13, 95% CI: 0.99, 1.30), which persisted after adjustment for birth weight (RIR = 1.12, 95% CI: 0.97, 1.28). We also observed a trend of increasing relative incidence of events over decreasing quintiles of birth weight; infants in the lowest quintile had a 26% higher relative event rate compared to the highest quintile, which was robust to adjustment for sex (Unadjusted RIR = 1.26, 95% CI: 1.01, 1.56; Adjusted RIR = 1.23, 95% CI: 0.99, 1.53). The risk of all-cause health services utilization immediately following vaccination, was elevated in female infants and infants having lower birth weight. Further study is warranted to determine if vaccine dosing should take infant weight into account.
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Affiliation(s)
- Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- ICES, University of Ottawa, Ottawa, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Deshayne B. Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- ICES, University of Ottawa, Ottawa, Canada
- Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Assaf P. Oron
- Maternal, Newborn, and Child Health, Institute for Disease Modeling, Bellevue, Washington, USA
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- ICES, University of Ottawa, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wilson K, Duque DR, Murphy MS, Hawken S, Pham-Huy A, Kwong J, Deeks SL, Potter BK, Crowcroft NS, Bulman DE, Chakraborty P, Little J. T-cell receptor excision circle levels and safety of paediatric immunization: A population-based self-controlled case series analysis. Hum Vaccin Immunother 2018; 14:1378-1391. [PMID: 29420131 PMCID: PMC6037463 DOI: 10.1080/21645515.2018.1433971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 12/21/2022] Open
Abstract
T-cell receptor excision circle levels are a surrogate marker of T-cell production and immune system function. We sought to determine whether non-pathological levels of infant T-cell receptor excision circles were associated with adverse events following immunization. A self-controlled case series design was applied on a sample of 231,693 children who completed newborn screening for severe combined immunodeficiency in Ontario, Canada between August 2013 and December 2015. Exposures included routinely administered pediatric vaccines up to 15 months of age. Main outcomes were combined health services utilization for recognized adverse events following immunization. 1,406,981 vaccination events were included in the final dataset. 103,007 children received the Pneu-C-13 or Men-C-C vaccine and 97,998 received the MMR vaccine at 12 months of age. 67,725 children received the varicella immunization at 15 months. Our analysis identified no association between newborn T-cell receptor excision circle levels and subsequent health services utilization events following DTa-IPV-Hib, Pneu-C-13, and Men-C-C vaccinations at 2-month (RI 0.94[95%CI 0.87-1.02]), 4-month (RI 0.82[95%CI 0.75-0.9]), 6-month (RI 0.63[95%CI 0.57-0.7]) and 12-month (RI 0.49[95%CI 0.44-0.55]). We also found no trends in health services utilization following MMR (RI 1.43[95%1.34-1.52]) or varicella (RI 1.14[95%CI 1.05-1.23]) vaccination. Our findings provide further support for the safety of pediatric vaccinations.
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Affiliation(s)
- Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Malia S.Q Murphy
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Anne Pham-Huy
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Jeffrey Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shelley L. Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Beth K. Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Hawken S, Potter BK, Little J, Benchimol EI, Mahmud S, Ducharme R, Wilson K. The use of relative incidence ratios in self-controlled case series studies: an overview. BMC Med Res Methodol 2016; 16:126. [PMID: 27664070 PMCID: PMC5035460 DOI: 10.1186/s12874-016-0225-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/14/2016] [Indexed: 11/21/2022] Open
Abstract
Background The self-controlled case series (SCCS) is a useful design for investigating associations between outcomes and transient exposures. The SCCS design controls for all fixed covariates, but effect modification can still occur. This can be evaluated by including interaction terms in the model which, when exponentiated, can be interpreted as a relative incidence ratio (RIR): the change in relative incidence (RI) for a unit change in an effect modifier. Methods We conducted a scoping review to investigate the use of RIRs in published primary SCCS studies, and conducted a case-study in one of our own primary SCCS studies to illustrate the use of RIRs within an SCCS analysis to investigate subgroup effects in the context of comparing whole cell (wcp) and acellular (acp) pertussis vaccines. Using this case study, we also illustrated the potential utility of RIRs in addressing the healthy vaccinee effect (HVE) in vaccine safety surveillance studies. Results Our scoping review identified 122 primary studies reporting an SCCS analysis. Of these, 24 described the use of interaction terms to test for effect modification. 21 of 24 studies reported stratum specific RIs, 22 of 24 reported the p-value for interaction, and less than half (10 of 24) reported the estimate of the interaction term/RIR, the stratum specific RIs and interaction p-values. Our case-study demonstrated that there was a nearly two-fold greater RI of ER visits and admissions following wcp vaccination relative to acp vaccination (RIR = 1.82, 95 % CI 1.64–2.01), where RI estimates in each subgroup were clearly impacted by a strong healthy vaccinee effect. Conclusions We demonstrated in our scoping review that calculating RIRs is not a widely utilized strategy. We showed that calculating RIRs across time periods is useful for the detection of relative changes in adverse event rates that might otherwise be missed due to the HVE. Many published studies of vaccine-associated adverse events could have missed/underestimated important safety signals masked by the HVE. With further development, our application of RIRs could be an important tool to address the HVE, particularly in the context of self-controlled study designs.
