Safety of measles, mumps, and rubella vaccine in adolescents and adults in the vaccine safety Datalink

Kayla E Hanson; Mona Marin; Matthew F Daley; Holly C Groom; Lisa A Jackson; Lina S Sy; Nicola P Klein; Malini B DeSilva; Lakshmi Panagiotakopoulos; Eric Weintraub; Edward A Belongia; Huong Q McLean

doi:10.1016/j.jvacx.2023.100268

Safety of measles, mumps, and rubella vaccine in adolescents and adults in the vaccine safety Datalink

Vaccine X. 2023 Feb 4:13:100268. doi: 10.1016/j.jvacx.2023.100268. eCollection 2023 Apr.

Authors

Affiliations

¹ Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States.
² Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA 30333, United States.
³ Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, United States.
⁴ Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States.
⁵ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States.
⁶ Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, United States.
⁷ Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, CA 94612, United States.
⁸ HealthPartners Institute, 8170 33 Ave S, Bloomington, MN 55425, United States.
⁹ Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30333, United States.

Abstract

Background: Measles, mumps, and rubella vaccine (MMR) is routinely administered to children; however, adolescents and adults may receive MMR for various reasons. Safety studies in adolescents and adults are limited. We report on safety of MMR in this age group in the Vaccine Safety Datalink.

Methods: We included adolescents (aged 9-17 years) and adults (aged ≥ 18 years) who received ≥ 1 dose of MMR from January 1, 2010-December 31, 2018. Pre-specified outcomes were identified by diagnosis codes. Clinically serious outcomes included anaphylaxis, encephalitis/myelitis, Guillain-Barré syndrome, immune thrombocytopenia, meningitis, and seizure. Non-serious outcomes were allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, non-specific reaction, parotitis, rash, and syncope. All serious outcomes underwent medical record review. Outcome-specific incidence was calculated in pre-defined post-vaccination windows. A self-controlled risk interval design was used to determine the relative risk of each outcome in a risk window after vaccination compared to a more distal control window.

Results: During the study period, 276,327 MMR doses were administered to adolescents and adults. Mean age of vaccinees was 34.8 years; 65.8 % were female; 53.2 % of doses were administered simultaneously with ≥ 1 other vaccine. Serious outcomes were rare, with incidence ≤ 6 per 100,000 doses for each outcome assessed, and none had a significant elevation in incidence during the risk window compared to the control window. Incidence of non-serious outcomes per 100,000 doses ranged from 3.4 for parotitis to 263.0 for arthropathy. Other common outcomes included injection site reaction and rash (157.0 and 112.9 per 100,000 doses, respectively). Significantly more outcomes were observed during the risk window compared to the control window for all non-serious outcomes except parotitis. Some variability was observed by sex and age group.

Conclusion: Serious outcomes after MMR are rare in adolescents and adults, but vaccinees should be counseled regarding anticipated local and systemic non-serious adverse events.

Keywords: ACIP, Advisory Committee on Immunization Practices; Adolescents; Adults; CDC, Centers for Disease Control and Prevention; CI, confidence interval; ED, emergency department; GBS, Guillain-Barré syndrome; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification; ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; IQR, interquartile range; ITP, immune thrombocytopenia; MMR; MMR, measles, mumps, and rubella vaccine; MMRV, measles, mumps, rubella, and varicella vaccine; RR, relative risk; SCRI, self-controlled risk interval; Safety; VAERS, Vaccine Adverse Event Reporting System; VSD, Vaccine Safety Datalink; Vaccine.