Encephalopathy after whole-cell pertussis or measles vaccination

Lack of evidence for a causal association in a retrospective case-control study

Paula Ray, Jean Hayward, David Michelson, Edwin Lewis, Joan Schwalbe, Steve Black, Henry Shinefield, Michael Marcy, Ken Huff, Joel Ward, John Mullooly, Robert Chen, Robert Davis

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

BACKGROUND: Whole-cell pertussis (wP) and measles vaccines are effective in preventing disease but have also been suspected of increasing the risk of encephalopathy or encephalitis. Although many countries now use acellular pertussis vaccines, wP vaccine is still widely used in the developing world. It is therefore important to evaluate whether wP vaccine increases the risk of neurologic disorders. METHODS: A retrospective case-control study was performed at 4 health maintenance organizations. Records from January 1, 1981, through December 31, 1995, were examined to identify children aged 0 to 6 years old hospitalized with encephalopathy or related conditions. The cause of the encephalopathy was categorized as known, unknown or suspected but unconfirmed. Up to 3 controls were matched to each case. Conditional logistic regression was used to analyze the relative risk of encephalopathy after vaccination with diphtheria-tetanus-pertussis (DTP) or measles-mumps-rubella (MMR) vaccines in the 90 days before disease onset as defined by chart review compared with an equivalent period among controls indexed by matching on case onset date. RESULTS: Four-hundred fifty-two cases were identified. Cases were no more likely than controls to have received either vaccine during the 90 days before disease onset. When encephalopathies of known etiology were excluded, the odds ratio for case children having received DTP within 7 days before onset of disease was 1.22 (95% confidence interval [CI] = 0.45-3.31, P = 0.693) compared with control children. For MMR in the 90 days before onset of encephalopathy, the odds ratio was 1.23 (95% confidence interval = 0.51-2.98, P = 0.647). CONCLUSIONS: In this study of more than 2 million children, DTP and MMR vaccines were not associated with an increased risk of encephalopathy after vaccination.

Original languageEnglish (US)
Pages (from-to)768-773
Number of pages6
JournalPediatric Infectious Disease Journal
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Whooping Cough
Measles
Brain Diseases
Case-Control Studies
Vaccination
Pertussis Vaccine
Diphtheria
Tetanus
Measles-Mumps-Rubella Vaccine
Odds Ratio
Acellular Vaccines
Confidence Intervals
Measles Vaccine
Mumps
Rubella
Health Maintenance Organizations
Encephalitis
Nervous System Diseases
Vaccines
Logistic Models

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Encephalopathy after whole-cell pertussis or measles vaccination : Lack of evidence for a causal association in a retrospective case-control study. / Ray, Paula; Hayward, Jean; Michelson, David; Lewis, Edwin; Schwalbe, Joan; Black, Steve; Shinefield, Henry; Marcy, Michael; Huff, Ken; Ward, Joel; Mullooly, John; Chen, Robert; Davis, Robert.

In: Pediatric Infectious Disease Journal, Vol. 25, No. 9, 01.09.2006, p. 768-773.

Research output: Contribution to journalArticle

Ray, P, Hayward, J, Michelson, D, Lewis, E, Schwalbe, J, Black, S, Shinefield, H, Marcy, M, Huff, K, Ward, J, Mullooly, J, Chen, R & Davis, R 2006, 'Encephalopathy after whole-cell pertussis or measles vaccination: Lack of evidence for a causal association in a retrospective case-control study', Pediatric Infectious Disease Journal, vol. 25, no. 9, pp. 768-773. https://doi.org/10.1097/01.inf.0000234067.84848.e1
Ray, Paula ; Hayward, Jean ; Michelson, David ; Lewis, Edwin ; Schwalbe, Joan ; Black, Steve ; Shinefield, Henry ; Marcy, Michael ; Huff, Ken ; Ward, Joel ; Mullooly, John ; Chen, Robert ; Davis, Robert. / Encephalopathy after whole-cell pertussis or measles vaccination : Lack of evidence for a causal association in a retrospective case-control study. In: Pediatric Infectious Disease Journal. 2006 ; Vol. 25, No. 9. pp. 768-773.
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AU - Hayward, Jean

AU - Michelson, David

AU - Lewis, Edwin

AU - Schwalbe, Joan

AU - Black, Steve

AU - Shinefield, Henry

AU - Marcy, Michael

AU - Huff, Ken

AU - Ward, Joel

AU - Mullooly, John

AU - Chen, Robert

AU - Davis, Robert

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