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J Allergy Clin Immunol. 2016 Mar;137(3):868-78. doi: 10.1016/j.jaci.2015.07.048. Epub 2015 Oct 6.

Risk of anaphylaxis after vaccination in children and adults.

Author information

1
Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga. Electronic address: mmm2@cdc.gov.
2
Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
3
Southern California Kaiser Permanente, Pasadena, Calif.
4
Kaiser Permanente Vaccine Study Center, Oakland, Calif.
5
Institute for Health Research, Kaiser Permanente, Denver, Colo.
6
Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Mass.
7
Group Health Research Institute, Seattle, Wash.
8
Center for Health Research, Kaiser Permanente Northwest, Portland, Ore.
9
Marshfield Clinic Research Foundation, Marshfield, Wis.
10
HealthPartners Institute for Education and Research, Minneapolis, Minn.
11
Kaiser Permanente Center for Health Research, and the Rollins School of Public Health, Emory University, Atlanta, Ga.

Abstract

BACKGROUND:

Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children.

OBJECTIVE:

We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis.

METHODS:

Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines.

RESULTS:

We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90-1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65-2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22-6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).

CONCLUSION:

Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat.

KEYWORDS:

Anaphylaxis; immunization; vaccine safety

PMID:
26452420
PMCID:
PMC4783279
[Available on 2017-03-01]
DOI:
10.1016/j.jaci.2015.07.048
[Indexed for MEDLINE]
Free PMC Article

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