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Vaccine. 2017 Mar 14;35(12):1615-1621. doi: 10.1016/j.vaccine.2017.02.013. Epub 2017 Feb 21.

Risk factors and familial clustering for fever 7-10days after the first dose of measles vaccines.

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Kaiser Permanente Vaccine Study Center, Oakland, CA, United States. Electronic address:
Kaiser Permanente Vaccine Study Center, Oakland, CA, United States.
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States.
Kaiser Permanente Colorado, Denver Health, Denver, CO, United States.
Group Health Research Institute, Seattle, WA, United States.
Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, United States.
Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States.



Seven to ten days after a first dose of a measles-containing vaccine (MCV; i.e., MMR or MMRV), children have elevated fever risk which can be associated with febrile seizures. This study investigated individual and familial factors associated with fever 7-10days after MCV.


Retrospective cohort study among children who were <36months of age at receipt of MCV in six sites of the Vaccine Safety Datalink from 1/1/2000 to 12/31/2012. We evaluated medically-attended clinic or emergency department visits with a code for fever 7-10days after any MCV ("MCV- associated"). We evaluated factors associated with MCV-associated fever using χ2 and multivariable logistic regression analyses.


Among 946,806 children vaccinated with MCV, we identified 7480 (0.8%) MCV-associated fever visits. Compared with children without fever after MCV, children with MCV-associated fever were more likely to have received MMRV than MMR (OR 1.3 95% CI 1.2, 1.5), have had medically attended fever both following previous vaccines (OR 1.3 95% CI 1.1, 1.6) and at any other previous time (OR 1.7 95% CI 1.6, 1.8), have had at least 1 prior seizure (OR 2.2 95% CI 1.7, 2.7), and have had >3 medical visits within the 6months before MCV (OR 1.7 95% CI 1.6, 1.8). In families with multiple MCV-immunized children, after adjusting for healthcare seeking behavior care for fever, those whose siblings had MCV-associated fever were more likely to also have MCV-associated fever (OR 3.5 95% CI 2.5, 4.8).


Children who received MMRV vaccine or who had prior medically-attended fevers and seizures during the first year of life had increased risk of fever after a first dose of measles vaccine. After adjusting for familial propensity to seek care, MCV-associated fever still clustered within families, suggesting a possible genetic basis for susceptibility to developing fever due to measles vaccines.


Fever; Measles; Safety; Vaccine

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