Vaccination:Purpura , Ecchymoses, Thrombocytopenia

Systemic Vaccine Reactions--Purpura , Ecchymoses, Thrombocytopenia

"Systemic reactions from vaccines include fever, irritability, loss of appetite, sleepiness and inconsolable crying. (22) Vaccines have also been shown to possibly produce more concerning symptoms such as purpura, ecchymosis, thrombocytopenia (23), and other conditions that cause brain swelling (43, 44, 45, 46) or increased intracranial pressure (47, 48, 49) in a recognized percentage of children.(50)"

dictionary.com :
Purpura--any of several hemorrhagic states characterized by patches of purplish discoloration resulting from extravasation of blood into the skin and mucous membranes —see THROMBOCYTOPENIC PURPURA

Ecchymosis--1. the purple or black-and-blue area resulting from a bruise
2. the escape of blood from ruptured blood vessels into the surrounding tissue to form a purple or black-and-blue spot on the skin

Thrombocytopenia--persistent decrease in the number of blood platelets that is often associated with hemorrhagic conditions called also thrombopenia —throm·bo·cy·to·pe·nic /-nik/ adjective

http://www.medicaljournal-ias.org/15_4/Sakha.pdf
HEPATITIS B VACCINATION AND INFANTILE IDIOPATHIC
THROMBOCYTOPENIC PURPURA
KAZEM SAKHA*
ARMAN MALEKIAN*
SAID ASLANABADI*
SUMMARY: Since 1993, Iranian infants have been routinely vaccinated against hepatitis B. In the period of 1993-2002, twenty five children with infantile thrombocytopenic purpura (ITP) were admitted to the Childrens Medical Center in Tabriz, Iran whereas between 1982 and 1992, only two cases were hospitalized with the same diagnosis. This suggests a cause and effect relationship between hepatitis B vaccination and ITP.

INTRODUCTION
ITP is an autoimmune disorder leading to a reduction of the number of peripheral blood platelets (1). For reasons not well understood, autoantibodies are generated against glycoproteins GpIb/Ix and GpIIb/IIIa and are stiuated on the surface of the platelets. Attachment of autoantibodies to these surface antigens leads to phagocytosis or
complement-induced lysis of the platelets involved. This process may also involve megakaryocytes, leading to a decrease in platelet production (2,4). Autoantibodies against platelet surface antigens have been detected in 75% of the patients (2,3).
ITP appears in two forms: acute or chronic. The acute form occurs predominantly in children. 85% of cases are preceded by a viral infection. The disorder may last for one or two months period and is self limited. Mumps, measles, rubella vaccine (MMR) has been implicated in the etiology of ITP (5-10). In Finland, 23 cases of ITP were reported among 70.000 MMR vaccines. The authors speculated that the vaccine leads to generation of antiplatelet antibodies (1). In another study, one case of ITP was recorded among 24.000 MMR vaccines (10).
Occurrence of ITP following DPT vaccination is rare. In a British study, only two cases were reported (8), this data is not significant when the widespread administration of
DPT vaccine is considered. Two cases of ITP have been reported in conjunction with small pox vaccination (12). Small numbers of cases following recombinant HBV have
been reported (13). There is no report of ITP following plasma-derived hepatitis vaccine (11).

MATERIALS AND METHODS
ITP cases between 1992 and 2002
The files of all 25 infants under six months of age, hospitalized at the Childrens Medical Center in Tabriz, Iran, between 1993 and 2002 and discharged with ITP as the final diagnosis were included in the present study. The diagnosis was established based on the clinical findings (purpura, ecchymosis), platelet count, bone marrow findings and exclusion of other causes.
*From Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran.
Medical Journal of Islamic World Academy of Sciences 15:4, 149-151, 2005

http://adc.bmj.com/cgi/content/abstract/84/3/227
Article
Short report

Idiopathic thrombocytopenic purpura and MMR vaccine E Millera, P Waighta, C P Farringtonb, N Andrewsa, J Stowec, B Taylorc

a Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, Colindale, London NW9 5EQ, UK, b Department of Statistics, The Open University, Milton Keynes MK7 6AA, UK, c Royal Free Campus, Royal Free and University College Medical School, University College London, London NW3 2PF, UK

Correspondence to: Dr Miller e.miller@phls.co.uk

Accepted 11 April 2000

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12534647&dopt=AbstractPlus
A CAUSAL ASSOCIATION BETWEEN MEASLES---mumps-rubella (MMR) vaccine and idiopathic thrombocytopenic purpura (ITP) was confirmed using immunisation/hospital admission record linkage. The absolute risk within six weeks of immunisation was 1 in 22 300 doses, with two of every three cases occurring in the six week post-immunisation period being caused by MMR.

