Abstract
In the Netherlands, children at 9 years of age receive a booster dT-IPV together with their second measles, mumps, and rubella (MMR) vaccination within the national immunization program. Safety is monitored continuously by enhanced passive surveillance. This population-based study was conducted to obtain more information on adverse events after vaccination at 9 years of age. Questionnaires on local and systemic reactions were distributed 1 and 3 weeks after vaccination, respectively, to parents of 1,250 healthy children who received their MMR and diphtheria, tetanus, and inactivated poliovirus injection (dT-IPV) vaccination as scheduled. Response to the quesionnaires was 57.0% and 46.5%, respectively. Local reactions occurred in 86.5% of the children within 7 days after vaccination, more often at the dT-IPV (83.4%) than at the MMR site (32.7%). Pain was the most reported symptom (80.8% at the dT-IPV site; 29.1% at the MMR site). Systemic events occurred in 33.4% children within 7 days after vaccination, with headache as the most frequently reported (20.8%). Systemic events occurred in 20.8% children 8–21 days after vaccination. Children with local reactions at only the dT-IPV site had significantly more systemic events (19.3%) than those without local reactions (3.4%, p < 0.01). Such difference was not found for the MMR site. No serious adverse events were reported. Medical intervention was applied to 133 children (130 used analgesics and for three children the GP was consulted by phone). In conclusion, the frequency of reported local reactions is high, especially at the dT-IPV site, but all symptoms were transient. However, the use of reduced antigen content vaccines in association with the occurrence of adverse events is meaningful to explore. Furthermore, the overall rates are useful for monitoring variations in adverse events rates in the general population.
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References
Ammari LK, Bell LM, Hodinka RL (1993) Secondary measles vaccine failure in healthcare workers exposed to infected patients. Infect Control Hosp Epidemiol 14:81–86
Andre FE (1999) Development and clinical application of new polyvalent combined paediatric vaccines. Vaccine 17:1620–16276
Baylor NW, Egan W, Richman P (2002) Aluminum salts in vaccines–US perspective. Vaccine 20(Suppl 3):S18–S23
Begue PC, Grimprel EM, Giovannangeli MD, Abitbol VI (1998) Comparative reactogenicity and immunogenicity of booster doses of diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine and diphtheria-tetanus-inactivated poliovirus vaccine in preadolescents. Pediatr Infect Dis J 17:804–809
Black C, Kaye JA, Jick H (2003) MMR vaccine and idiopathic thrombocytopaenic purpura. Br J Clin Pharmacol 55:107–111
Black S, Friedland LR, Schuind A, Howe B (2006) Immunogenicity and safety of a combined DTaP-IPV vaccine compared with separate DTaP and IPV vaccines when administered as pre-school booster doses with a second dose of MMR vaccine to healthy children aged 4–6 years. Vaccine 24:6163–6171
Bogaerts H (2003) The future of childhood immunizations: examining the European experience. Am J Manag Care 9:S30–S36
Brabin L, Roberts SA, Stretch R et al (2008) Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ 336:1056–1058
Bults M, Kemmeren JM, van der Maas NA (2007) Adverse events following booster doses of diphtheria-tetanus-inactivated poliovirus and acellular pertussis vaccines for 4-year-old children in The Netherlands. Vaccine 25:5272–5277
Chen RT, Goldbaum GM, Wassilak SG et al (1989) An explosive point-source measles outbreak in a highly vaccinated population. Modes of transmission and risk factors for disease. Am J Epidemiol 129:173–182
Clements CJ, Griffiths E (2002) The global impact of vaccines containing aluminium adjuvants. Vaccine 20(Suppl 3):S24–S33
Cochi S, Wharton M, Plotkin S (1994) Mumps vaccine. In: Plotkin SA, Mortimer EAJ (eds) Vaccines. WB Saunders, Philadelphia, pp 277–301
Davis RL, Marcuse E, Black S et al (1997) MMR2 immunisation at 4 to 5 years and 10 to 12 years of age: a comparison of adverse clinical events after immunisation in the Vaccine Safety Datalink Project. Pediatrics 100:767–771
Dodd D (2003) Benefits of combination vaccines: effective vaccination on a simplified schedule. Am J Manag Care 9:S6–S12
Gold MS, Noonan S, Osbourn M et al (2003) Local reactions after the fourth dose of acellular pertussis vaccine in South Australia. Med J Aust 179:191–194
Gothefors L, Bergstrom E, Backman M (2001) Immunogenicity and reactogenicity of a new measles, mumps and rubella vaccine when administered as a second dose at 12 years of age. Scand J Infect Dis 33:545–549