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Affiliation(s)
- Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada. .,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada. .,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada.
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
| | - Julian Little
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada
| | - Eric I Benchimol
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Salah Mahmud
- Department of Medicine, 727 McDermot Ave., Winnipeg, MB, R3E 3P5, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8 M5, Canada.,Institute for Clinical Evaluative Sciences Ottawa, Box 684, 1053 Carling Ave., Admin Services Bldg. Rm 1009, Ottawa, ON, K1Y4E9, Canada
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Rathore DK, Nair D, Raza S, Saini S, Singh R, Kumar A, Tripathi R, Ramji S, Batra A, Aggarwal KC, Chellani HK, Arya S, Bhatla N, Paul VK, Aggarwal R, Agarwal N, Mehta U, Sopory S, Natchu UCM, Bhatnagar S, Bal V, Rath S, Wadhwa N. Underweight full-term Indian neonates show differences in umbilical cord blood leukocyte phenotype: a cross-sectional study. PLoS One 2015; 10:e0123589. [PMID: 25898362 PMCID: PMC4405369 DOI: 10.1371/journal.pone.0123589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/19/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While infections are a major cause of neonatal mortality in India even in full-term neonates, this is an especial problem in the large proportion (~20%) of neonates born underweight (or small-for-gestational-age; SGA). One potential contributory factor for this susceptibility is the possibility that immune system maturation may be affected along with intrauterine growth retardation. METHODS In order to examine the possibility that differences in immune status may underlie the susceptibility of SGA neonates to infections, we enumerated the frequencies and concentrations of 22 leukocyte subset populations as well as IgM and IgA levels in umbilical cord blood from full-term SGA neonates and compared them with values from normal-weight (or appropriate-for-gestational-age; AGA) full-term neonates. We eliminated most SGA-associated risk factors in the exclusion criteria so as to ensure that AGA-SGA differences, if any, would be more likely to be associated with the underweight status itself. RESULTS An analysis of 502 such samples, including 50 from SGA neonates, showed that SGA neonates have significantly fewer plasmacytoid dendritic cells (pDCs), a higher myeloid DC (mDC) to pDC ratio, more natural killer (NK) cells, and higher IgM levels in cord blood in comparison with AGA neonates. Other differences were also observed such as tendencies to lower CD4:CD8 ratios and greater prominence of inflammatory monocytes, mDCs and neutrophils, but while some of them had substantial differences, they did not quite reach the standard level of statistical significance. CONCLUSIONS These differences in cellular lineages of the immune system possibly reflect stress responses in utero associated with growth restriction. Increased susceptibility to infections may thus be linked to complex immune system dysregulation rather than simply retarded immune system maturation.
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Affiliation(s)
- Deepak K. Rathore
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Deepa Nair
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Saimah Raza
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Savita Saini
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Singh
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Amit Kumar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Reva Tripathi
- Department of Obstetrics & Gynecology, Maulana Azad Medical College, New Delhi, India
| | - Siddarth Ramji
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Aruna Batra
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Kailash C. Aggarwal
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Harish K. Chellani
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics & Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod K. Paul
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Aggarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Agarwal
- Department of Obstetrics & Gynecology, General Hospital, Gurgaon, Haryana, India
| | - Umesh Mehta
- Department of Pediatrics, General Hospital, Gurgaon, Haryana, India
| | - Shailaja Sopory
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Uma Chandra Mouli Natchu
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Shinjini Bhatnagar
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
| | - Vineeta Bal
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Satyajit Rath
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India
| | - Nitya Wadhwa
- Pediatric Biology Centre, Translational Health Science and Technology Institute, Gurgaon, Haryana, India
- * E-mail:
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Hawken S, Potter BK, Benchimol EI, Little J, Ducharme R, Wilson K. Seasonal variation in rates of emergency room visits and acute admissions following recommended infant vaccinations in Ontario, Canada: A self-controlled case series analysis. Vaccine 2014; 32:7148-53. [DOI: 10.1016/j.vaccine.2014.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022]
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Hawken S, Kwong JC, Deeks SL, Crowcroft NS, Ducharme R, Manuel DG, Wilson K. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study. PLoS One 2013; 8:e81070. [PMID: 24324662 PMCID: PMC3852020 DOI: 10.1371/journal.pone.0081070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We investigated the association between a child's birth order and emergency room (ER) visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. Methods We included all children born in Ontario between April 1st, 2006 and March 31st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI) of events among 1st-born and later-born children using relative incidence ratios (RIR). Results For the 2-month vaccination, the RIR for 1st-borns versus later-born children was 1.37 (95% CI: 1.19–1.57), which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1st-borns vs. later-borns was 1.70 (95% CI: 1.45–1.99), representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1st vs. later-borns was 1.27 (95% CI: 1.09–1.48), or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02–1.21), or 249 excess events/100,000 vaccinated. Conclusions Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1st-born children had significantly higher relative incidence of events compared to later-born children.
