The risk of immune thrombocytopenic purpura after vaccination in children and adolescents

Sean T. O'Leary, Jason M. Glanz, David L. McClure, Aysha Akhtar, Matthew F. Daley, Cynthia Nakasato, Roger Baxter, Robert Davis, Hector S. Izurieta, Tracy A. Lieu, Robert Ball

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown. METHODS: Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods. RESULTS: There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae. CONCLUSIONS: ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.

Original languageEnglish (US)
Pages (from-to)248-255
Number of pages8
JournalPediatrics
Volume129
Issue number2
DOIs
StatePublished - Feb 1 2012

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Idiopathic Thrombocytopenic Purpura
Vaccination
Diphtheria-Tetanus-acellular Pertussis Vaccines
Measles-Mumps-Rubella Vaccine
Vaccines
Hepatitis A
Chickenpox
Hepatitis A Vaccines
Chickenpox Vaccine
Managed Care Programs
Platelet Count
Age Groups
Organizations
Incidence

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

O'Leary, S. T., Glanz, J. M., McClure, D. L., Akhtar, A., Daley, M. F., Nakasato, C., ... Ball, R. (2012). The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics, 129(2), 248-255. https://doi.org/10.1542/peds.2011-1111

The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. / O'Leary, Sean T.; Glanz, Jason M.; McClure, David L.; Akhtar, Aysha; Daley, Matthew F.; Nakasato, Cynthia; Baxter, Roger; Davis, Robert; Izurieta, Hector S.; Lieu, Tracy A.; Ball, Robert.

In: Pediatrics, Vol. 129, No. 2, 01.02.2012, p. 248-255.

Research output: Contribution to journalArticle

O'Leary, ST, Glanz, JM, McClure, DL, Akhtar, A, Daley, MF, Nakasato, C, Baxter, R, Davis, R, Izurieta, HS, Lieu, TA & Ball, R 2012, 'The risk of immune thrombocytopenic purpura after vaccination in children and adolescents', Pediatrics, vol. 129, no. 2, pp. 248-255. https://doi.org/10.1542/peds.2011-1111
O'Leary ST, Glanz JM, McClure DL, Akhtar A, Daley MF, Nakasato C et al. The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics. 2012 Feb 1;129(2):248-255. https://doi.org/10.1542/peds.2011-1111
O'Leary, Sean T. ; Glanz, Jason M. ; McClure, David L. ; Akhtar, Aysha ; Daley, Matthew F. ; Nakasato, Cynthia ; Baxter, Roger ; Davis, Robert ; Izurieta, Hector S. ; Lieu, Tracy A. ; Ball, Robert. / The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. In: Pediatrics. 2012 ; Vol. 129, No. 2. pp. 248-255.
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N2 - BACKGROUND: The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown. METHODS: Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods. RESULTS: There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae. CONCLUSIONS: ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.

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