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The epidemiology branch of the center for biologics Evaluation of the Food and Drug Administration maintains strict post-licensure safety surveillance of pharmaceutical products used in the United States. In early 1994, the FDA was contacted by the mother of a young girl who had experienced total loss of scalp hair after both the second and third doses of hepatitis B vaccine (HBV). A retrospective review of the records of the national vaccine surveillance systems that have been in place since 1969 yielded 60 cases of partial or complete hair loss that occurred one day to one month following immunizations. In four cases, there was a second occurrence of hair loss following readministration of the same vaccine. Sixteen of the patients were children, and 11 of these patients were girls. Seventy-seven (46/60) percent of the patients had received either HBV alone (40) or HBV plus another vaccine (6). In 14 patients, a variety of vaccines other than HBV had been given.
Wise and colleagues conclude that this series, particularly the four cases of hair loss with a clear-cut recurrence of hair loss after rechallenge with the same vaccine, provides a causal relationship to vaccinationsespecially HBV vaccination. They do not believe that this is a chance occurrence. By an extrapolation of data from Minnesota, it was estimated that there are about 50,000 case of alopecia areata in the United States annually, but the distinctive age and gender distribution of these cases, as well as the recurrence with rechallenge, was considered to make a chance occurrence unlikely. Wise et al believe that immunizations warrant consideration as a potential cause of hair loss and a relationship that should receive further study.
From a pediatric point of view, many childhood immunizations, including two doses of HBV, are given in early infancy when significant hair loss might not be noticeable.
Hair loss after immunization:
a. is coincidental.
b. is most often associated with HBV immunization.
c. occurs only with primary vaccinations.
d. occurs more often in males than females.