THROMBOCYTOPENIC PURPURA AFTER MEASLES, MUMPS AND RUBELLA VACCINATION- A RETROSPECTIVE SURVEY BY THE FRENCH-REGIONAL-PHARMACOVIGILANCE-CENTER AND PASTEUR-MERIEUX-SERA-ET-VACCINS

Background. Thrombocytopenic purpura (TP) after vaccination with measl es, mumps and rubella has occasionally been reported. Objectives. To e valuate the incidence and characteristics of thrombocytopenic purpura reported in France after measles, mumps or rubella vaccination with mo novalent or multivalent vaccines, Methods. A retrospective epidemiolog ic survey was conducted. AU confirmed cases of TP reported spontaneous ly either to the French Regional Pharmacovigilance Centres or to the m anufacturer (Pasteur-Merieux Serums ct Vaccins) between 1984 and June 30, 1992, were reviewed. Results. Sixty cases of TP in children betwee n 1 and 11 years of age occurred 2 to 45 days after administration of 1 of 7 vaccines. The reported incidence of TP varied from 0.17 and 0.2 3/100 000 doses of measles or rubella vaccines, respectively, given al one to 0.87/100 000 doses of combined measles-rubella vaccines and 0.9 5/100 000 doses of the measles-mumps-rubella vaccine. The mean platele t count was 8000 +/- 6000/mm(3) and was lower than 10 000/mm(3) in 58% of cases. The immediate outcome was favorable in 89.5% of cases. Conc lusions. According to the clinical course and biologic findings, vacci ne associated TP appears to be similar to that occurring after natural measles or rubella infections and is not distinguishable from acute c hildhood idiopathic thrombocytopenic purpura not associated with vacci nation. Such observations, combined with a clear temporal relationship between measles mumps-rubella vaccination and the occurrence of TP, m ake a causal relationship highly plausible. Nevertheless the incidence of these events remains relatively low with a favorable immediate out come.