title: Thrombocytopenic purpura after measles-mumps-rubella vaccination: a systematic review of the literature and guidance for management.
abstract: OBJECTIVE
  To determine the incidence of immune thrombocytopenic purpura (ITP) after measles-mumps-rubella (MMR) immunization compared with natural measles and rubella, its clinical course and outcome, and the risk of recurrence after repeat MMR vaccination.
  
  
  METHODS
  We performed a systematic review of the Ovid MEDLINE (1950 to present) bibliographic database. We selected studies that reported cases of thrombocytopenia in a known number of children who were immunized with MMR vaccine before development of ITP. We also extracted data from the same and other studies regarding bleeding manifestations and the resolution of MMR-associated thrombocytopenia or thrombocytopenic purpura within 6 months. Finally, we studied the risk of ITP recurrence after MMR immunization or reimmunization.
  
  
  RESULTS
  On the basis of 12 studies, the incidence of MMR-associated ITP ranged from 0.087 to 4 (median 2.6) cases per 100,000 vaccine doses. Severe bleeding manifestations were rare, and MMR-associated thrombocytopenia resolved within 6 months from diagnosis in 93% of the children. MMR vaccination of unimmunized patients with ITP and revaccination of patients with prior ITP did not lead to recurrence of thrombocytopenia.
  
  
  CONCLUSIONS
  MMR-associated ITP is rare, self-limited, and non-life threatening, and susceptible children with ITP should be immunized with MMR at the recommended ages.
authors.affiliation: Department of Pediatrics, University Hospital of Alexandroupolis and Democritus University of Thrace Medical School, Alexandroupolis, Thrace, Greece. emantada@med.duth.gr
authors.forename: Elpis
authors.initials: E
authors.lastname: Mantadakis
authors.forename: Evangelia
authors.initials: E
authors.lastname: Farmaki
authors.forename: George R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D006801:Humans; D015994:Incidence; D022542:Measles-Mumps-Rubella Vaccine / Q000009:adverse effects*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011696:Purpura, Thrombocytopenic / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D022542:Measles-Mumps-Rubella Vaccine