1: Br J Clin Pharmacol. 2003 Jan;55(1):107-11.
MMR vaccine and idiopathic thrombocytopaenic purpura.
Black C, Kaye JA, Jick H.

Department of Public Health, Aberdeen University, Aberdeen, UK. corri.black@abdn.ac.uk

AIMS: To estimate the relationship between idiopathic thrombocytopaenic purpura (ITP) and the measles, mumps and rubella (MMR) vaccination in children; calculating the relative risk estimate for ITP with in 6 weeks after MMR vaccination and the attributable risk of ITP within 6 weeks after MMR vaccination. METHODS: Using the General Practice Research Database we identified children with a first-time diagnosis of ITP from a base population of children aged less than 6 years between January 1988 and December 1999. After describing the characteristics of all the children identified with ITP, we focused on cases aged 13-24 months to perform a population-based, case-control analysis to estimate the relative risk of developing ITP within 6 weeks after MMR vaccination. We also calculated the risk of ITP attributable to the MMR vaccination. RESULTS: Sixty-three children with a first time diagnosis of ITP were identified; 23 cases were between 13 and 24 months old. The relative risk estimate for ITP within 6 weeks after MMR vaccination, compared to the combined group of unvaccinated children and children vaccinated with MMR more than 26 weeks previously was 6.3 (95% CI 1.3-30.1). The attributable risk of developing ITP within 6 weeks after MMR vaccination was estimated to be 1 in 25,000 vaccinations (95% confidence interval 21,300, 89,400). CONCLUSION: This study confirms the increased risk of ITP within 6 weeks after MMR vaccination. However, the attributable risk of ITP within 6 weeks after MMR vaccination is low.

PMID: 12534647 [PubMed - indexed for MEDLINE]

http://www.ingentaconnect.com/content/mksg/ejh/2006/00000077/00000004/art00010
Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome
Authors: Wang, Jiaan-Der; Huang, Fang-Liang1; Chen, Po-Yen2; Wang, Teh-Ming3; Chi, Ching-Shiang1; Chang, Te-Kau1
Source: European Journal of Haematology, Volume 77, Number 4, October 2006 , pp. 334-337(4)

Abstract:
Wang J-D, Huang F-L, Chen P-Y, Wang T-M, Chi C-S, Chang T-K. Acute immune thrombocytopenic purpura in infants: associated factors, clinical features, treatment and long-term outcome.

The natural course of acute immune thrombocytopenic purpura (ITP) in infants is poorly described in the literature. A retrospective study of 17 consecutive patients <1?yr of age admitted and treated for acute ITP between 1996 and 2005 was conducted. We investigated their demographics, vaccination history, clinical features, laboratory examinations, response to treatment and long-term outcome. There were 11 male and six female infants. Their ages ranged from 24?d to 12?months with a median of 3?months. All infants presented with petechiae and/or ecchymoses. Fourteen cases had platelet counts below 20?×?109/L at the time of admission. They all had good response to a single course of treatment (14/17) or multiple courses of treatment (3/17). None had progressed into chronic ITP. Seven infants had a causal relationship with immunization, five associated with hepatitis B, one diphtheria-pertussis-tetanus, one diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine-conjugated Haemophilus influenza vaccines. These seven infants responded to treatment within 3-9?d after therapy with intravenous immunoglobulin, high-dose methylprednisolone or oral steroids. Re-boosters with vaccines revealed no recurrence of the disease in all of these seven patients. The study suggests that further immunization is not contraindicated in infants experiencing acute ITP associated with vaccines.

http://www.chiro.org/LINKS/ABSTRACTS/Issues_in_Chiropractic_Pediatrics.shtml

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