Vaccine safety in children: huge benefit, minimal risks

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The Rand Corporation updated a 2011 Institute of Medicine consensus report on vaccine safety (National Academies Press 2011). To do so, they performed a systematic review of evidence published from 2010 to August 2013. Of 20,478 possible articles, 67 met inclusion criteria. The combined data revealed the following:

Concerning adverse events associated with vaccines:

  • Hepatitis A vaccine: Moderate evidence of an association with immune thrombocytopenic purpura (ITP) only in older children (age 7–17 years).
  • MMR (measles, mumps and rubella) vaccine: Strong evidence of an association with febrile seizure. Moderate evidence of an association with ITP.
  • Pneumococcal (PCV13) vaccine: Moderate evidence of an association with febrile seizure (estimated rates for infants aged 16 months, 13.7 per 100,000 doses for PCV13 alone and 45 per 100,000 for PVC13 combined with influenza trivalent inactivated vaccine).
  • Rotavirus vaccine: Moderate evidence of an association with intussusception (estimated rate, 1–5 cases per 100,000 doses).

Equally important: What is not associated with vaccines:

  • High-quality evidence that MMR vaccine is not associated with autism.
  • No vaccines studied were associated with childhood leukemia.
  • Moderate evidence that DTaP (diphtheria, tetanus, and acellular pertussis) vaccine is not associated with diabetes mellitus and hepatitis B vaccination is not associated with multiple sclerosis.
  • Moderate evidence that Hib (Haemophilus influenza type b) vaccine is not associated with serious adverse events.

Comment

This study should reassure everyone that vaccines are safe, that adverse events are rare, and in most cases will resolve completely. Transparency about adverse events may provide reassurance of the benefit of immunizations. If these data do not reassure parents, at least clinicians can speak with confidence of the safety and importance of vaccines for the health of children.

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Source:
NEJM Journal Watch & Pediatrics

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