Erythema multiforme, Stevens Johnson syndrome, and toxic epidermal necrolysis reported after vaccination, 1999–2017

Details

• Alternative Title:
  Vaccine
• Personal Author:
  Su, John R. ; Haber, Penina ; Ng, Carmen S. ; Marquez, Paige L. ; Dores, Graça M. ; Perez-Vilar, Silvia ; Cano, Maria V.
• Description:
  Background:
  
  Since the last review of vaccine safety surveillance data for erythema multiforme (EM), Stevens Johnson syndrome (SJS), SJS/TEN, and toxic epidermal necrolysis (TEN) (EM/SJS/TEN), over 37 new vaccines have been introduced in the United States. We sought to describe reported EM/SJS/TEN after vaccines during 1999–2017.
  
  Methods:
  
  We identified U.S. reports of EM/SJS/TEN received by the Vaccine Adverse Event Reporting System (VAERS) during 1999–2017. We stratified analysis by condition (EM, SJS, or TEN), and analyzed reports by serious or non-serious status, sex, age group, time from vaccination to symptom onset, exposure to known causes of EM/SJS/TEN, and vaccines administered. We used Empirical Bayesian data mining to detect vaccine-AE pairs reported more frequently than expected.
  
  Results:
  
  Of 466,027 reports to VAERS during 1999–2017, we identified 984 reports of EM, 89 reports of SJS, 6 reports of SJS/TEN, and 7 reports of TEN. Few reports of EM (9%), and most reports of SJS (52%), SJS/TEN (100%), and TEN (100%) were serious. Overall, 55% of reports described males, 48% described children aged < 4 years; 58% of EM/SJS/TEN occurred ≤ 7 days after vaccination. Few reports (≤5%) described exposure to known causes of EM/SJS/TEN. Overall, childhood vaccines (e.g., combined measles, mumps, and rubella vaccine) were most commonly reported. We identified 6 deaths; 4 were exposed to medications associated with EM/SJS/TEN. EM after smallpox vaccine was reported disproportionately among people aged 19–49 years.
  
  Conclusions:
  
  EM/SJS/TEN were rarely reported after vaccination; data mining identified a known association between EM and smallpox vaccine.
  
  
• Subjects:
  Adolescent Adult Bayes Theorem Child Child, Preschool Erythema Multiforme Female Humans Male Middle Aged Stevens-Johnson Syndrome United States Vaccination Young Adult

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• Keywords:
  Data Mining Erythema Multiforme Stevens Johnson Syndrome Surveillance Toxic Epidermal Necrolysis Vaccine Vaccine Safety VAERS
• Source:
  Vaccine. 38(7):1746-1752
• Pubmed ID:
  31870573
• Pubmed Central ID:
  PMC7008074
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  38
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2b7b9a7d8278735ae4cac700a53e4d33fc3caec082e214837bd9a3e1c44d20cdff5088726672fbd1f8387c3ea8585ba2f7168ecd530a8b43ce7389c61d39aae7
• Download URL:
  https://stacks.cdc.gov/view/cdc/85009/cdc_85009_DS1.pdf
• File Type:
  [PDF - 97.47 KB ]