C-B5-02: H1N1 Vaccine Safety Monitoring in the Vaccine Safety Datalink Project: New Challenges and Useful Lessons

Abstract

Background and Aims: The worldwide introduction of influenza A (H1N1) vaccines in fall 2009 has raised widespread public questions about the safety of these new vaccines. The Vaccine Safety Datalink Project, a collaboration among CDC and eight health care systems in the HMORN, began accelerated monitoring of this vaccine’s safety in early fall 2009. Methods: The VSD Project conducts near real-time monitoring of potential adverse events following vaccination for all new vaccines. Each week, each site updates dynamic data files, and the coordinating center analyzes all data cumulatively. Repeated analysis of the same data requires adjustment for multiple testing. To address this issue, VSD uses sequential statistical methods. Evaluation of H1N1 vaccine safety poses special challenges, including confounding by indication, seasonality, and new priority groups including pregnant women. We are using several analytic methods, including: Self-controlled case-series, which compares exposed vs. unexposed time windows within the same individual; Poisson, which compares the outcomes during the current season with expected rates based on historical data for seasonal influenza vaccine; and Difference-in-difference, which compares the relative risk in exposed vs. unexposed time windows for H1N1 vaccine during the current season with the relative risk for seasonal influenza vaccine during cumulative prior seasons. Results: Pre-specified outcomes of interest include: Guillain-Barre syndrome, neuropathies, seizures, encephalitis, Bell’s palsy, ataxia, anaphylaxis, spontaneous abortion, pre-eclampsia, stroke, myocarditis and wheezing. Historical rates of these outcomes were calculated for time windows after seasonal influenza vaccination in prior seasons (2000/01–2008/09). The sequential analysis methods above will be used, and relative and absolute risks will be estimated for each outcome. For outcomes found associated with vaccination in preliminary analyses, additional evaluation will be conducted using temporal scan analyses, logistic regression, and when appropriate, medical record review.