Update: Vaccine Side Effects, Adverse Reactions, (ACIP) part-3
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Personal and Family History of Convulsions
An increased risk of these convulsions may occur among children with a prior history of convulsions or those with a history of convulsions in first-degree family members (i.e., siblings or parents) (20). Although the precise risk cannot be determined, it appears to be low.
In developing vaccination recommendations for these children, ACIP considered a number of factors, including risks from measles disease, the large proportion (5%-7%) of children with a personal or family history of convulsions, and the fact that convulsions following measles vaccine are uncommon. Studies conducted to date have not established an association between MMR vaccination and the development of a residual seizure disorder (5). ACIP concluded that the benefits of vaccinating these children greatly outweigh the risks. They should be vaccinated just as children without such histories.
Because the period for developing vaccine-induced fever occurs approximately 5-12 days after vaccination, prevention of febrile seizures is difficult. Prophylaxis with antipyretics has been suggested as one alternative, but these agents may not be effective if given after the onset of fever. To be effective, such agents would have to be initiated before the expected onset of fever and continued for 5-7 days. However, parents should be alert to the occurrence of fever after vaccination and should treat their children appropriately.
Children who are being treated with anticonvulsants should continue to take them after measles vaccination. Because protective levels of most currently available anticonvulsant drugs (e.g., phenobarbital) are not achieved for some time after therapy is initiated, prophylactic use of these drugs does not seem feasible.
The parents of children who have either a personal or family history of seizures should be advised of the small increased risk of seizures following measles vaccination. In particular, they should be told in advance what to do in the unlikely event that a seizure occurs. The permanent medical record should document that the small risk of postimmunization seizures and the benefits of vaccination have been discussed.
Subacute Sclerosing Panencephalitis (SSPE)
Measles vaccine significantly reduces the likelihood of developing SSPE, as evidenced by the near elimination of SSPE cases after widespread measles vaccination began. SSPE has been reported rarely in children who do not have a history of natural measles infection but who have received measles vaccine. The available evidence suggests that at least some of these children may have had an unidentified measles infection before vaccination and that the SSPE probably resulted from the natural measles infection. The administration of live measles vaccine does not increase the risk for SSPE, regardless of whether the vaccinee has had measles infection or has previously received live measles vaccine (5,21).
Fully reversible with IVIg
Surveillance of adverse reactions in the United States and other countries indicates that MMR vaccine can, in rare circumstances, cause clinically apparent thrombocytopenia within the 2 months after vaccination. In prospective studies, the reported incidence of clinically apparent thrombocytopenia after MMR vaccination ranged from one case per 30,000 vaccinated children in Finland (22) and Great Britain (23) to one case per 40,000 in Sweden, with a temporal clustering of cases occurring 2-3 weeks after vaccination (24). With passive surveillance, the reported incidence was approximately one case per 100,000 vaccine doses distributed in Canada and France (25), and approximately one case per 1 million doses distributed in the United States (26). The clinical course of these cases was usually transient and benign, although hemorrhage occurred rarely (26). Furthermore, the risk for thrombocytopenia during rubella or measles infection is much greater than the risk after vaccination. Of 30,000 school-children in one Pennsylvania county who had been infected with rubella during the 1963-64 measles epidemic, 10 children developed thrombocytopenic purpura (incidence: one case per 3,000 children) (27). Based on case reports, the risk for thrombocytopenia may be higher for persons who previously have had idiopathic thrombocytopenic purpura, particularly for those who had thrombocytopenic purpura after an earlier dose of MMR vaccine (5,28,29).
Reversiable with IVIg
There is no evidence of an increased risk for adverse reactions after administration of live measles vaccine to persons who are already immune to measles as a result of either previous vaccination or natural disease.
Precautions and Contraindications Pregnancy
Live measles vaccine, when given as a component of MR or MMR, should not be given to women known to be pregnant or who are considering becoming pregnant within the next 3 months. Women who are given monovalent measles vaccine should not become pregnant for at least 30 days after vaccination. This precaution is based on the theoretical risk of fetal infection, although no evidence substantiates this theoretical risk. Considering the importance of protecting adolescents and young adults against measles, asking women if they are pregnant, excluding those who are, and explaining the theoretical risks to the others before vaccination are sufficient precautions.
The decision to administer or delay vaccination because of a current or recent febrile illness depends largely on the cause of the illness and the severity of symptoms. Minor illnesses, such as a mild upper-respiratory infection with or without low-grade fever, are not contraindications for vaccination. For persons whose compliance with medical care cannot be assured, every opportunity should be taken to provide appropriate vaccinations.
Children with moderate or severe febrile illnesses can be vaccinated as soon as they have recovered from the acute phase of the illness. This wait avoids superimposing adverse effects of vaccination on the underlying illness or mistakenly attributing a manifestation of the underlying illness to the vaccine. Performing routine physical examinations or measuring temperatures are not prerequisites for vaccinating infants and children who appear to be in good health. Asking the parent or guardian if the child is ill, postponing vaccination for children with moderate or severe febrile illnesses, and vaccinating those without contraindications are appropriate procedures in childhood immunization programs.
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