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Risk of Immune Thrombocytopenic Purpura After Measles-Mumps-Rubella Immunization in Children
Abstract
BACKGROUND: The measles-mumps-rubella vaccine has been associated with immune thrombocytopenia purpura in 2 small studies. METHODS: 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. RESULTS: 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. CONCLUSION: 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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“Twenty cases had been classified as exposed and 43 as not exposed.”
From Vaccines for measles, mumps and rubella in children (2012) · cites this paper as France 2008
Citations
Cites
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The Xs and Y of immune responses to viral vaccines
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Sex-based differences in immune function and responses to vaccination
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Sex and Gender Differences in the Outcomes of Vaccination over the Life Course
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“It is estimated that approximately 1:40 000 children develop secondary ITP after receiving measlesmumps-rubella (MMR) vaccine.(7) Well-documented cases of acquired immune thrombocytopenia have been reported after varicella and other vaccinations as well, including one described in this issue of the American Journal of…”
Background
Metadata
- Authors
- France, E. K., Glanz, J., Xu, S., Hambidge, S., Yamasaki, K., Black, S. B., Marcy, M., Mullooly, J. P., Jackson, L. A., Nordin, J., Belongia, E. A., Hohman, K., Chen, R. T., Davis, R., & for the Vaccine Safety Datalink Team
- Affiliations
- Department of Preventive Medicine
- Kaiser Permanente (US)
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
- Group Health Cooperative (US)
- Regions Hospital (US)
- Marshfield Clinic Research Foundation (US)
- Harvard Pilgrim Health Care (US)
- Centers for Disease Control and Prevention (US)
- ORCID
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2008-03-01
- Volume
- 121
- Issue
- 3
- Pages
- e687-e692
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2007741934
- Cited by
- 165
- References
- 17
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 11 · 2022: 14 · 2021: 16 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 9 · 2016: 6 · 2015: 11 · 2014: 8 · 2013: 14 · 2012: 12
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Keywords
- idiopathic thrombocytopenic purpura, MMR vaccine, vaccine adverse events, children, platelet count, incidence rate ratio, attributable risk, infants, sex differences
- MeSH terms
- Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Immunization Schedule, Male, Purpura, Thrombocytopenic, Registries, Retrospective Studies, Severity of Illness Index, United States, Cohort Studies, Incidence, Poisson Distribution, Age Distribution, Sex Distribution, Risk Assessment, Measles-Mumps-Rubella Vaccine
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