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No increased risk of relapse after meningococcal C conjugate vaccine in nephrotic syndrome
  1. Brent Taylor1,
  2. Nick Andrews2,
  3. Julia Stowe1,
  4. Laila Hamidi-Manesh1,
  5. Elizabeth Miller3
  1. 1
    General and Adolescent Paediatric Unit, Institute of Child Health, University College London, London, UK
  2. 2
    Statistics, Modelling and Bioinformatics Department, Health Protection Agency Centre for Infections, London, UK
  3. 3
    Immunisation Department, Health Protection Agency Centre for Infections, London, UK
  1. Elizabeth Miller, Immunisation Department, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK; liz.miller{at}hpa.org.uk

Abstract

Objectives: To investigate whether meningococcal C conjugate vaccine (MCCV) caused relapse in children with steroid-responsive nephrotic syndrome.

Design: A population-based study was conducted using an active surveillance system, developed to assess adverse events following vaccination, which linked hospital record information on relapses of nephrotic syndrome to community child health population MCCV data. An ecological study looking at hospital admissions for nephrotic syndrome in different age cohorts of children before and after the MCCV introductory campaign was also carried out.

Settings: South East England, and England and Wales.

Patients: 52 children having 162 relapses of nephrotic syndrome. Also, all hospital admissions of children aged 2–18 years with steroid-responsive nephrotic syndrome in England and Wales between 1995 and 2003, relating admissions to when MCCV was introduced in specific age cohorts.

Main outcome measures and analysis method: Self-controlled case series analysis looking for increased risk of relapse following MCCV and changes in admission rates for nephrotic syndrome (incidence ratio) following the introduction of MCCV to different age cohorts of children.

Results: There was no increased risk of relapse following MCCV in the self-control case series, where a relative incidence of 0.95 (95% confidence interval (CI) 0.61–1.47) was found in the 6-month post-vaccination period, or in the ecological study, which gave an incidence rate ratio of 1.05 (95% CI 0.95 to 1.15) for the quarter when MCCV was introduced and the following two quarters.

Conclusions: We found no association between MCCV and nephrotic syndrome, which is therefore not a contraindication to meningococcal vaccination.

  • meningococcal C conjugate vaccine
  • childhood nephrotic syndrome
  • vaccine-associated adverse events
  • self-controlled case-series method

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Footnotes

  • JS is supported by DoH Research and Development Directorate grant 1216520.

  • Competing interests: EM’s department has received reimbursement for meningococcal C surveillance reports to vaccine manufacturers in accordance with the code of practice for the department (see http://www.hpa.org.uk/infections/about/dir/psp.pdf). There are no other conflicts of interest.

  • Ethics: The linked data adverse vaccination events programme has MREC and Patient Information Advisory Group approval.

  • Contributions of authors: EM, NA and BT designed the study, JS and LH-M identified the case notes and processed the data, BT assessed relapses, NA undertook the statistical analyses and all authors contributed to writing the paper.

  • Abbreviations:
    CI
    confidence interval
    GOSH
    Great Ormond Street Hospital
    IRR
    incidence rate ratio
    MCCV
    meningococcal C conjugate vaccine
    MHRA
    Medicines and Healthcare Products Regulatory Agency

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