Original ArticleThrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic Review of the Literature and Guidance for Management
Section snippets
Methods
We searched the Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE 1950 to Present electronic bibliographic database on June 26, 2009, to identify articles that combined the terms measles or mumps or rubella or measles-mumps-rubella vaccine or the abbreviation “MMR” and thrombocytop(a)enia or thrombocytop(a)enic purpura with both the American and the British spelling for these terms. Additionally, we hand-searched the bibliographic references of relevant studies for
Results
Our initial search identified 206 potentially eligible publications. By applying the combined limits of English-only articles, humans, and children 0-18 years old, an additional 103 articles were automatically removed. However, manual search revealed 1 of them to be eligible. After removing 41 case reports, 36 journal articles, and 5 reviews that contained no data on MMR-associated ITP, the number of potentially eligible studies was limited to 22. A total of 13 additional studies were removed
Discussion
Our first goal was to calculate the incidence of thrombocytopenia after MMR vaccination compared with that after measles and rubella. The chance of developing ITP after MMR vaccination is approximately 2.6/100 000 vaccine doses (median value, range 0.087 to 4/100 000).17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 The risk of thrombocytopenia after natural measles or rubella is several fold higher ranging from 6 to 1200/100 000 cases.29, 30, 31, 32 Remarkably, there is no overlap in the
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The authors declare no conflicts of interest.