MMR2 immunization at 4 to 5 years and 10 to 12 years of age: a comparison of adverse clinical events after immunization in the Vaccine Safety Datalink project. The Vaccine Safety Datalink Team.
BACKGROUND
The Advisory Committee on Immunization Practices recommends a second dose of measles, mumps, and rubella vaccine (MMR2) at age 4 to 5 years of age, whereas the American Academy of Pediatrics suggests MMR2 immunization at age 11 to 12 years of age. Because there is little information on whether the rate of adverse reactions to MMR2 immunization varies among these two age groups, we took advantage of differing immunization policies at two large HMOs to compare the frequency of clinical events after, and possibly related to, MMR2 immunization.


METHODS
Information was collected on clinical events plausibly associated to MMR immunization (seizures, pyrexia, malaise/fatigue, nervous/musculoskeletal symptoms, rash, edema, induration/ecchymoses, lymphadenopathy, thrombocytopenia, aseptic meningitis, and joint pain) in two cohorts. At three facilities at Northern California Kaiser (Oakland, CA), 8514 children received MMR2 immunization at age 4 to 6 years of age; at Group Health Cooperative (Seattle, WA) 18 036 children received MMR2 immunization at age 10 to 12 years of age. To account for age-related differences in health care use, within each HMO, clinical events in a 30-day period after immunization were compared with a 30-day period before vaccination.


RESULTS
Children 10 to 12 years of age were 50% more likely to have a clinical event after MMR2 immunization than in the period before immunization (odds ratio, 1.45; 95% confidence interval: 1.00,2.10). Children 4 to 6 years of age were less likely to have a visit for an event after immunization compared with the period before immunization (odds ratio, 0.64; 95% confidence interval: 0.40,1.01).


CONCLUSIONS
These results suggest that the risk for clinical events after MMR2 immunizations is greater in the 10- to 12-year age group.
Davis
R L
RL
Group Health Cooperative, Seattle, Washington 98101-1448, USA.
Marcuse
E
E
Black
S
S
Shinefield
H
H
Givens
B
B
Schwalbe
J
J
Ray
P
P
Thompson
R S
RS
Chen
R
R
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary / Q000009:adverse effects*; D008297:Male; D008458:Measles Vaccine / Q000009:adverse effects*; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000009:adverse effects*; D012411:Rubella Vaccine / Q000009:adverse effects*; D017778:Vaccines, Combined / Q000009:adverse effects
D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D012411:Rubella Vaccine; D017778:Vaccines, Combined