Enhancing global vaccine pharmacovigilance: Proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination. Issue 3 (8th January 2018)

• Record Type: Journal Article
• Authors: Kuli-Lito, Georgina; Kostaqi, Entela; Petrela, Elizana; Castellano, Vanesa E.; Chiarvetti, Lucia; Falcó, Adriana; Gentile, Angela; Guirau, Karina; Carrega, Maria Eugenia Pérez; Rasjido, Susana; Testino, Sofía; Vizzotti, Carla; Buttery, Jim; Mcminn, Alissa; Quinn, Julie; Avendaño, Marcela; González, Marcela; Lagos, Rosanna; Maturana, Marcelo; Muñoz, Fernando; Saldaña, Adiela; Soza, Guillermo; Zhang, Tao; Zhang, Xiyan; Ding, Yunfang; Zhang, Jun; Alvarez-Olmos, Martha I.; Sastoque, Luz Amparo; Mezerville, Marcela Hernández-de; Machado, Vicenta; Roverssi, Ileana; Camacho, Angélica Vargas; Luque, Marco Tulio; Mendoza, Liset; Ravi, Mandyam; Manjunath, V.G.; Karimi, Abdollah; Ghanaie, Roxana Mansour; Seifi, Kimia; Shirvani, Fariba; Ashrafi, Mahmoud Reza; Parvaneh, Nima; Kochakzadeh, Leily; Mamishi, Sertareh; Kompani, Farzad; Eshaghi, Hamid; Pirmoazen, Vahideh; Aquije Hernández, Renne F.; Díaz, Maria Esther Castillo; Mamani, Gladys Turpo; Thoon, Koh Cheng; Oh, Bee Khiam; Yelen, ; Cutland, Clare; Madhi, Shabir A.; Groome, Michelle; Velaphi, Sithembiso; Izu, Alane; Diep, Linh; Hwinya, Cleopas; Pérez-Vilar, Silvia; Díez-Domingo, Javier; Martín-Navarro, Marian; Soriano-García, Esther; Tuells, Jose; Pande, Stephen Legesi; Alaroker, Florence; Amulen, Dorothy; Akareut, Margaret; Areto, Esther; Komo, Richard Samson; Quinto, Ogwang; Giachetto, Gustavo; Speranza, Noelia; Zunino, Carlos; Perez-Vilar, Silvia; Weibel, Daniel; Sturkenboom, Miriam; Black, Steven; Maure, Christine; Castro, Jose Luis; Bravo-Alcántara, Pamela; Dodd, Caitlin N.; Romio, Silvana A.; de Ridder, Maria; Nakato, Swabra; Molina-León, Helvert Felipe; Elango, Varalakshmi; Zuber, Patrick L.F.;
• Is Part Of: Vaccine. Volume 36:Issue 3(2018)
• Page Start: 347
• Page End: 354
• Publication Date: 2018-01-08
• Subjects: Post-marketing surveillance -- Vaccine safety -- Global Vaccine Safety Initiative (GVSI) -- Adverse events following immunization (AEFI); AEFI adverse events following immunization -- AM aseptic meningitis -- CI Confidence Interval -- CSF cerebrospinal fluid -- EMC Erasmus Medical Center -- FDA Food and Drug Administration -- GVSI Global Vaccine Safety Initiative -- ITP immune thrombocytopenic purpura -- IRR incidence rate ratio -- LMICs low and middle-income countries -- MMR measles, mumps, rubella vaccines -- PMNs polymorphonuclear leukocytes -- OR odds ratio -- SCCS self-controlled case series -- SCRI self-controlled risk interval -- WHO World Health Organization; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2017.05.012
• Languages: English
• ISSNs: 0264-410X

Abstract

Abstract: New vaccines designed to prevent diseases endemic in low and middle-income countries (LMICs) are now being introduced without prior record of utilization in countries with robust pharmacovigilance systems. To address this deficit, our objective was to demonstrate feasibility of an international hospital-based network for the assessment of potential epidemiological associations between serious and rare adverse events and vaccines in any setting. This was done through a proof-of-concept evaluation of the risk of immune thrombocytopenic purpura (ITP) and aseptic meningitis (AM) following administration of the first dose of measles-mumps-containing vaccines using the self-controlled risk interval method in the primary analysis. The World Health Organization (WHO) selected 26 sentinel sites (49 hospitals) distributed in 16 countries of the six WHO regions. Incidence rate ratios (IRR) of 5.0 (95% CI: 2.5–9.7) for ITP following first dose of measles-containing vaccinations, and of 10.9 (95% CI: 4.2–27.8) for AM following mumps-containing vaccinations were found. The strain-specific analyses showed significantly elevated ITP risk for measles vaccines containing Schwarz (IRR: 20.7; 95% CI: 2.7–157.6), Edmonston-Zagreb (IRR: 11.1; 95% CI: 1.4–90.3), and Enders'Edmonston (IRR: 8.5; 95% CI: 1.9–38.1) strains. A significantly elevated AM risk for vaccines containing the Leningrad-Zagreb mumps strain (IRR: 10.8; 95% CI: 1.3–87.4) was also found. This proof-of-concept study has shown, for the first time, that an international hospital-based network for the investigation of rare vaccine adverse events, using common standardized procedures and with high participation of LMICs, is feasible, can produce reliable results, and has the potential to characterize differences in risk between vaccine strains. The completion of this network by adding large reference hospitals, particularly from tropical countries, and the systematic WHO-led implementation of this approach, should permit the rapid post-marketing evaluation of safety signals for serious and rare adverse events for new and existing vaccines in all settings, including LMICs.