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Pediatr Infect Dis J. 2020 Mar;39(3):247-253. doi: 10.1097/INF.0000000000002550.

Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age.

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From the Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Centers for Disease Control and Prevention, Immunization Safety Office, Atlanta, Georgia.
Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon.
Kaiser Permanente Washington, Health Research Institute, Seattle, Washington.
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California.
Marshfield Clinic Research Institute, Marshfield, Wisconsin.
HealthPartners Institute, Minneapolis, Minnesota.
Division of Research, Kaiser Permanente of Northern California, Oakland, California.
Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado.



Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age.


We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003-2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non-vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders.


Among 428,608 children, 48.9% were female, 4.9% had ≥1 immunization visit with live vaccines only and 10.3% had a non-vaccine-targeted infection. In males, lower risk of non-vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95% confidence interval (CI): 0.72-0.94; live and inactivated vaccines concurrently aHR: 0.91, 95% CI: 0.88-0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non-vaccine-targeted infection risk (aHR = 0.94, 95% CI: 0.91-0.97 vs. last receipt of inactivated vaccines only).


We observed modest associations between live vaccine receipt and non-vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.

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