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PLoS One. 2013 Aug 20;8(8):e71818. doi: 10.1371/journal.pone.0071818. eCollection 2013.

The expected number of background disease events during mass immunization in China.

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School of Public Health, Capital Medical University, Beijing, China ; Municipal Key Laboratory of Clinical Epidemiology, Beijing, China ; School of Medical Sciences, Edith Cowan University, Perth, Australia.


It is critical to distinguish events that are temporarily associated with, but not caused by, vaccination from those caused by vaccination during mass immunization. We performed a literature search in China National Knowledge Infrastructure and Pubmed databases. The number of coincident events was calculated based on its incidence rate and periods after receipt of a dose of hypothesized vaccine. We included background incidences of Guillain-Barré syndrome, anaphylaxis, seizure, sudden adult death syndrome, sudden cardiac death, spontaneous abortion, and preterm labour or delivery. In a cohort of 10 million individuals, 7.71 cases of Guillain-Barré syndrome would be expected to occur within six weeks of vaccination as coincident background cases. Even for rare events, a large number of events can be expected in a short period because of the large population targeted for immunization. These findings may encourage health authorities to screen the safety of vaccines against unpredictable pathogens.

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