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Nephrotic syndrome following four-component meningococcal B vaccination: Epidemiologic investigation of a surveillance signal

De Serres, Gaston, Billard, Marie-Noëlle, Gariépy, Marie-Claude, Roy, Marie-Claude, Boucher, François D., Gagné, Hélène, Belley, Sylvie, Toth, Eveline, Landry, Monique, Skowronski, Danuta M.
Vaccine 2019 v.37 no.35 pp. 4996-5002
biopsy, children, confidence interval, epidemiological studies, indigenous species, monitoring, nephrotic syndrome, questionnaires, risk, serotypes, steroids, vaccination, vaccines, Quebec
In May 2014, a mass vaccination campaign with four-component meningococcal serogroup B (4CMenB) vaccine was launched in a localized region of Quebec, Canada experiencing high invasive meningococcal B disease endemicity. Active post-marketing surveillance identified several cases of nephrotic syndrome (NS) among ∼49,000 vaccinated individuals aged 2 months to 20 years. We report the epidemiologic investigation of this potential vaccine safety signal.Active vaccine safety surveillance was conducted electronically, with participants completing an online questionnaire prompted at 7 days after each dose and 6 months following the last dose. Additional NS cases were sought from provincial hospitalization and emergency room databases.In the year following the first dose of 4CMenB vaccination, four confirmed NS cases (three hospitalized) were identified among vaccinated children 2–5-years-old with onset several months post-vaccination. None had renal biopsy but given their age, and positive response to steroids, idiopathic NS was presumptively diagnosed. Among vaccinated children 1–9-years-old, the NS incidence in the year post-vaccination was 17.7 per 100,000 (1 per 5650 vaccinees) with an NS hospitalization rate (i.e. excluding the outpatient case) that was 3.6-fold higher (95%CI = 0.7–11.8; p = 0.12) than the rest of the province for the same period, and 8.3-fold greater (95%CI = 1.1–62.0; p = 0.039) than during the eight years preceding the immunization campaign in the affected region.Active safety surveillance identified an unexpected increase in NS incidence following 4CMenB vaccination. Further epidemiological investigation identified four vaccinated cases in total over a 12 month period of follow up. The greater risk in vaccinees had wide confidence intervals with he lower limit including or just above the nul value, an observation with no or marginal statistical significance. The temporal association with vaccination may be explained by other causes and/or chance clustering of a rare event unrelated to vaccination. To confirm or refute a potential link to vaccination, surveillance in other jurisdictions administering 4CMenB to children 1–9-years-old is needed.