Revaccination outcomes of children with vaccine proximate seizures

Lucy Deng; Margie Danchin; Georgina Lewis; Abigail Cheung; Anita J Campbell; Ushma Wadia; Krist Ewe; Nicholas Wood

doi:10.1016/j.vaccine.2021.02.016

Revaccination outcomes of children with vaccine proximate seizures

Vaccine. 2021 Mar 12;39(11):1565-1571. doi: 10.1016/j.vaccine.2021.02.016. Epub 2021 Feb 19.

Authors

Lucy Deng¹, Margie Danchin², Georgina Lewis³, Abigail Cheung⁴, Anita J Campbell⁵, Ushma Wadia⁵, Krist Ewe⁶, Nicholas Wood⁷

Affiliations

¹ National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, Australia. Electronic address: lucy.deng@health.nsw.gov.au.
² Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
³ Murdoch Children's Research Institute, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
⁴ Department of Allergy & Clinical Immunology, Women's and Children's Hospital, Adelaide, Australia.
⁵ Department of Infectious Diseases, Immunisation Service, Perth Children's Hospital, Nedlands, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia; School of Medicine, The University of Western Australia, Perth, Australia.
⁶ Department of Infectious Diseases, Immunisation Service, Perth Children's Hospital, Nedlands, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
⁷ National Centre for Immunisation Research and Surveillance, Children's Hospital at Westmead, Westmead, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Westmead, Australia.

PMID: 33612344
DOI: 10.1016/j.vaccine.2021.02.016

Abstract

Background: Seizures, whether febrile or afebrile, occurring within 14 days following vaccination can be considered as vaccine proximate seizures (VPSs). While the attributable risk and clinical severity of first febrile VPS is well known, the risk and clinical outcomes of VPS recurrence is less well defined.

Methods: We conducted a retrospective review of revaccination management and outcomes in children who experienced a VPS as their first seizure seen in Australian Specialist Immunisation Clinics between 2013 and 2017. Vaccination outcomes were compared between children who had a VPS as their only seizure (VPS only) and children who had further non-vaccine proximate seizures following their initial VPS (VPS+) prior to review at the clinic.

Results: We identified 119 children with a VPS as their first seizure, of which 61 (51%) went on to have other seizures (VPS+). Children with VPS+ were more likely to present at a younger age (6.2 vs 12.5 months, P = 0.03), with afebrile seizures (42.6% vs 15.5%, P = 0.002) compared to VPS only children. VPS recurrence on revaccination was uncommon in both groups, but more common in VPS+ children (12.5% vs 2.4%, P = 0.07). Having an epilepsy diagnosis, specifically Dravet syndrome, was associated with VPS recurrence (P < 0.001). Of the four children with Dravet syndrome who had VPS recurrence, all had status epilepticus following revaccination.

Conclusion: In children who presented with a single VPS as their only seizure, VPS recurrence on revaccination was uncommon. Children who had multiple non-vaccine proximate seizures following their initial VPS (VPS+) were more likely to present with afebrile VPS, at a younger age and have a VPS recurrence with vaccination. In these children, particularly those aged < 12 months, assessment and investigation for diagnosis of Dravet syndrome should be considered and additional precautions for revaccination undertaken as they are at highest risk of VPS recurrence.

Keywords: Adverse events following immunization; Immunization; Seizures.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Child
Humans
Immunization, Secondary
Infant
Retrospective Studies
Seizures*
Vaccines* / adverse effects

Substances

Vaccines