No evidence of an increase of bacterial and viral infections following Measles, Mumps and Rubella vaccine

doi:10.1016/j.vaccine.2008.12.038

Vaccine

Volume 27, Issue 9, 25 February 2009, Pages 1422-1425

https://doi.org/10.1016/j.vaccine.2008.12.038 Get rights and content

Abstract

The suggestion that multi-antigen vaccines might overload the immune system has led to calls for single antigen vaccines. In 2003 we showed that rather than an increase there appeared to be a reduced risk of severe bacterial infection in the three months following Measles, Mumps and Rubella vaccine (MMR). The present analysis of illnesses in a general population is based on an additional 10 years of data for bacterial infections and also includes admissions with viral infections. Analyses were carried out using the self-controlled case-series method and separately for bacterial and viral infection cases, using risk periods of 0–30 days, 31–60 days and 61–90 days post MMR vaccine. An analysis was also carried out for those cases which were given MMR and Meningococcal serogroup C (MCC) vaccines concomitantly.

A reduced risk was seen in the 0–30-day period for both bacterial infection (relative incidence = 0.68, 95% CI 0.54–0.86) and viral infections (relative incidence = 0.68, 95% CI 0.49–0.93). There was no increased risk in any period when looking at combined viral or bacterial infections or for individual infections with the single exception of an increased risk in the 31–60 days post vaccination period for herpes infections (relative incidence = 1.69, 95% CI 1.06–2.70). For the children given Meningococcal group C vaccines concomitantly no significantly increased risk was seen in either the bacterial (relative incidence = 0.54, 95% CI 0.26–1.13) or viral cases (relative incidence = 0.46, 95% CI 0.11–1.93).

Our study confirms that the MMR vaccine does not increase the risk of invasive bacterial or viral infection in the 90 days after the vaccination and does not support the hypothesis that there is an induced immune deficiency due to overload from multi-antigen vaccines.

Section snippets

Background

Addition of a number of new vaccines to the infant vaccination programme in recent years has raised theoretical concerns about the possible adverse effects of multiple immunisations on the developing immune system [1]. One such concern relates to the potential for increasing susceptibility to other infections as a result of “immune overload”. When reviewing this issue in 2002, the US Institute of Medicine concluded that the available epidemiological evidence favoured rejection of a causal

Methods

Children aged 12–23 months were identified from computerised hospital admission records from North, East and South London, Essex, East Anglia, Sussex and Kent, for the period 1st April 1995 to 1st May 2005. Admissions were identified using ICD 9 and 10 codes for bacterial and viral infections (specific codes available on request). Each episode is coded with an ICD code which can be found in any of the seven diagnostic fields, with the first field being the primary diagnosis. Bacterial

Results

A total of 2077 admissions in 2025 children were linked to an MMR record. An admission within 14 days of an earlier admission with the same condition was considered part of the same episode. Of these admissions, 871 were coded as lobar pneumonia and 449 as invasive bacterial infection. Of the children with more than one bacterial infection, 25 had 2 episodes, 3 had 3 episodes and 1 child had 8 episodes.

Of the viral infection admissions, 18 were coded as viral encephalitis/viral meningitis/CNS,

Discussion

Our results show that MMR vaccine administered in the second year of life, either alone or with concomitant MCC vaccine, does not increase the risk of severe infection, bacterial or viral, in various periods up to three months after vaccination. It therefore adds weight to the existing epidemiological evidence that multiple immunisations do not “overload” the immune system and increase susceptibility to heterologous infection [1]. Moreover, there is no scientific rationale for the hypothesis;

Acknowledgement

JS is supported by a Department of Health Research and Development Directorate grant 039/031.

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No evidence of an increase of bacterial and viral infections following Measles, Mumps and Rubella vaccine

Abstract

Section snippets

Background

Methods

Results

Discussion

Acknowledgement

J Infect

Lancet

Apparent decreased risk of invasive bacterial disease after heterologous childhood immunization

Am J Dis Child

No increased risk for invasive bacterial infection found following diphtheria-tetanus-pertussis immunization

Pediatrics

DTP immunization and susceptibility to infectious diseases. Is there a relationship?

Am J Dis Child

Does recent vaccination increase the risk of occult bacteremia?

Pediatr Emerg Care

Bacterial infections, immune overload, and MMR vaccine. Measles, mumps, and rubella

Arch Dis Child