Vaccine Safety Datalink Project: A New Tool for Improving Vaccine Safety Monitoring in the United States

作者：Robert T. Chen, John W. Glasser, Philip Rhodes, Robert Lowell Davis, William Eric Barlow, Robert S. Thompson, John P. Mullooly, STEVEN B. BLACK, Henry R. Shinefield, Constance M. Vadheim, S. Michael Marcy, Joel I. Ward, Robert P. Wise, Steven G.F. Wassilak, Stephen C. Hadler, the Vaccine Safety Datalink Team · 发表于：PEDIATRICS · 年份：1997 · DOI：10.1542/peds.99.6.765 · 被引用次数：347 · 研究领域：Bacterial Infections and Vaccines、Vaccine Coverage and Hesitancy、Pharmacovigilance and Adverse Drug Reactions

OBJECTIVE: To fill the large "gaps and limitations" in current scientific knowledge of rare vaccine adverse events identified in recent reviews of the Institute of Medicine. METHODS: Computerized information on immunization, medical outcomes, and potential confounders on more than 500 000 children 0 to 6 years of age is linked annually at several health maintenance organizations to create a large cohort for multiple epidemiologic studies of vaccine safety. RESULTS: Analysis of 3 years of follow-up data shows that 549 488 doses of diphtheria-tetanus-pertussis (DTP) and 310 618 doses of measles-mumps-rubella (MMR) vaccines have been administered to children in the study cohort. Analyses for associations between vaccines and 34 medical outcomes are underway. Screening of automated data shows that seizures are associated with receipt of DTP on the same day (relative risk [RR], 2.1; 95% confidence interval [CI], 1.1 to 4.0) and 8 to 14 days after receipt of MMR (RR, 3.0; 95% CI, 2.1 to 4.2). The diversity of vaccination exposures in this large cohort permits us to show that an apparent association of seizures 8 to 14 days after Haemophilus influenzae type b vaccine (RR, 1.6; 95% CI, 1.2 to 2.1) was attributable to confounding by simultaneous MMR vaccination; the association disappears with appropriate adjustment (RR, 1.0; 95% CI, 0.7 to 1.4). CONCLUSION: Preliminary design, data collection, and analytic capability of the Vaccine Safety Datalink project has been validated by replic...