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

Abstract

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.

• Authors: John R Su, Penina Haber, Carmen S Ng, Paige L Marquez, Graça M Dores, Silvia Perez-Vilar, Maria V Cano
• Journal: Vaccine (Vaccine) Vol. 38 Issue 7 Pg. 1746-1752 (02 11 2020) ISSN: 1873-2518 [Electronic] Netherlands
• PMID: 31870573 (Publication Type: Journal Article)
• Copyright: Published by Elsevier Ltd.

Topics

• Adolescent
• Adult
• Bayes Theorem
• Child
• Child, Preschool
• Erythema Multiforme (chemically induced, epidemiology)
• Female
• Humans
• Male
• Middle Aged
• Stevens-Johnson Syndrome (epidemiology, etiology)
• United States (epidemiology)
• Vaccination (adverse effects)
• Young Adult