Repeat whole cell vaccinations should be avoided after hypotonic-hyporesponsive episodes

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7158.604a (Published 29 August 1998) Cite this as: BMJ 1998;317:604
  1. Alberto E Tozzi, Paediatrician (tozzi@iss.it),
  2. Marta L Ciofi degli Atti, Paediatrician,
  3. Stefania Salmaso, Biologist,
  4. Alessandra Anemona, Statistician
  1. Istituto Superiore di Sanità, Laboratory of Epidemiology and Biostatistics, Viale Regina Elena 299, 00161 Rome, Italy

    EDITOR—Vermeer-de Bondt et al1 imply that recurrence of hypotonic-hyporesponsive episodes is exceptionally rare and that therefore their occurrence after whole cell vaccination should not be a contraindication for further doses. During the clinical trial on pertussis vaccines in Italy we studied 15 601 infants who received three doses of either a whole cell diphtheria-tetanus-pertussis vaccine, one of two acellular diphtheria-tetanus-pertussis vaccines, or a diphtheria-tetanus vaccine.2

    We monitored hypotonic-hyporesponsive episodes within 48 hours of vaccination, …

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