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PEDIATRICS Vol. 99 No. 6 June 1997, pp. 765-773
Received Apr 1, 1996; accepted Jun 14, 1996.
,,,
,,
From the * National Immunization Program, Centers for Disease
Control and Prevention, Atlanta, Georgia; Center for Health Studies,
Group Health Cooperative of Puget Sound, Seattle, Washington; § Center
for Health Research, Northwest Kaiser Permanente, Portland, Oregon;
Pediatric Vaccine Study Center, Northern California Kaiser
Permanente, Oakland; ¶ Center for Vaccine Research, Harbor-UCLA Medical
Center, Torrance, California; # Southern California Kaiser Permanente,
Pasadena; and ** Center for Biologics Evaluation and Research, Food and
Drug Administration, Rockville, Maryland.
Objective. To fill the large "gaps and limitations" in current scientific knowledge of rare vaccine adverse events identified in recent reviews of the Institute of Medicine.
Methods. Computerized information on immunization, medical outcomes, and potential confounders on more than 500 000 children 0 to 6 years of age is linked annually at several health maintenance organizations to create a large cohort for multiple epidemiologic studies of vaccine safety.
Results. Analysis of 3 years of follow-up data shows that 549 488 doses of diphtheria-tetanus-pertussis (DTP) and 310 618 doses of measles-mumps-rubella (MMR) vaccines have been administered to children in the study cohort. Analyses for associations between vaccines and 34 medical outcomes are underway. Screening of automated data shows that seizures are associated with receipt of DTP on the same day (relative risk [RR], 2.1; 95% confidence interval [CI], 1.1 to 4.0) and 8 to 14 days after receipt of MMR (RR, 3.0; 95% CI, 2.1 to 4.2). The diversity of vaccination exposures in this large cohort permits us to show that an apparent association of seizures 8 to 14 days after Haemophilus influenzae type b vaccine (RR, 1.6; 95% CI, 1.2 to 2.1) was attributable to confounding by simultaneous MMR vaccination; the association disappears with appropriate adjustment (RR, 1.0; 95% CI, 0.7 to 1.4).
Conclusion. Preliminary design, data collection, and analytic capability of the Vaccine Safety Datalink project has been validated by replication of previous known associations between seizures and DTP and MMR vaccines. The diversity in vaccine administration schedules permits potential disentangling of effects of simultaneous and combined vaccinations. The project provides a model of public health-managed care collaborations in addition to an excellent infrastructure for safety and other studies of vaccines.
Key words: vaccines, immunization, adverse reactions, databases, record linkage, vaccine safety.
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