, et al
Postvaccination febrile seizure severity and outcome
):pii:e20182120; doi:

Investigators from multiple institutions in Australia conducted a prospective cohort study comparing clinical features, management, and outcomes in children with a first febrile seizure (FS) occurring soon after vaccination (vaccine-proximate febrile seizure [VP-FS]) and those with a nonvaccine-proximate febrile seizure (NVP-FS). Study participants were children <6 years old presenting to 1 of 5 hospitals in Australia between May 2013 and June 2014 with a first seizure associated with a temperature >38°C; patients with preexisting neurologic conditions and those with a central nervous system infection were excluded. Children with an FS occurring within 2 days after receiving inactivated vaccine, 5–14 days after receiving a live-attenuated vaccine, or 0–14 days after receiving a combination live and inactivated vaccine were classified as having a VP-FS. Those with an FS not temporally related to receiving a vaccination were categorized as having an NVP-FS. Data on demographics, previous history, clinical management, microbiology test results, and short-term outcome were collected. The primary study outcomes included prolonged seizure duration (>15 minutes), recurrent seizures within 24 hours, prolonged hospitalization (>1 day), and use of antiepileptic drugs (AEDs). Outcomes between children with VP-FS and NVP-FS were compared with logistic regression analyses controlling for age and sex.

Data were analyzed in 1,022 children, including 67 (6%) with VP-FS and 955 (94%) with NVP-FS. Children with VP-FS were significantly younger than were those with NVP-FS (median ages, 13 and 20 months, respectively; P<.001). For children with VP-FS, 56 (84%) had received a measles-containing vaccine before their FS; the peak incidence of FS was 9 days after vaccination. Among children in whom testing was performed, the rates of identification of a viral or bacterial infection were similar in those with VP-FS or NVP-FS (30% and 28%, respectively; P=.82). The rates of prolonged seizure duration were similar in patients with VP-FS (14.9%) and NVP-FS (10.3%; OR, 1.40; 95% CI, 0.70–2.79). There was also no difference in rates of repeat seizures (9.0% for those with VP-FS and 9.4% for those with NVP-FS; OR, 0.88; 95% CI, 0.59–1.31) or prolonged hospitalization (17.9% for those with VP-FS and 11.9% for those with NVP-FS; OR, 1.50; 95% CI, 0.76–2.94). Although AED use was significantly more common to stop seizures in those with VP-FS than in those with NVP-FS, rates of AED use at discharge were similar in the 2 groups (3.0% and 1.7%, respectively; OR, 1.68; 95% CI, 0.37–7.66).

The authors conclude that there was no difference in outcomes among children with VP-FS and those with NVP-FS.

Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

The current investigators address an important question raised by many parents: are vaccines safe? Whole-cell pertussis, measles, and certain influenza vaccines have been shown to increase the risk of FS....

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