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Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality
a latency of 7 to 10 days. All but one of the seizures were associated with fever; however, the vaccine administered to the child with the febrile seizures was not specified. The children were followed for up to 7 years, and all 10 children who had received measles vaccination ''did well'' with no long-term neuralgic sequel.
Nader and Warren (1968) described 23 cases of neuralgic disease that followed administration of measles vaccine and that were reported to the U.S. National Communicable Disease Center between 1965 and 1967. During that time, 15 million doses of measles vaccine were distributed throughout the United States. Eleven of the 23 patients were reported to have seizures or convulsions (three of which were noted to be accompanied by fever), and there was one case of persistent spastic quadriplegia. One of the cases of seizures persisted after the acute phase of the illness.
Beale (1974) reported on the measles vaccine experience in the United Kingdom. From 1968 to 1974, more than 3 million children were immunized with Schwarz or Beckenham 31 measles vaccines. Adverse reactions were reported to the governmental Committee on Safety of Medicines. There were 57 febrile convulsions associated with the Schwarz vaccine and 65 associated with the Beckenham 31 vaccine. No other data describing the nature of the seizures or long-term follow-up of the patients were available.
In a study of voluntary reporting of reactions to vaccination in the North West Thames region of England between 1975 and 1981, when approximately 170,000 children received live measles vaccine (as well as other childhood vaccines), there were 26 reports of convulsions without evidence of neuralgic damage following measles vaccination (Pollock and Morris, 1983). No further details were provided, except that at follow-up the children were normal.
Maspero and colleagues (1991) reported a case series of 1,148 children immunized in 1990 in Lombardy, Italy, with the Edmonston-Zagreb vaccine strain and compared them with a case series of children in a nearby district immunized from 1980 to 1987 with the Schwarz vaccine strain. The authors reported that they saw no neuralgic events following administration of the Edmonston-Zagreb vaccine. There was no comparable statement regarding the incidence of neuralgic outcomes in the population immunized with the Schwarz strain.
A 19-month-old Japanese boy was immunized with measles vaccine (Schwarz strain) and 11 days later developed a fever and prolonged (30 minutes) convulsions with loss of consciousness (Abe, 1985). He had four more brief convulsions over the next 6 months, all with fever, and his electroencephalogram exhibited transient abnormalities 14 months later. The report indicated that 2.5 years following the first seizure, the boy's development appeared to be normal.
Haun and Ehrhardt (1973) described an 11-month-old child who devel-