Are Routine Immunizations Safe in People With Epilepsy?

Gregory L. Krauss, MD

Disclosures

September 19, 2000

Question

Are there any recommendations (or contraindications) regarding immunizations in patients with epilepsy? Specifically:

1. flu shot

2. pneumococcal vaccine

3. DTP

4. measles

5. chickenpox

Andrew Wilner, MD

Response from Gregory L. Krauss, MD

Modern vaccines are safe and effective (CDC: General recommendations on immunization recommendations of the advisory committee on immunization practices. January 28, 1994. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00025027.htm). Epidemiologic studies show no overall increase in the incidence of epilepsy associated with vaccinations, but extremely rare cases of neurologic complications may occur.[1] Oral poliovirus, for example, has been associated with rare cases of CNS infection (with seizures) in which polioviruses have been isolated. The risks for neurologic complications from measles and other childhood illnesses, however, are many-fold higher than the risks of neurologic complications from their vaccines.[2,3]

To encourage vaccination, the US Federal government established The National Vaccine Injury Compensation Program in 1986. This is a system under which compensation can be paid on behalf of a person who has been injured or who died as a result of receiving a vaccine. The program is intended as an alternative to civil litigation, in that negligence need not be proven. This system can be reached at: 1-800-338-2382.

Acute seizures rarely occur (< 1 in 10,000 doses) after childhood vaccinations. There is a 2- to 3-fold increased risk of seizures on the day of receiving DTP (diphtheria-tetanus-pertussis) and 1-2 weeks after receiving MMR (measles-mumps-rubella). Childhood vaccines are associated with an approximately 1% risk of fever, and most acute seizures are benign febrile seizures or epileptic seizures triggered, but not caused, by fever. The acellular pertussis vaccine is less likely to produce seizures and other neurologic reactions than are previous cellular vaccines.[4] Hypersensitivity to a vaccine component -- most commonly to egg embryo proteins -- is a contraindication to receiving some vaccines.

It is recommended that children with epilepsy have full childhood vaccinations. Patients with extremely uncontrolled seizures or new or progressive neurologic conditions should have vaccinations delayed until their medical situations are stabilized.[5]

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