The Individual Perspective: Did This Vaccine Harm this Person?

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you carry out proper immuno-logic drug use in your practice.

Side Effects of Vaccination: A Consumer's Guide to Cause and Effect

Credit

This lesson is good for 0.2 CE units, with a passing grade of 70%.

Objectives

1. To describe historical examples of adverse events truly and spuriously associated with vaccination. 2. To describe a rational basis for deciding whether adverse events are causally or coincidentally linked to a medication. 3. To demonstrate how to apply this rational basis to a variety of exposure—outcome associations.

Vaccine safety controversies and the future of vaccination programs

In the years following the hepatitis B vaccination/multiple sclerosis controversy, a number of new issues regarding vaccine safety have been raised, in some cases leading to more debate and confusion. Against this background, an international group of experts was convened to review the current points of view concerning the use of thimerosal as a preservative and its potential risks; the suggested link between thimerosal-containing vaccines and acute lymphoblastic leukemia; the alleged association between aluminum-containing vaccines/macrophagic myofasciitis and general systemic complaints; a possible link between vaccination and autoimmune pathology; and a hypothetical link between measles-mumps-rubella vaccination and autism. At present, there are no data to conclude that childhood vaccines, and in particular hepatitis B vaccine, pose a serious health risk or justify a change in current immunization practice. However, vaccine "scares" continue to have an international impact on immunization coverage. Creating a positive environment for immunization can be achieved by repositioning the value of vaccines and vaccination, supported by evidence-based information. The role of international organizations, the media, and the industry in the implementation of communication strategies was discussed and the impact of litigation issues on vaccination was evaluated. The Viral Hepatitis Prevention Board confirms its commitment to current recommendations for universal and risk group hepatitis B vaccination and further encourages the conduct of vaccine safety studies and the dissemination of their results.

Incidence of Adverse Reactions to Vaccines in a Paediatric Population

OBJECTIVE

To detect the appearance and specify the types of adverse reactions to vaccines registered in a paediatric population.

PATIENTS AND METHODS

A 6-month, prospective, observational, multicentre epidemiological vaccine safety study was undertaken in 2002 covering a paediatric population subject to vaccine administration. A two-phase telephone survey of all patients was conducted, comprising an initial call at 1 week and a follow-up call at 30 days after the vaccine administration date. A paediatrician was responsible for diagnosing the specific type of adverse reaction.

RESULTS

Of a total sample of 946 children, ranging in age from 0 to 14 years (50.8% girls, 49.1% boys), 191 non-serious suspected adverse reactions were detected, representing 19% of the vaccinated children. Reactions to the diphtheria, tetanus, pertussis acellular and Haemophilus influenzae type b (DTPa + Hib) vaccine appeared in 43.4% of cases, followed by reactions to the measles, mumps, rubella (MMR) [18.4%] and adult tetanus and diphtheria (Td) [17.8%] vaccines. The most frequent types of adverse reactions to vaccines were: injection-site oedema (12.2 per 1000 doses); pain at site of inoculation (10.3 per 1000 doses); temperature not recorded but believed by parents to be very high (4.6 per 1000 doses); and measured temperature indicating fever of 39-40.5 masculineC (4.4 per 1000 doses). Fifty-five percent (n = 21) of cases of injection-site oedema were attributed to DTPa + Hib vaccine (18.8 per 1000 doses), followed by 18.4% (n = 7) attributable to Td vaccine (112 per 1000 doses). Indeed, this latter vaccine was responsible for 43.8% (n = 14; 226 per 1000 doses) of all reported pain at the site of inoculation. MMR vaccine was linked to the occurrence of fever of 39-40.5 masculineC in 52% of cases (n = 10; 29 per 1000 doses). Two children were treated by the emergency services, but there were no deaths or hospitalisations.

CONCLUSIONS

An active search for subjects with suspected adverse reactions to vaccines led to the detection of reactions that are usually not reported. Primary-care physicians and nurses must be vigilant for information on adverse reactions to vaccines in paediatric populations.

Guillain-Barré Syndrome and Vaccination: Usually Unrelated

With the rapid pace of immunologic research, it is more important than ever for readers to understand rational immunodiagnosis, immunoprophylaxis, and immunotherapy. This column is intended to help you carry out proper immunologic drug use in your practice.