September 10, 2019

5 questions with a vaccine safety researcher

Dr. Nicola Klein finds clinical vaccine research and pediatrics a good combination.

Nicola Klein, MD, PhD, traveling in London.

Nicola Klein, MD, PhD, has directed the Kaiser Permanente Vaccine Study Center since 2006. As a research scientist with the Kaiser Permanente Division of Research, she investigates new ways to protect children and adults from disease through vaccination.

The Vaccine Study Center studies the safety and effectiveness of both existing vaccines and those in development. Dr. Klein received her medical degree and doctorate degree in biochemistry from New York University School of Medicine and completed a residency in pediatrics at the Lucile Salter Packard Children’s Hospital at Stanford.

Why is Kaiser Permanente a good place to study vaccines?

Kaiser Permanente is a phenomenal place to do vaccine research. The Vaccine Study Center conducts a wide range of vaccine studies, from clinical trials studying investigational vaccines to vaccine effectiveness and safety studies after vaccines are in widespread use. We therefore have a uniquely broad view of the entire vaccine landscape, which ranges from early-stage development to routine use in large populations.

In particular, because vaccines are designed, tested, and licensed on the basis of being very safe, one needs to study huge populations to find any unanticipated serious or rare safety outcomes. Kaiser Permanente is the ideal place to do these studies because of the large numbers of patients, the efficient way we promote vaccination to protect our members from disease, and our ability to monitor all the health outcomes using our fully integrated electronic medical records.

How does being a physician inform your research work?

Vaccines are a large part of a pediatrician’s clinical practice. My motivation is to protect both children and adults by offering high-level, rigorous, and honest scientific evidence around the safety and effectiveness of vaccines.

It’s helpful to have the physician’s point of view. For example, I understand how challenging it can be to fit in discussions with parents about the vaccination schedule and their questions regarding vaccines during a primary care visit. Having this clinical perspective and background is always going to inform and improve research.

What research studies are you most proud of?

I’m proud of the body of work that the Vaccine Study Center has done to understand the effectiveness over time of the whooping cough vaccine. Most importantly, we found the vaccine’s tendency to wane and that this has been a substantial contributor to recent whooping cough outbreaks in California.

I am also proud of all our prior and ongoing vaccine safety studies. For example, we reported about 10 years ago that in toddlers, the MMRV vaccine — the combination vaccine for measles, mumps, rubella, and varicella (or, chicken pox) — was associated with an increased risk of seizures with fever, or febrile seizures, 7 to 10 days after vaccination when compared with giving separate MMR and varicella vaccines.

Our finding of increased risk for febrile seizures after MMRV has also led to my current interest investigating genetic and familial associations with fever and febrile seizures after the first dose of measles vaccine. We found that a sibling of a child who had a fever 7 to 10 days after a measles vaccine is about 3 1/2 times more likely to also have fever after his or her measles vaccine, suggesting a familial and possibly genetic basis for the fever.

What motivated you to study vaccine development and safety?

I first got interested in vaccines early in my career when I was investigating the basic science of hepatitis B viral regulation. After completing my PhD and my clinical training as a pediatrician, I realized that studying vaccines and infectious diseases was an ideal way to merge my interests in both basic science and clinical care.

What keeps you going outside of work?

I enjoy traveling, baking, reading, skiing, hiking, exercising — which often just means getting on the treadmill — and spending as much time as possible with my family.