1. Vaccine administration and the development of immune thrombocytopenic purpura in children
Abstract
“The most important reasons cited by the opponents of vaccines are concerns about vaccine safety. Unlike issues such as autism for which no indisputable documentation of direct relationship with vaccine use is available, immune thrombocytopenic purpura (ITP) is an adverse event that can really follow vaccine administration, and may limit vaccine use because little is known about which vaccines it may follow, its real incidence and severity, the risk of chronic disease, or the possibility of recurrences after new doses of the same vaccine. The main aim of this review is to clarify the real importance of thrombocytopenia as an adverse event and discuss how it may interfere with recommended vaccination schedules. The available data clearly indicate that ITP is very rare and the only vaccine for which there is a demonstrated cause-effect relationship is the measles, mumps and rubella (MMR) vaccine that can occur in 1 to 3 children every 100,000 vaccine doses. However, also in this case, the incidence of ITP is significantly lower than that observed during the natural diseases that the vaccine prevents. Consequently, ITP cannot be considered a problem limiting vaccine use except in the case of children suffering from chronic ITP who have to receive MMR vaccine. In these subjects, the risk-benefit ratio of the vaccine should be weighed against the risk of measles in the community”
Links
https://www.ncbi.nlm.nih.gov/pubmed/23324619
Citations
Cecinati, Valerio, Nicola Principi, Letizia Brescia, Paola Giordano, and Susanna Esposito. "Vaccine Administration and the Development of Immune Thrombocytopenic Purpura in Children." Human Vaccines & Immunotherapeutics 9.5 (2013): 1158-162.
“The most important reasons cited by the opponents of vaccines are concerns about vaccine safety. Unlike issues such as autism for which no indisputable documentation of direct relationship with vaccine use is available, immune thrombocytopenic purpura (ITP) is an adverse event that can really follow vaccine administration, and may limit vaccine use because little is known about which vaccines it may follow, its real incidence and severity, the risk of chronic disease, or the possibility of recurrences after new doses of the same vaccine. The main aim of this review is to clarify the real importance of thrombocytopenia as an adverse event and discuss how it may interfere with recommended vaccination schedules. The available data clearly indicate that ITP is very rare and the only vaccine for which there is a demonstrated cause-effect relationship is the measles, mumps and rubella (MMR) vaccine that can occur in 1 to 3 children every 100,000 vaccine doses. However, also in this case, the incidence of ITP is significantly lower than that observed during the natural diseases that the vaccine prevents. Consequently, ITP cannot be considered a problem limiting vaccine use except in the case of children suffering from chronic ITP who have to receive MMR vaccine. In these subjects, the risk-benefit ratio of the vaccine should be weighed against the risk of measles in the community”
Links
https://www.ncbi.nlm.nih.gov/pubmed/23324619
Citations
Cecinati, Valerio, Nicola Principi, Letizia Brescia, Paola Giordano, and Susanna Esposito. "Vaccine Administration and the Development of Immune Thrombocytopenic Purpura in Children." Human Vaccines & Immunotherapeutics 9.5 (2013): 1158-162.
2. A collaborative approach to investigating the risk of thrombocytopenic purpura after measles–mumps–rubella vaccination in England and Denmark
Abstract
“The assessment of rare adverse events following vaccination may not be possible within a single country due to an insufficiently large denominator population. In 2008 a European consortium (VAESCO) was funded to perform collaborative vaccine safety studies. To help assess the feasibility of multi-country collaboration England and Denmark, who have established vaccine safety research infrastructures, undertook to work to a common protocol and share results and data to estimate the risk of a known true adverse event, thrombocytopenic purpura (TP) following measles–mumps–rubella (MMR) vaccination. TP is a known rare reaction to MMR and therefore provided an opportunity to assess whether two countries would produce similar results when working collaboratively. Despite some initial problems with ensuring data were comparable, the two countries gave very similar estimates of the relative incidence in the 6 weeks after vaccination and a pooled relative incidence estimate of 2.13 (95% confidence interval 1.55–2.94) and attributable risk of 1 in 50,000 doses. Both countries used hospital admissions for TP and the analysis was performed using the self controlled case series method which is particularly suited to collaborative studies because of its implicit control for individual level confounding. The study therefore shows the potential for vaccine safety collaborations across Europe to detect true associations through use of common protocols and sharing of results or data”
Links
https://www.ncbi.nlm.nih.gov/pubmed/21699947
Citations
Andrews, Nick, Julia Stowe, Elizabeth Miller, Henrik Svanström, Kari Johansen, Jan Bonhoeffer, and Anders Hviid. "A Collaborative Approach to Investigating the Risk of Thrombocytopenic Purpura after Measles mumps rubella Vaccination in England and Denmark." Vaccine 30.19 (2012): 3042-046.
