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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.

Author information

1
From the Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado.
2
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
3
Centers for Disease Control and Prevention, Immunization Safety Office, Atlanta, Georgia.
4
Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon.
5
Kaiser Permanente Washington, Health Research Institute, Seattle, Washington.
6
Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, California.
7
Marshfield Clinic Research Institute, Marshfield, Wisconsin.
8
HealthPartners Institute, Minneapolis, Minnesota.
9
Division of Research, Kaiser Permanente of Northern California, Oakland, California.
10
Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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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