Cumulative and episodic vaccine aluminum exposure in a population-based cohort of young children

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• 作者：Jason M. Glanz^a ; ^b ; ^{jason.m.glanz@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Sophia R. Newcomer^a ; ^{sophia.r.newcomer@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Matthew F. Daley^a ; ^c ; ^{matthew.f.daley@kp.org" class="auth_mail" title="E-mail the corresponding author} ; David L. McClure^d ; ¹ ; ^{dave_epi@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Roger P. Baxter^f ; ^{roger.baxter@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Michael L. Jackson^g ; ^{jackson.ml@ghc.org" class="auth_mail" title="E-mail the corresponding author} ; Allison L. Naleway^h ; ^{allison.naleway@kpchr.org" class="auth_mail" title="E-mail the corresponding author} ; Marlene M. Luggⁱ ; ^{marlene.m.lugg@kp.org" class="auth_mail" title="E-mail the corresponding author} ; Frank DeStefano^j ; ^{fxd1@cdc.gov" class="auth_mail" title="E-mail the corresponding author}
• 关键词：ACIP ; Advisory Committee on Immunization Practices ; ADU ; average number of days undervaccinated ; ICD-9-CM ; International Classification of Diseases ; 9th edition ; Clinical Modification ; EHR ; electronic health record ; MCO ; managed care organization ; VSD ; Vaccine Safety Datalink
• 刊名：Vaccine
• 出版年：2015
• 出版时间：27 November 2015
• 年：2015
• 卷：33
• 期：48
• 页码：6736-6744
• 全文大小：720 K

文摘

In addition to antigens, vaccines contain small amounts of preservatives, adjuvants, and residual substances from the manufacturing process. Some parents have concerns about the safety of these ingredients, yet no large epidemiological studies have specifically examined associations between health outcomes and vaccine ingredients, other than thimerosal. This study examined the extent to which the Vaccine Safety Datalink (VSD) could be used to study vaccine ingredient safety in children.

Methods

Children born 2004–2011 were identified in VSD data. Using immunization records, two cohorts were identified: children who were up-to-date and children who were undervaccinated before age 2 years. A database was also created linking vaccine type and manufacturer with ingredient amounts documented in vaccine package inserts. Thirty-four ingredients in two or more infant vaccines were identified. However, only amounts (in mg) for aluminum were consistently documented and commonly contained in infant vaccines. Analyses compared vaccine aluminum exposure across cohorts and determined the statistical power for studying associations between aluminum exposure and hypothetical vaccine adverse events.

Results

Among 408,608 children, mean cumulative vaccine aluminum exposure increased from 1.11 to 4.00 mg between ages 92–730 days. Up-to-date children were exposed to 11–26% more aluminum from vaccines than undervaccinated children. Power analyses demonstrated that safety studies of aluminum could detect relative risks ranging from 1.1 to 5.8 for a range of adverse event incidence.

Conclusions

The safety of vaccine aluminum exposure can be feasibly studied in the VSD. However, possible biological mechanisms and confounding variables would need to be considered before conducting any studies.