“The assessment of rare adverse events following vaccination may not be possible within a single country due to an insufficiently large denominator population. In 2008 a European consortium (VAESCO) was funded to perform collaborative vaccine safety studies. To help assess the feasibility of multi-country collaboration England and Denmark, who have established vaccine safety research infrastructures, undertook to work to a common protocol and share results and data to estimate the risk of a known true adverse event, thrombocytopenic purpura (TP) following measles–mumps–rubella (MMR) vaccination. TP is a known rare reaction to MMR and therefore provided an opportunity to assess whether two countries would produce similar results when working collaboratively. Despite some initial problems with ensuring data were comparable, the two countries gave very similar estimates of the relative incidence in the 6 weeks after vaccination and a pooled relative incidence estimate of 2.13 (95% confidence interval 1.55–2.94) and attributable risk of 1 in 50,000 doses. Both countries used hospital admissions for TP and the analysis was performed using the self controlled case series method which is particularly suited to collaborative studies because of its implicit control for individual level confounding. The study therefore shows the potential for vaccine safety collaborations across Europe to detect true associations through use of common protocols and sharing of results or data”
Links
https://www.ncbi.nlm.nih.gov/pubmed/21699947
Citations
Andrews, Nick, Julia Stowe, Elizabeth Miller, Henrik Svanström, Kari Johansen, Jan Bonhoeffer, and Anders Hviid. "A Collaborative Approach to Investigating the Risk of Thrombocytopenic Purpura after Measles mumps rubella Vaccination in England and Denmark." Vaccine 30.19 (2012): 3042-046.
3. Immune Thrombocytopenic Purpura after Recombinant Hepatitis B Vaccine: Retrospective Study of Seven Cases
Abstract
“Recombinant hepatitis B vaccine is usually well tolerated. Clinical and laboratory test manifestations with immunologic mechanisms have nonetheless been described following use of this vaccine. We retrospectively report 7 cases of thrombocytopenia occurring within 3 months (7 weeks on the average) of 1 or following injections of recombinant hepatitis B vaccine. Four boys and 3 girls, average age 12 y, were involved. Three had a history of immune thrombocytopenic purpura. Four had haemorrhagic manifestations. The haemogram showed thrombocytopenia (24×109 /l on the average) without alterations of the other lines. Infectious and immune aetiologies were excluded in all cases. The course varied after treatment by corticosteroids, high-dose intravenous immunoglobulin, or both. After describing the different manifestations subsequent to recombinant hepatitis B vaccination, we discuss post-vaccinal thrombocytopenias (vaccines in question, mechanisms) and the reality of this entity.”
Links
https://www.ncbi.nlm.nih.gov/pubmed/9730294
Citations
Maggy, Didier Neau Fabrice Bonnet. "Immune Thrombocytopenic Purpura after Recombinant Hepatitis B Vaccine: Retrospective Study of Seven Cases." Scandinavian Journal of Infectious Diseases 30.2 (1998): 115-18.
“Recombinant hepatitis B vaccine is usually well tolerated. Clinical and laboratory test manifestations with immunologic mechanisms have nonetheless been described following use of this vaccine. We retrospectively report 7 cases of thrombocytopenia occurring within 3 months (7 weeks on the average) of 1 or following injections of recombinant hepatitis B vaccine. Four boys and 3 girls, average age 12 y, were involved. Three had a history of immune thrombocytopenic purpura. Four had haemorrhagic manifestations. The haemogram showed thrombocytopenia (24×109 /l on the average) without alterations of the other lines. Infectious and immune aetiologies were excluded in all cases. The course varied after treatment by corticosteroids, high-dose intravenous immunoglobulin, or both. After describing the different manifestations subsequent to recombinant hepatitis B vaccination, we discuss post-vaccinal thrombocytopenias (vaccines in question, mechanisms) and the reality of this entity.”
