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Rate of recurrent collapse after vaccination with whole cell pertussis vaccine: follow up study

BMJ 1998; 316 doi: (Published 21 March 1998) Cite this as: BMJ 1998;316:902
  1. Patricia E Vermeer-de Bondt, child health consultant (,
  2. Jerry Labadie, clinical investigator,
  3. Hans C Rümke, paediatrician- epidemiologist
  1. Laboratory for Clinical Vaccine Research, National Institute of Public Health and Environment, PO Box 1, 3720 BA Bilthoven, Netherlands
  1. Correspondence to: Dr Vermeer-de Bondt
  • Accepted 10 October 1997

Whole cell vaccines against pertussis can induce a hypotonic-hyporesponsive episode or shock-like syndrome (collapse) in children,1 but this may also occur with diphtheria and tetanus vaccines, acellular pertussis vaccine, and without vaccination.2 Two prospective studies estimated that the rate of collapse after vaccination was considerable (13 out of 35 284 and 9 out of 15 752). 3 4 The only follow up study, which assessed a small series, was inconclusive about sequelae.5

Comparing the rates of collapse between countries poses problems because of differences in vaccination schedules and vaccines and in the way adverse reactions are monitored and symptoms reported. Moreover, case definitions are inconsistent.

Although the rate of recurrent collapse after whole cell pertussis vaccine has not been studied, for over 30 years repeat doses of vaccine have been contraindicated in children who experience a collapse reaction. Before 1993, in both the Netherlands and the United States children who had had a collapse reaction after …

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