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Unformatted text preview: 656 N Engl J Med, Vol. 345, No. 9 August 30, 2001 www.nejm.org The New England Journal of Medicine THE RISK OF SEIZURES AFTER RECEIPT OF WHOLE-CELL PERTUSSIS OR MEASLES, MUMPS, AND RUBELLA VACCINE W ILLIAM E. B ARLOW , P H .D., R OBERT L. D AVIS , M.D., M.P.H., J OHN W. G LASSER , P H .D., M.P.H., P HILLIP H. R HODES , P H .D., R OBERT S. T HOMPSON , M.D., J OHN P. M ULLOOLY , P H .D., S TEVEN B. B LACK , M.D., H ENRY R. S HINEFIELD , M.D., J OEL I. W ARD , M.D., S. M ICHAEL M ARCY , M.D., F RANK D E S TEFANO , M.D., AND R OBERT T. C HEN , M.D., FOR THE C ENTERS FOR D ISEASE C ONTROL AND P REVENTION V ACCINE S AFETY D ATALINK W ORKING G ROUP A BSTRACT Background The administration of the diphtheria and tetanus toxoids and whole-cell pertussis (DTP) vaccine and measles, mumps, and rubella (MMR) vac- cine has been associated with seizures. We studied the relation between these vaccinations and the risk of a first seizure, subsequent seizures, and neurodevelop- mental disability in children. Methods This cohort study was conducted at four large health maintenance organizations and included reviews of the medical records of children with sei- zures. We calculated the relative risks of febrile and nonfebrile seizures among 679,942 children after 340,386 vaccinations with DTP vaccine, 137,457 vac- cinations with MMR vaccine, or no recent vaccination. Children who had febrile seizures after vaccination were followed to identify the risk of subsequent sei- zures and other neurologic disabilities. Results Receipt of DTP vaccine was associated with an increased risk of febrile seizures only on the day of vaccination (adjusted relative risk, 5.70; 95 percent confidence interval, 1.98 to 16.42). Receipt of MMR vaccine was associated with an increased risk of fe- brile seizures 8 to 14 days after vaccination (relative risk, 2.83; 95 percent confidence interval, 1.44 to 5.55). Neither vaccination was associated with an increased risk of nonfebrile seizures. The number of febrile sei- zures attributable to the administration of DTP and MMR vaccines was estimated to be 6 to 9 and 25 to 34 per 100,000 children, respectively. As compared with other children with febrile seizures that were not associated with vaccination, the children who had fe- brile seizures after vaccination were not found to be at higher risk for subsequent seizures or neurodevel- opmental disabilities. Conclusions There are significantly elevated risks of febrile seizures after receipt of DTP vaccine or MMR vaccine, but these risks do not appear to be as- sociated with any long-term, adverse consequences. (N Engl J Med 2001;345:656-61.) Copyright 2001 Massachusetts Medical Society. From the Immunization Studies Program, Center for Health Studies, Group Health Cooperative, Seattle (W.E.B., R.L.D., R.S.T.); the Department of Biostatistics, University of Washington, Seattle (W.E.B.); the National Im- munization Program, Vaccine Safety and Development Activity, Centers for Disease Control and Prevention, Atlanta (J.W.G., P.H.R., F.D., R.T.C.); theDisease Control and Prevention, Atlanta (J....
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