Links
https://www.ncbi.nlm.nih.gov/pubmed/9730294
Citations
Maggy, Didier Neau Fabrice Bonnet. "Immune Thrombocytopenic Purpura after Recombinant Hepatitis B Vaccine: Retrospective Study of Seven Cases." Scandinavian Journal of Infectious Diseases 30.2 (1998): 115-18.
4. Thrombocytopenic purpura as adverse reaction to recombinant hepatitis B vaccine
Abstract
Three cases of immune thrombocytopenic purpura after the first dose of recombinant hepatitis B vaccine occurred in infants under 6 months of age. Other possible causes of this condition were excluded. Antiplatelet antibodies were present. A defect in platelet production was excluded in two children. Corticosteroid treatment was eVective. Subsequent administration of other vaccines (against polio, diphtheria, and tetanus) did not cause relapse of thrombocytopenia.
Links
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717498/
Citations
Ronchi, F., P. Cecchi, F. Falcioni, A. Marsciani, G. Minak, G. Muratori, P. L. Tazzari, and S. Beverini. "Thrombocytopenic Purpura as Adverse Reaction to Recombinant Hepatitis B Vaccine." Archives of Disease in Childhood 78.3 (1998): 273-74.
Three cases of immune thrombocytopenic purpura after the first dose of recombinant hepatitis B vaccine occurred in infants under 6 months of age. Other possible causes of this condition were excluded. Antiplatelet antibodies were present. A defect in platelet production was excluded in two children. Corticosteroid treatment was eVective. Subsequent administration of other vaccines (against polio, diphtheria, and tetanus) did not cause relapse of thrombocytopenia.
Links
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717498/
Citations
Ronchi, F., P. Cecchi, F. Falcioni, A. Marsciani, G. Minak, G. Muratori, P. L. Tazzari, and S. Beverini. "Thrombocytopenic Purpura as Adverse Reaction to Recombinant Hepatitis B Vaccine." Archives of Disease in Childhood 78.3 (1998): 273-74.
5. Vaccination associated thrombocytopenic purpura in children
Abstract
“Patients who presented with purpura and blood platelets <30x10(9)/l within 1 month after vaccination were collected from a population based material of 506 consecutive pediatric patients with newly diagnosed ITP. Of the 35 such patients, 24 had thrombocytopenia after MMR vaccination giving an estimated ITP risk of approximately 1 in 30,000 MMR inoculations. Symptoms of the 35 patients were nearly always acute. Thrombocytopenia disappeared within a month in 74% of the study patients and lasted longer than 6 months in only 10%. Bleeding episodes were uncommon during the follow-up period. We conclude that the incidence of symptomatic thrombocytopenia after vaccinations is much lower than that after respective natural infections and that the outcome in most cases is excellent.”
Links
https://www.ncbi.nlm.nih.gov/pubmed/17126957
Citations
Rajantie, J., B. Zeller, I. Treutiger, and S. Rosthöj. "Vaccination Associated Thrombocytopenic Purpura in Children." Vaccine 25.10 (2007): 1838-840
“Patients who presented with purpura and blood platelets <30x10(9)/l within 1 month after vaccination were collected from a population based material of 506 consecutive pediatric patients with newly diagnosed ITP. Of the 35 such patients, 24 had thrombocytopenia after MMR vaccination giving an estimated ITP risk of approximately 1 in 30,000 MMR inoculations. Symptoms of the 35 patients were nearly always acute. Thrombocytopenia disappeared within a month in 74% of the study patients and lasted longer than 6 months in only 10%. Bleeding episodes were uncommon during the follow-up period. We conclude that the incidence of symptomatic thrombocytopenia after vaccinations is much lower than that after respective natural infections and that the outcome in most cases is excellent.”
Links
https://www.ncbi.nlm.nih.gov/pubmed/17126957
Citations
Rajantie, J., B. Zeller, I. Treutiger, and S. Rosthöj. "Vaccination Associated Thrombocytopenic Purpura in Children." Vaccine 25.10 (2007): 1838-840