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Affiliation(s)
- Steven Hawken
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shelley L. Deeks
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Robin Ducharme
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas G. Manuel
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Wilson K, Ducharme R, Hawken S. Association between socioeconomic status and adverse events following immunization at 2, 4, 6 and 12 months. Hum Vaccin Immunother 2013; 9:1153-7. [PMID: 23328278 PMCID: PMC3899153 DOI: 10.4161/hv.23533] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Using a population-based self-controlled case series design, we examined data on children born between the years 2002 and 2009 in the province of Ontario, Canada. We specifically examined how socioeconomic status (SES) influences rates of adverse events following immunization (AEFI), defined as emergency room visits and / or hospital admissions. For vaccination at 2, 4 and 6 mo combined, the relative incidence of AEFI (95% CI) in the first 72 h after vaccination was 0.69 (0.67 to 0.71). For all three vaccinations combined, we observed no relationship between the relative incidence of an event and quintile of socioeconomic status (p = 0.1433). For the 12-mo vaccination alone, the relative incidence of events (95% CI) on days 4 to 12 following immunization was 1.35 (1.31 to 1.38). We observed a significant relationship between socioeconomic status and vaccination at 12 mo, with lower SES being associated with a higher relative incidence of events (p = 0.0075). When the lowest 2 quintiles of income combined were compared with the highest 3 quintiles, the relative incidence ratio (95% CI) was 0.94 (0.89 to 0.99, p = 0.02). These results translate to 150 additional adverse events in the lower SES quintiles as compared with the higher SES quintiles for every 100,000 children vaccinated, or 1 additional event for every 666 individuals vaccinated. Future studies should explore potential explanations for this observation.
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Affiliation(s)
- Kumanan Wilson
- Department of Medicine; Ottawa Hospital Research Institute; University of Ottawa; Ottawa, ON Canada; ICES@Uottawa; Ottawa Hospital Research Institute; University of Ottawa; Ottawa, ON Canada
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Wilson K, Hawken S, Kwong JC, Deeks SL, Crowcroft NS, Manuel D. Vaccine and Immunization Surveillance in Ontario (VISION) - using linked health administrative databases to monitor vaccine safety. Vaccine 2012; 30:6115-20. [PMID: 22709951 DOI: 10.1016/j.vaccine.2012.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
Vaccine safety surveillance is a critical component of any population-wide vaccination program. In the province of Ontario, Canada we developed a vaccine safety surveillance system utilizing linked health administration databases. VISION (Vaccine and Immunization Surveillance in Ontario) has conducted population based self-controlled case series analyses to evaluate the safety of recommended pediatric vaccines in the general population and in specific subgroups. We present our experiences with developing this system including preliminary findings and challenges. Key methodological observations include: (1) aggregate health services data as an endpoint appears useful (2) graphical description of events following vaccination are valuable and (3) relative incidence ratios are helpful for overcoming the healthy vaccinee effect.
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Affiliation(s)
- Kumanan Wilson
- Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Administrative Services Building, Room 1009, Box 684, Ottawa, ON K1Y 4E9, Canada.
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Wilson K, Hawken S. Incidence of adverse events in premature children following 2-month vaccination. Hum Vaccin Immunother 2012; 8:592-5. [PMID: 22634444 DOI: 10.4161/hv.19377] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Using a population based self-controlled case series study design we examined data on 834,740 children in the province of Ontario, Canada. We observed that when comparing to SGA10 term children (term children born in the lowest 10th percentile of weight for a given gestational age), relative incidence of emergency room visits and admission in the 3 d post 2 mo vaccination progressively decreased in near term (relative incidence ratio 0.89 (95% CI 0.74-1.07)) and very premature children [(0.67(0.49-0.93)]. When compared with all term children this decrease in risk is not statistically significant. We speculate that the immune response is reduced in premature children resulting in reduced adverse events. This is masked when comparing to all term children because the reduced birth weight of premature children results in a comparatively increased dose of vaccine. This in turn results in an increased immune response and risk of immediate adverse reactions. Future studies of immune response in premature children should examine the impact of weight at the time of immunization.
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Affiliation(s)
- Kumanan Wilson
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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