Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine
- P K Armstrong1,
- G K Dowse1,
- P V Effler2,
- D Carcione1,
- C C Blyth3,
- P C Richmond3,
- G C Geelhoed4,
- F Mascaro5,
- M Scully1,
- T S Weeramanthri6
- 1Communicable Disease Control Directorate, Department of Health Western Australia, Shenton Park, Western Australia, Australia
- 2Prevention and Control Program, Communicable Disease Control Directorate, Department of Health Western Australia, Shenton Park, Western Australia, Australia
- 3University of WA School of Paediatrics and Child Health, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- 4Department of Emergency Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- 5Department of Infection Control, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
- 6Public Health Division, Department of Health Western Australia, Perth, Western Australia, Australia
- Correspondence to Dr Paul Armstrong;
- Received 3 November 2010
- Accepted 26 April 2011
- Published 30 May 2011
Background The 2010 influenza vaccination program for children aged 6 months to 4 years in Western Australia (WA) was suspended following reports of severe febrile reactions, including febrile convulsions, following vaccination with trivalent inactivated influenza vaccine (TIV).
Methods To investigate the association between severe febrile reactions and TIV, three studies were conducted: (i) rates of febrile convulsions within 72 h of receiving TIV in 2010 were estimated by vaccine formulation and batch; (ii) numbers of children presenting to hospital emergency departments with febrile convulsions from 2008 to 2010 were compared; and (iii) a retrospective cohort study of 360 children was conducted to compare the reactogenicity of available TIV formulations.
Findings In 2010, an estimated maximum of 18 816 doses of TIV were administered and 63 febrile convulsions were recorded, giving an estimated rate of 3.3 (95% CI 2.6 to 4.2) per 1000 doses of TIV administered. The odds of a TIV-associated febrile convulsion was highly elevated in 2010 (p<0.001) and was associated with the vaccine formulations of one manufacturer—Fluvax and Fluvax Junior (CSL Biotherapies). The risk of both febrile convulsions (p<0.0001) and other febrile reactions (p<0.0001) was significantly greater for Fluvax formulations compared to the major alternate brand. The risk of febrile events was not associated with prior receipt of TIV or monovalent 2009 H1N1 pandemic vaccine. The biological cause of the febrile reactions is currently unknown.
Interpretation One brand of influenza vaccine was responsible for the increase in febrile reactions, including febrile convulsions. Until the biological reason for this is determined and remediation undertaken, childhood influenza vaccination programs should not include Fluvax-type formulations and enhanced surveillance for febrile reactions in children receiving TIV should be undertaken.
To cite: Armstrong PK, Dowse GK, Effler PV, et al. Epidemiological study of severe febrile reactions in young children in Western Australia caused by a 2010 trivalent inactivated influenza vaccine. BMJ Open 2011;1:e000016. doi:10.1136/bmjopen-2010-000016
Funding The investigations were funded from the internal resources of the authors' organisations.
Competing interest None.
Contributors PA, GD and PE designed the studies. FM, MS, CB, GG and DC were responsible for acquisition of the data. PE and GD were responsible for the statistical analysis. PA, GD, PE, CB, TW, DC and PR analysed and interpreted the data. All authors contributed to the writing of the report. All authors saw and approved the final report. All authors had full access to all of the data (including statistical reports and tables) in the study and can take full responsibility for the integrity of the data and the accuracy of the data analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Datasets are available from the corresponding author at .
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