Risk of Immune Thrombocytopenic Purpura After Measles-Mumps-Rubella Immunization in Children

Department of Preventive Medicine, Kaiser Pemanente Colorado, Denver, CO 80231, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2008; 121(3):e687-92. DOI: 10.1542/peds.2007-1578
Source: PubMed


The measles-mumps-rubella vaccine has been associated with immune thrombocytopenia purpura in 2 small studies.
By using the Vaccine Safety Datalink, we identified measles-mumps-rubella-vaccinated children aged 1 to 18. A case of immune thrombocytopenia purpura was defined as a patient with a platelet count of < or = 50,000/microL with clinical bleeding and normal red and white blood cell indices. The immune thrombocytopenia purpura incidence rates during exposed (42 days after vaccination) and unexposed time periods were determined. A retrospective cohort of vaccinated children was used to determine incident rate ratios for children aged 1 to 18 years, 12 to 23 months, and 12 to 15 months.
A total of 1,036,689 children received 1,107,814 measles-mumps-rubella vaccinations; there were 259 confirmed patients with immune thrombocytopenia purpura. Because only 5 exposed cases occurred after age 2, analyses were limited to children aged 12 to 23 months. Exposed patients aged 12 to 23 months had lower median platelet counts than those who were unexposed and had similar median duration of illness (11 vs 10 days). The incident rate ratio was highest for children aged 12 to 15 months at 7.10. The incident rate ratio for boys aged 12 to 15 months was 14.59, and the incident rate ratio for girls in the same age group was 3.22. Seventy-six percent of immune thrombocytopenia purpura cases in children aged 12 to 23 months were attributable to measles-mumps-rubella vaccination. This vaccine causes 1 case of immune thrombocytopenia purpura per every 40,000 doses.
Measles-mumps-rubella vaccine that is given in the second year of life is associated with an increased risk of immune thrombocytopenia purpura.

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    • "Once established, the size of the VSD network enabled CDC and HMO researchers to undertake a series of seminal research projects that evaluated the risk of new (and existing) vaccines, and it also allowed researchers the ability to quickly respond to new concerns about vaccine safety. Such studies conducted by the VSD included ones that outlined the risk of seizures following whole-cell pertussis or measles-mumps-rubella vaccine, found a lack of association between thimerosal containing vaccines and risk for poor neurodevelopment or for autism and analyzed the risk for idiopathic thrombocytopenic purpura ITP after measles, mumps and rubella (MMR) vaccination [9,10,11,12]. "
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    • "Thrombocytopenia is common in many infectious processes , especially in association with infectious mononucleosis, cytomegalovirus infection, rubella, measles, Gram-negative bacteria , and rickettsial diseases. The combined live vaccines such as the measles-mumps-rubella (MMR) and MR vaccines [5] [6] may have an increased risk for inducing ITP, especially in early infancy [7]. "
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