I. Whole cell pertussis vaccine
- Common adverse effects (some of 1st 4 in 96%; all more common in older kids, all more common if occurred with a previous dose)
- Low grade fever (42%, peaks @ 7-24h; not sig. ass'd with local inflamm.); n.b. if fever occurs > 24h after vaccination can't assume it's from the vaccine!
- Crankyness and increased crying (84%, peaks @ 6h; sig. ass'n with local inflamm.)
- Increased sleeping (58%, peaks @ 6h)
- Anorexia & vomiting (10-20%)
- Local inflamm. (85%, peaks @ 6h, last longer than other rxns)
- Increased risk of Sz (1:1750-13K immunizations), esp. in kids predisposed, esp. to febrile Sz (no evidence of sequelae or increased risk for epilepsy, however)
- Uncommon adverse effects--These reactions contraindicate further whole-cell PERTUSSIS (3% of vacc's; rarely recur with repeated admin.; used to be absol. contraind., but found not to be ass'd with permanent sequelae; decision to vaccinate should depend on pt's risk for b. pertussis exposure)
- Fever > 105'F (40.5c) <48h post-vacc, not due to other ident. cause; us. due to pertussis component; occurs in 0.3%
- Inconsolable crying x >3h <48h post-vacc; occurs in 1%; no neurol. sequelae; immuniz. series has been completed in such kids without probs; less likely to occur with subsequent doses
- Sz with/without fever <3d post-vacc (occur in about 0.06%); no evident sequelae, even if proceeds to status epilepticus; if occurs, delay further doses of DT or DPT until kid's neurol. status is w/u'd & stabilized; in future, co-administer acetaminophen 15mg/kg at time of vacc & Q4h x 24h. n.b. D & T components not known to carry any risk of sz.
- Hypotonic-hyporesponsive episode <48h post-vacc.; scary but no sequelae; give remainder of doses as DT; occurs in about 0.06%
- Anaphylaxis: don't attempt further vacc. with any of DPT components; can refer to allergist for skin testing/desens.
- Acute encephalopathy <7d post vacc., not due to other identifiable cause
- Us. consists of major change in metal status, gen'lized/focal sz lasting > few hrs, recovery taking >24h)
- May cause long-term neurologic sequelae; "NCES" study estimated risk of this to be 1:330,000. NCES authors later reviewed data and concluded that no connection bet. vacc & brain damage and that no recognizable post-pertussis vacc. sd. existed
- Prob. occurs in about 0.001% of vaccinees. Whether a causeal relationship exists is a matter of controversy as of 1997
- Don't give more pertussis vacc., wait few mos. then give remainder of doses as DT.
II. Acellular Pertussis Vaccine
III. "Cocooning" for prevention of Pertussis in infants
IV. Tetanus toxoid, Reduced Diphtheria Toxoid-Acellular Pertussis Vaccine-"Tdap" (Adacel, Boostrix)