Association between Trivalent Inactivated Vaccination and Risk of Febrile Seizures among Children Aged 6-80 Months Old in the Influenza Season 2010-2011 Pubblico

Chen, Jie (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/9w032313j?locale=it
Published

Abstract

Febrile seizures, also referred as febrile convulsions, are seizures occurring in children aged 6 months through 6 years old who do not have the intracranial infection, metabolic disturbance, or history of febrile seizures. Among several risk factors such as fever, prenatal and early childhood exposure, concurrent infection, and vaccination that were suggested to cause febrile seizure, the association between children-recommended vaccination and febrile convulsions has become one the most active research areas. Trivalent Inactivated Vaccine (TIV) was suspected to be associated with elevated risk of convulsion in several studies. Using a large cohort study dataset with an enrollment of over 790,000 children in the influenza season 2010-2011, we were able to thoroughly investigate the association between TIV and children convulsion. With the goal of assessing association between TIV and children convulsion, this cohort study first compared risk of at least one convulsion between TIV vaccinated and TIV unvaccinated children in the flu season of 2010-2011 by using logistic regression. Then we tested the association between the number of convulsion events and TIV vaccination from the 1st TIV vaccination date till the end of the season, by using Poisson regression and Negative Binomial Regression. Lastly, we investigated if non-linear effect of age on convulsion incidence exists after controlling for TIV vaccination. Results from different modeling method were consistent; TIV vaccination was positively associated with convulsion. Children aged between 12- 23 were the most vulnerable group to convulsion.

Table of Contents

Table of Contents

Abbreviation................................................................................................................................... 1

Introduction.................................................................................................................................... 1

Definition, Incidence and Symptoms of Febrile Seizures............................................................. 1

Risk Factors for Febrile Seizures.................................................................................................. 2

Trivalent Inactivated Vaccine and Other Childhood Vaccination Related to Febrile Seizures....... 3

Statement of Research Questions.................................................................................................. 5

Data and Methods........................................................................................................................... 6

Data Source and Study Design...................................................................................................... 6

Study Population.......................................................................................................................... 6

Outcome Definitions.................................................................................................................... 7

Screening Explanatory Variables and Primary Analysis................................................................ 7

Logistic Regression Modeling....................................................................................................... 8

Poisson Regression Modeling....................................................................................................... 9

Negative Binomial Regression Modeling.................................................................................... 10

Generalized Additive Modeling.................................................................................................. 11

Results........................................................................................................................................... 12

Descriptive Analysis................................................................................................................... 12

Logistic Regression (Model 1).................................................................................................... 12

Poisson Regression (Model 2 and 3)........................................................................................... 14

Negative Binomial Regression.................................................................................................... 15

Non-linear Effect of Age............................................................................................................ 15

Discussion...................................................................................................................................... 17

Validation................................................................................................................................... 17

Limitation and Future Work........................................................................................................ 19

References..................................................................................................................................... 21

Figures........................................................................................................................................... 24

Tables............................................................................................................................................ 27

APPENDIX A - SAS CODE.......................................................................................................... 40

APPENDIX B - R CODE.............................................................................................................. 57

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