The risk of immune thrombocytopenic purpura after vaccination in children and adolescents

Pediatrics. 2012 Feb;129(2):248-55. doi: 10.1542/peds.2011-1111. Epub 2012 Jan 9.


Background: The risk of immune thrombocytopenic purpura (ITP) after childhood vaccines other than measles-mumps-rubella vaccine (MMR) is unknown.

Methods: Using data from 5 managed care organizations for 2000 to 2009, we identified a cohort of 1.8 million children ages 6 weeks to 17 years. Potential ITP cases were identified by using diagnostic codes and platelet counts. All cases were verified by chart review. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.

Results: There were 197 chart-confirmed ITP cases out of 1.8 million children in the cohort. There was no elevated risk of ITP after any vaccine in early childhood other than MMR in the 12- to 19-month age group. There was a significantly elevated risk of ITP after hepatitis A vaccine at 7 to 17 years of age, and for varicella vaccine and tetanus-diphtheria-acellular pertussis vaccine at 11 to 17 years of age. For hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines, elevated risks were based on one to two vaccine-exposed cases. Most cases were acute and mild with no long-term sequelae.

Conclusions: ITP is unlikely after early childhood vaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Chickenpox Vaccine / adverse effects
  • Chickenpox Vaccine / immunology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / adverse effects
  • Diphtheria-Tetanus-acellular Pertussis Vaccines / immunology
  • Female
  • Hepatitis A Vaccines / adverse effects
  • Hepatitis A Vaccines / immunology
  • Humans
  • Infant
  • Male
  • Purpura, Thrombocytopenic, Idiopathic / epidemiology*
  • Purpura, Thrombocytopenic, Idiopathic / etiology*
  • Retrospective Studies
  • Risk
  • United States
  • Vaccination / adverse effects*


  • Chickenpox Vaccine
  • Diphtheria-Tetanus-acellular Pertussis Vaccines
  • Hepatitis A Vaccines