Rulin C Hechter1, Lei Qian2, Sara Y Tartof3, Lina S Sy4, Nicola P Klein5, Eric Weintraub6, Cheryl Mercado7, Allison Naleway8, Huong Q McLean9, Steven J Jacobsen10. 1. Kaiser Permanente Southern California, USA. Electronic address: Rulin.C.Hechter@kp.org. 2. Kaiser Permanente Southern California, USA. Electronic address: Lei.X.Qian@kp.org. 3. Kaiser Permanente Southern California, USA. Electronic address: Sara.Y.Tartof@kp.org. 4. Kaiser Permanente Southern California, USA. Electronic address: Lina.S.Sy@kp.org. 5. Kaiser Permanente Northern California, USA. Electronic address: Nicola.Klein@kp.org. 6. Immunization Safety Office, Centers for Disease Control and Prevention, USA. Electronic address: eiw8@cdc.gov. 7. Kaiser Permanente Southern California, USA. Electronic address: Cheryl.M.Carlson@kp.org. 8. Kaiser Permanente Northwest, USA. Electronic address: Allison.Naleway@kpchr.org. 9. Marshfield Clinic Research Institute, USA. Electronic address: mclean.huong@marshfieldresearch.org. 10. Kaiser Permanente Southern California, USA. Electronic address: Steven.J.Jacobsen@kp.org.
Abstract
OBJECTIVES: We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS: We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS: Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS: Routinely administered vaccines are generally safe for HIV-infected adults.
OBJECTIVES: We evaluate safety of routine vaccination among adults infected with human immunodeficiency virus (HIV) in five healthcare organizations in the United States. METHODS: We conducted a retrospective cohort study of HIV-infected adults who received inactivated influenza vaccines, hepatitis B vaccines, pneumococcal vaccines, or tetanus, diphtheria, and acellular pertussis vaccines between 2002 and 2013. We conducted self-controlled case series analysis to estimate the relative risk (RR) for 11 pre-specified adverse events (AEs) requiring medical attention. RESULTS: Among 20,417 HIV-infected adults (90.2% male), a total of 137,674 vaccine doses were administered. Based on ICD-9 codes, we detected an increased risk of cellulitis and infection (RR: 1.18, 95% CI: 1.03-1.35) among all patients, and an increased risk of stroke/cerebrovascular diseases among patients with an HIV viral load >10,000 copies/ml (adjusted RR: 3.94, 95% CI: 1.32-11.72). Further analyses on chart confirmed cases of stroke/cerebrovascular diseases indicated no statistically significant increased risk (adjusted RR: 1.72, 95% CI: 0.41-7.24). There was no evidence of increased risk for other AEs following routine vaccination in HIV-infected adults. CONCLUSIONS: Routinely administered vaccines are generally safe for HIV-infected adults.
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