Gust DA, Campbell S, Kennedy A et al (2006) Parental concerns and medical-seeking behavior after immunization. Am J Prev Med 31:32–35
Gustaffson L, Hallander HO, Olin P et al (1996) A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine. N Engl J Med 334(3):49–355
Halperin SA, Scheifele D, Mills E et al (2003) Nature, evolution, and appraisal of adverse events and antibody response associated with the fifth consecutive dose of a five-component acellular pertussis-based combination vaccine. Vaccine 21:2298–2306
Huang LM, Chang LY, Tang H et al (2005) Immunigenicity and reactogenicity of a reduced-antigen-content diphtheria-tetanus-acellular pertussis vaccine in healthy Taiwanese children and adolescents. J Adolesc Health 37:517
Jefferson T, Rudin M, Di Pietrantonj C (2004) Adverse events after immunisation with aluminium-containing DTP vaccines: systematic review of the evidence. Lancet Infect Dis 4:84–90
LeBaron CW, Daoling BI, Sullivan BJ et al (2006) Evaluation of potentially common adverse events associated with the first and second doses of measles-mumps-rubella vaccine. Pediatrics 118:1422–1430
Maas van der NAT, Zonnenberg-Hoff IF, David S, et al (2008) Adverse events following immunisation under the national vaccination programme of The Netherlands. Number XIV—Reports in 2007. National Institute for Public Health and Environment, Bilthoven
Markowitz L, Katz S (1994) Measles vaccine. In: Plotkin SA, Mortimer EAJ (eds) Vaccines. WB Saunders, Philadelphia, pp 229–276
Marshall H, Nolan T, Roberton D et al (2006) A comparison of booster immunisation with a combination DTPa-IPV vaccine or DTPa plus IPV in separate injections when co-administered with MMR, at age 4–6 years. Vaccine 24:6120–6128
de Melker H, Gerritsen A, Hahné S (2007) The national immunisation programme in the Netherlands. RIVM, Bilthoven
Miller E, Waight P, Laurichesse H et al (2001) Immunogenicity and reactogenicity of acellular diphtheria/tetanus/pertussis vaccines given as a pre-school booster: effect of simultaneous administration of MMR. Vaccine 19:3904–3911
Olin P, Rasmussen F, Gustaffson L et al (1997) Randomised controlled trial of two-component, three-component, and five-component acellular pertussis vaccines compard with whole-cell pertussis vaccine. Lancet 350:1569–1577
Parment PA, Svahn A, Ruden U et al (2003) Immunogenicity and reactogenicity of a single dose of live attenuated varicella vaccine and a booster dose of measles-mumps-rubella vaccine given concomitantly at 12 years of age. Scand J Infect Dis 35:736–742
Peltola H, Heinonen OP (1986) Frequency of true adverse reactions to measles-mumps-rubella vaccine. A double-blind placebo-controlled trial in twins. Lancet 1:939–942
Rennels MB (2002) Combination vaccines. Pediatr Infect Dis J 21:255–257
Rennels MB (2003) Extensive swelling reactions occurring after booster doses of diphtheria-tetanus-acellular pertussis vaccines. Semin Pediatr Infect Dis 14:196–198
Sanger R, Behre U, Krause KH et al (2007) Booster vaccination and 1-year follow-up of 4–8 year old children with a reduced-antigen-content dTpa-IPV vaccine. Eur J Pediatr 166:1229–1236
Scheifele DW, Halperin SA, Ferguson AC (2001) Assessment of injection site reactions to an acellular pertussis-based combination vaccine, including novel use of skin tests with vaccine antigens. Vaccine 19:4720–4726
Scheifele DW, Halperin SA, Ochnio JJ et al (2005) A modified vaccine reduces the rate of large injection site reactions to the preschool booster dose of diphtheria-tetanus-acellular pertussis vaccine: results of a randomized, controlled trial. Pediatr Infect Dis J 24:1059–1066
Virtanen M, Peltola H, Paunio M, Heinonen OP (2000) Day-to-day reactogenicity and the healthy vaccinee effect of measles-mumps-rubella vaccination. Pediatrics 106:e62
Wei F, Mullooly JP, Goodman M et al (2009) Identification and characteristics of vaccine refusers. BMC Pediatr 5:18
Zhu F, Zhan S, Hou Q et al (2010) Booster vaccination against pertussis in Chinese children at 6 years of age using reduced antigen content diphteria-tetanus-acellular pertussis vaccine (BoostrixTM). Hum Vaccin 6:263–269
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Kemmeren, J.M., van der Maas, N.A.T. & de Melker, H.E. Parental reports of adverse events following simultaneously given dT-IPV and MMR vaccines in healthy 9-year-old children. Eur J Pediatr 170, 339–345 (2011). https://doi.org/10.1007/s00431-010-1294-4
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DOI: https://doi.org/10.1007/s00431-010-1294-4