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Vaccine coverage among children with epilepsy in two Canadian provinces: A Canadian immunization research network
Christiaan H Righolt1, Gurpreet Pabla1, Jessy Donelle2
1Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Insights
Children with epilepsy have similar vaccine coverage to those without epilepsy, but early-life vaccination is crucial. Optimizing immunization for children with epilepsy ensures protection against preventable diseases.
Area of Science:
- Pediatric Neurology
- Immunology
- Public Health
Background:
- Children with epilepsy face higher risks from vaccine-preventable infections.
- Data on vaccine coverage in pediatric epilepsy populations are limited.
- Understanding vaccination status is key to preventing complications.
Purpose of the Study:
- To compare vaccine coverage and timeliness between children with and without epilepsy.
- To identify potential disparities in immunization rates in pediatric epilepsy.
- To inform strategies for optimizing vaccine uptake in this vulnerable group.
Main Methods:
- Retrospective cohort study of 2005-2013 births in Manitoba and Ontario, Canada.
- Two cohorts: 2-year-olds and 7-year-olds, divided into epilepsy and non-epilepsy groups.
- Logistic regression and meta-analysis used to assess vaccination coverage and timeliness (MMR, DTaP).
Main Results:
- Overall vaccine coverage was similar between children with and without epilepsy at ages 2 and 7 years.
- Infants diagnosed with epilepsy before 6 months showed slightly lower coverage at age 2, which resolved by age 7.
- Timeliness of measles, mumps, rubella (MMR) and diphtheria, tetanus, pertussis (DTaP) vaccines was comparable across groups.
Conclusions:
- Children with epilepsy are not significantly under-vaccinated compared to peers.
- Vaccination should be optimized in children with epilepsy, particularly early in life.
- Herd protection may be less reliable for children with epilepsy, emphasizing individual immunization.
Objectives:
Children with epilepsy are at increased risk of complications from vaccine-preventable infections, yet information on vaccine coverage in these children is scarce. We aimed to compare vaccine coverage among children with epilepsy to children without epilepsy.
Study Design:
We conducted a retrospective cohort study including all 2005-2013 births in Manitoba and Ontario, Canada, creating two cohorts: 2-year-olds and 7-year-olds (followed to age 2 and 7 years). We split each cohort into epilepsy and non-epilepsy subcohorts. We assessed vaccination coverage based on provincial schedules and determined timeliness of MMR (measles, mumps, rubella) dose 1 (recommended at 12 months) and DTaP (diphtheria, tetanus, pertussis) dose 4 (recommended at 18 months). We used logistic regression to calculate adjusted odds ratios (aORs) of the association between epilepsy and vaccination, combining both provincial estimates using random effects meta-analysis.
Results:
We included 16,558 2-year-olds (Manitoba, 653; Ontario, 15,905) and 13,004 7-year-olds (Manitoba, 483; Ontario, 12,521) with epilepsy. At age 2 years, the aOR for up-to-date vaccination among children with versus without epilepsy was 0.9 (95% confidence interval 0.8-1.1); at age 7 years it was 1.0 (0.9-1.1). Infants diagnosed with epilepsy before age 6 months were less likely to be up-to-date at age 2 years (0.9; 0.8-0.9), although this difference disappeared by age 7 years. Vaccine timeliness was similar between children with and without epilepsy for MMR dose 1 and DTaP dose 4.
Conclusions:
Overall, this study suggests that children with epilepsy are not significantly under-vaccinated compared to their peers without epilepsy. As children with epilepsy are at a higher risk of complications from vaccine-preventable diseases, vaccination in children with epilepsy should be optimized, especially early in life, as these children may not be able to rely on herd protection.