Mortality Rates and Cause-of-Death Patterns in a Vaccinated Population


      Determining the baseline mortality rate in a vaccinated population is necessary to be able to identify any unusual increases in deaths following vaccine administration. Background rates are particularly useful during mass immunization campaigns and in the evaluation of new vaccines.


      Provide background mortality rates and describe causes of death following vaccination in the Vaccine Safety Datalink (VSD).


      Analyses were conducted in 2012. Mortality rates were calculated at 0–1 day, 0–7 days, 0–30 days, and 0–60 days following vaccination for deaths occurring between January 1, 2005, and December 31, 2008. Analyses were stratified by age and gender. Causes of death were examined, and findings were compared to National Center for Health Statistics (NCHS) data.


      Among 13,033,274 vaccinated people, 15,455 deaths occurred between 0 and 60 days following vaccination. The mortality rate within 60 days of a vaccination visit was 442.5 deaths per 100,000 person-years. Rates were highest in the group aged ≥85 years, and increased from the 0–1-day to the 0–60-day interval following vaccination. Eleven of the 15 leading causes of death in the VSD and NCHS overlap in both systems, and the top four causes of death were the same in both systems.


      VSD mortality rates demonstrate a healthy vaccinee effect, with rates lowest in the days immediately following vaccination, most apparent in the older age groups. The VSD mortality rate is lower than that in the general U.S. population, and the causes of death are similar.
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        • Allred N.J.
        • Shaw K.M.
        • Santibanez T.A.
        • Rickert D.L.
        • Santoli J.M.
        Parental vaccine safety concerns: results from the National Immunization Survey, 2001-2002.
        Am J Prev Med. 2005; 28: 221-224
        • Poland G.A.
        • Jacobson R.M.
        Understanding those who do not understand: a brief review of the anti-vaccine movement.
        Vaccine. 2001; 19: 2440-2445
        • Nakada H.
        • Narimatsu H.
        • Tsubokura M.
        • et al.
        Risk of fatal adverse events after H1N1 influenza vaccination.
        Clin Infect Dis. 2010; 50: 1548-1549
        • McNeil M.M.
        • Broder K.R.
        • Vellozzi C.
        • DeStefano F.
        Risk of fatal adverse events after H1N1 influenza vaccine: limitations of passive surveillance data.
        Clin Infect Dis. 2010; 51 (author reply 872–3): 871-872
        • Lee G.M.
        • Greene S.K.
        • Weintraub E.S.
        • et al.
        H1N1 and seasonal influenza vaccine safety in the vaccine safety datalink project.
        Am J Prev Med. 2011; 41: 121-128
        • Black S.
        • Eskola J.
        • Siegrist C.A.
        • et al.
        Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines.
        Lancet. 2009; 374: 2115-2122
        • Baggs J.
        • Gee J.
        • Lewis E.
        • et al.
        The Vaccine Safety Datalink: a model for monitoring immunization safety.
        Pediatrics. 2011; 127: S45-S53
        • Varricchio F.
        • Iskander J.
        • Destefano F.
        • et al.
        Understanding vaccine safety information from the Vaccine Adverse Event Reporting System.
        Pediatr Infect Dis J. 2004; 23: 287-294
      1. International statistical classification of diseases and related health problems. Geneva, Switzerland: WHO, 2004.

        • Minino A.M.
        • Murphy S.L.
        • Xu J.
        • Kochanek K.D.
        Deaths: final data for 2008. USDHHS, Hyattsville MD2011
        • Klein R.J.
        • Schoenborn C.A.
        Age adjustment using the 2000 projected U.S. population.
        USDHHS, Hyattsville MDJanuary 2001
        • Fine P.E.
        • Chen R.T.
        Confounding in studies of adverse reactions to vaccines.
        Am J Epidemiol. 1992; 136: 121-135
        • CDC Advisory Committee on Immunization
        • American Academy of Pediatrics
        • American Academy of Family Physicians
        Recommended immunization schedule for persons aged 0-6 years—U.S. 2008.
        S D Med. 2008; 61: 222
        • Jackson L.A.
        • Nelson J.C.
        • Benson P.
        • et al.
        Functional status is a confounder of the association of influenza vaccine and risk of all cause mortality in seniors.
        Int J Epidemiol. 2006; 35: 345-352
        • Carlo W.A.
        Kliegman: Nelson textbook of pediatrics.
        19th ed. Saunders, Philadelphia PA2011
        • Eriksen E.M.
        • Perlman J.A.
        • Miller A.
        • et al.
        Lack of association between hepatitis B birth immunization and neonatal death: a population-based study from the vaccine safety datalink project.
        Pediatr Infect Dis J. 2004; 23: 656-662
        • Reichert T.A.
        • Simonsen L.
        • Sharma A.
        • Pardo S.A.
        • Fedson D.S.
        • Miller M.A.
        Influenza and the winter increase in mortality in the U.S., 1959-1999.
        Am J Epidemiol. 2004; 160: 492-502
        • Sakamoto-Momiyama M.
        Seasonality in human mortality.
        University of Tokyo Press, Tokyo, Japan1972
        • Rosenwaike I.
        Seasonal variation of deaths in the U.S., 1951-1960.
        Am Stat Assoc J. 1966; 61: 706-719
        • McMichael A.J.
        Standardized mortality ratios and the "healthy worker effect": scratching beneath the surface.
        J Occup Med. 1976; 18: 165-168
        • Wen C.P.
        • Tsai S.P.
        • Gibson R.L.
        Anatomy of the healthy worker effect: a critical review.
        J Occup Med. 1983; 25: 283-289
        • Dunne E.
        • Duggan M.
        • O'Mahony J.
        Mental health services for homeless: patient profile and factors associated with suicide and homicide.
        Ir Med J. 2012; 105 (74): 71-72
        • Singh G.K.
        • Azuine R.E.
        • Siahpush M.
        • Kogan M.D.
        All-cause and cause-specific mortality among U.S. youth: socioeconomic and rural-urban disparities and international patterns.
        J Urban Health. 2012;
        • Silvers L.E.
        • Varricchio F.E.
        • Ellenberg S.S.
        • Krueger C.L.
        • Wise R.P.
        • Salive M.E.
        Pediatric deaths reported after vaccination: the utility of information obtained from parents.
        Am J Prev Med. 2002; 22: 170-176
        • Kempe A.
        • Daley M.F.
        • McCauley M.M.
        • et al.
        Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians.
        Am J Prev Med. 2011; 40: 548-555
        • Stoto M.A.
        • Evans G.
        • Bostrom A.
        Vaccine risk communication.
        Am J Prev Med. 1998; 14: 237-239