Febrile Seizure Risk after Vaccination in Children One to Five Months of Age

• Authors: Jonathan Duffy, Centers for Disease Control and Prevention; Simon J. Hambidge, Kaiser Permanente; Lisa A. Jackson, Kaiser Permanente; Elyse O. Kharbanda, HealthPartners Inst; Nicola P. Klein, Kaiser Permanente; Allison Naleway, Kaiser Permanente; Saad Omer, Emory University; Eric Weintraub, Centers for Disease Control and Prevention
• Journal Title: Pediatric Neurology
• Volume: Volume 76
• Publisher: Elsevier: 12 months | 2017-11-01, Pages 72-78
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.pediatrneurol.2017.08.005
• Subjects: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Biology, Microbiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Pediatrics; Neurosciences & Neurology; febrile seizure; vaccines; immunization; cohort studies; infant; SAFETY; PERTUSSIS; MEASLES; MUMPS; IMMUNIZATION; DIPHTHERIA; TETANUS

Abstract

Background: The risk of febrile seizure is temporarily increased for a few days after the administration of certain vaccines in children aged six to 23 months. Our objective was to determine the febrile seizure risk following vaccination in children aged one to five months, when six different vaccines are typically administered. Methods: We identified emergency department visits and inpatient admissions with International Classification of Diseases, Ninth Revision, febrile seizure codes among children enrolled in nine Vaccine Safety Datalink participating health care organizations from 2006 through 2011. Febrile seizures were confirmed by medical record abstraction. We used the self-controlled risk-interval method to compare the incidence of febrile seizure during postvaccination days 0 to 1 (risk interval) versus days 14 to 20 (control interval). Results: We identified 15 febrile seizure cases that occurred after 585,342 vaccination visits. The case patients were aged three to five months. The patients had received a median of four (range two to six) vaccines simultaneously. The incidence rate ratio of febrile seizure after vaccination was 23 (95% confidence interval 5.13 to 100.8), and the attributable risk was 3.92 (95% confidence interval 1.68 to 6.17) febrile seizure cases per 100,000 persons vaccinated. Conclusions: Vaccination in children aged three to five months was associated with a large relative risk of febrile seizure on the day of and the day after vaccination, but the risk was small in absolute terms. Postvaccination febrile seizure should not be a concern for the vast majority of children receiving vaccines, but clinicians might take this risk into consideration when evaluating and treating children susceptible to seizures precipitated by fever.