Importance Some parents are concerned that multiple vaccines in early childhood could weaken their child’s immune system. Biological data suggest that increased vaccine antigen exposure could increase the risk for infections not targeted by vaccines. Objective To examine estimated cumulative vaccine antigen exposure through the first 23 months of life in children with and without non–vaccine-targeted infections from 24 through 47 months of age. Design, Setting, and Participants A nested case-control study was conducted in 6 US health care organizations participating in the Vaccine Safety Datalink. Cases were identified by International Classification of Diseases codes for infectious diseases in the emergency department and inpatient medical settings and then validated by medical record review. Cases of non–vaccine-targeted infection were matched to controls by age, sex, health care organization site, and chronic disease status. Participants were children ages 24 through 47 months, born between January 1, 2003, and September 31, 2013, followed up until December 31, 2015. Exposures Cumulative vaccine antigen exposure, estimated by summing the number of antigens in each vaccine dose received from birth through age 23 months. Main Outcomes and Measures Non–vaccine-targeted infections, including upper and lower respiratory infections and gastrointestinal infections, from 24 through 47 months of age, and the association between these infections and estimated cumulative vaccine exposure from birth through 23 months. Conditional logistic regression was used to estimate matched odds ratios representing the odds of non–vaccine-targeted infections for every 30-unit increase in estimated cumulative number of antigens received. Results Among the 944 patients (193 cases and 751 controls), the mean (SD) age was 32.5 (6.3) months, 422 (45%) were female, and 61 (7%) had a complex chronic condition. Through the first 23 months, the estimated mean (SD) cumulative vaccine antigen exposure was 240.6 (48.3) for cases and 242.9 (51.1) for controls. The between-group difference for estimated cumulative antigen exposure was −2.3 (95% CI, −10.1 to 5.4; P = .55). Among children with vs without non–vaccine-targeted infections from 24 through 47 months of age, the matched odds ratio for estimated cumulative antigen exposure through age 23 months was not significant (matched odds ratio, 0.94; 95% CI, 0.84 to 1.07). Conclusions and Relevance Among children from 24 through 47 months of age with emergency department and inpatient visits for infectious diseases not targeted by vaccines, compared with children without such visits, there was no significant difference in estimated cumulative vaccine antigen exposure through the first 23 months of life.

中文翻译：

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生命最初 23 个月的估计累积疫苗抗原暴露与 24 至 47 个月的非疫苗靶向感染之间的关联

重要性 一些家长担心在幼儿期接种多种疫苗会削弱孩子的免疫系统。生物学数据表明，增加疫苗抗原暴露可能会增加疫苗未靶向感染的风险。目的 检查 24 至 47 个月大的有和没有非疫苗靶向感染的儿童在生命的前 23 个月内估计的累积疫苗抗原暴露量。设计、设置和参与者 在参与疫苗安全数据链的 6 个美国卫生保健组织中进行了嵌套病例对照研究。病例由急诊科和住院医疗机构的传染病国际疾病分类代码确定，然后通过病历审查进行验证。非疫苗靶向感染病例按年龄、性别、卫生保健组织地点和慢性病状态与对照组相匹配。参与者为 24 至 47 个月的儿童，出生于 2003 年 1 月 1 日至 2013 年 9 月 31 日，随访至 2015 年 12 月 31 日。 暴露 累积疫苗抗原暴露，通过对出生时接种的每一剂疫苗中的抗原数量求和来估计通过年龄 23 个月。主要结果和措施 非疫苗靶向感染，包括 24 至 47 个月大的上呼吸道和下呼吸道感染和胃肠道感染，以及这些感染与从出生到 23 个月的估计累积疫苗暴露之间的关联。条件逻辑回归用于估计匹配的优势比，代表接收的抗原估计累积数量每增加 30 个单位，非疫苗靶向感染的几率。结果 944例患者（193例和751例对照）中，平均（SD）年龄为32.5（6.3）个月，422（45%）例为女性，61例（7%）为复杂慢性病。在前 23 个月中，病例的估计平均 (SD) 累积疫苗抗原暴露为 240.6 (48.3)，对照组为 242.9 (51.1)。估计累积抗原暴露的组间差异为 -2.3（95% CI，-10.1 至 5.4；P = .55）。在 24 至 47 个月大的有与没有非疫苗靶向感染的儿童中，23 个月龄期间估计累积抗原暴露的匹配优势比不显着（匹配优势比，0.94；95% CI，0.84 至 1.07）。结论和相关性 24 至 47 个月大的儿童因非疫苗目标传染病急诊和住院就诊，与没有此类就诊的儿童相比，前 23 个月的估计累积疫苗抗原暴露量没有显着差异。生活。