Febrile Seizure Risk Following Monovalent COVID-19 mRNA Vaccination in US Children Aged 2-5 Years

Author:

Anderson Steven A,Smith Elizabeth R,Wan Zhiruo,Amend Kandace L,Secora Alex,Djibo Djeneba Audrey,Kazemi Kamran,Song Jennifer,Parlett Lauren E,Seeger John D,Selvam Nandini,McMahill-Walraven Cheryl N,Hu Mao,Chillarige Yoganand,Forshee Richard A

Abstract

ABSTRACTObjectiveTo evaluate febrile seizure risk following monovalent COVID-19 mRNA vaccination among children aged 2-5 years.MethodsThe primary analysis evaluated children who had a febrile seizure outcome in the 0-1 days following COVID-19 vaccination. A self-controlled case series analysis was performed in three commercial insurance databases to compare the risk of seizure in the risk interval (0-1 days) to a control interval (8-63 days).The exposure of interest was receipt of dose 1 and/or dose 2 of monovalent COVID-19 mRNA vaccinations.The primary outcome was febrile seizure (0-1 day risk interval).A conditional Poisson regression model was used to compare outcome rates in risk and control intervals and estimate incidence rate ratios (IRR) and 95% confidence intervals (CIs). Meta-analyses were used to pool results across databases.ResultsThe primary meta-analysis found a statistically significant increased incidence of febrile seizure, in the 0-1 days following mRNA-1273 vaccination compared to the control interval (IRR: 2.52, 95% CI: 1.35 to 4.69, risk difference (RD)/100,000 doses = 3.22 (95%CI -0.31 to 6.75)). For the BNT162b2 vaccination, the IRR was elevated but not statistically significant (IRR: 1.41, 95%CI: 0.48 to 4.11, RD/100,000 doses = -0.25 (95%CI -2.75 to 2.24).ConclusionsAmong children aged 2-5 years, the analysis showed a small elevated incidence rate ratio of febrile seizures in the 0-1 days following the mRNA-1273 vaccination. Based on the current body of scientific evidence, the safety profile of the monovalent mRNA vaccines remains favorable for use in young children.Article SummaryIn this self-controlled case series study, researchers evaluated whether there is an elevated risk of febrile seizure immediately following monovalent COVID-19 mRNA vaccination.What’s Known on This SubjectThe United States Food and Drug Administration previously noted a potential safety concern for seizure in children aged 2-5 years receiving the ancestral monovalent COVID-19 mRNA vaccines.What This Study AddsIn this self-controlled case series that included participants aged 2-5 years from three commercial insurance databases, the incidence rate ratio of febrile seizures was significantly elevated in the 0-1 days following mRNA-1273 administration. Absolute risk was small.

Publisher

Cold Spring Harbor Laboratory

Reference16 articles.

1. U.S. Food & Drug Administration. Coronavirus (COVID-19) Update: FDA Authorizes Moderna and Pfizer-BioNTech COVID-19 Vaccines for Children Down to 6 Months of Age. 2022; https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-covid-19-vaccines-children, 2023.

2. Centers for Disease Control and Prevention. Stay Up to Date with COVID-19 Vaccines. 2023; https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html, 2023.

3. U.S. Food & Drug Administration. Vaccines and Related Biological Products Advisory Committee Meeting: FDA Review of Effectiveness and Safety of Moderna COVID-19 Vaccine in Children 6 Months through 5 Years of Age, Emergency Use Authorization Amendment. 2022; https://www.fda.gov/media/159254/download.

4. U.S. Food & Drug Administration. Vaccines and Related Biological Products Advisory Committee Meeting: FDA Review of Effectiveness and Safety of Pfizer-BioNTech COVID-19 Vaccine in Children 6 Months through 4 Years of Age, Emergency Use Authorization Amendment. 2022; https://www.fda.gov/media/159255/download.

5. U.S. Food & Drug Administration. COVID-19 Vaccine Safety Surveillance. 2021; https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/covid-19-vaccine-safety-surveillance, 2023.

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