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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

PERTUSSIS VACCINE

  1. BENEFITS

    Pertussis (whooping cough) is a bacterial infection of the respiratory tract resulting in severe coughing spells (paroxysms), often followed by an inspiratory whoop and vomiting. The paroxysmal stage lasts 2-4 weeks. The total duration of illness in uncomplicated cases is 6-10 weeks. Complications include apneic spells, seizures, pneumonia, encephalopathy, and death. Complications are much more common in the first year of life; the frequencies of pneumonia, seizures, and encephalopathy in young infants hospitalized with pertussis are 20%, 2.5%, and 0.5% respectively. At least half of those who develop pertussis encephalopathy sustain permanent brain damage.

    Pertussis is prevented in over 80% of children who have received at least 3 doses of vaccine and is milder in vaccinated children who do become ill.

  2. ADVERSE REACTIONS

    Common minor reactions to pertussis vaccine include:

    fever 30oC47%
    local redness 2.4 cm7%
    swelling 2.4 cm9%
    pain at injection site51%
    drowsiness32%
    fretfulness53%
    anorexia21%
    vomiting6%

    The incidence and height of fever can be significantly reduced by administration of acetaminophen (15 mg/kg/dose) at the time of vaccination and every 4 hours thereafter as necessary. Fussiness is also significantly reduced. Such treatment has less effect on local reactions.

    Sterile abscesses may occur at a rate of 1 per 1000,000 doses, most often as the result of inadvertent subcutaneous injection of adsorbed vaccine.

  3. MATERIAL RISKS

    Uncommon, but severe reactions occurring within 48 - 72 hours of vaccination include:

    persistent, inconsolable crying 3 hr. - 1%
    convulsions - 1 in 1750 doses
    hypotonic-hyporesponsive state - 1 in 1750 cases
    encephalopathy - 1 in 140,000 doses
    permanent brain damage - 1 in 310,000 doses

    The risk of encephalopathy and brain damage temporally associated with pertussis vaccine is under on-going study and is probably significantly less than the above figures, which are based on the U.K. Childhood Encephalopathy Study. On-going surveillance of adverse reactions to DPT in Alberta has resulted in an estimate of the same order of magnitude as the British study.

    Administration of pertussis vaccine has not been shown to result in an increased risk of sudden infant death syndrome, infantile spasms, or Reye's syndrome.

    There may be an increased risk of convulsions in a child with a history of previous seizure or with a history of seizures in parents or siblings. Such convulsions almost always occur in association with high fever and do not increase the risk of brain damage or subsequent epilepsy. The incidence of such seizures associated with fever can probably be reduced by the use of prophylactic acetaminophen as discussed above.

  4. REPORTABLE EVENTS

    Major reactions occurring within 72 hours of vaccination, including: convulsion, hypotonic-hyporesponsive state, fever greater than 40.5oC, persistent crying over 3 hours, encephalopathy, and/or systemic allergic reaction.

    THE NATIONAL ADVISORY COMMITTEE ON IMMUNIZATION (NACI) HAS MADE NEW RECOMMENDATIONS REGARDING PERTUSSIS IMMUNIZATION. "CONTRAINDICATIONS AND INDICATIONS" HAVE BEEN DIVIDED INTO "ABSOLUTE", "RELATIVE" AND "DEFERRED". PLEASE SEE CANADA COMMUNICABLE DISEASE REPORT 1993 (30 MARCH); 19-6: 41-44




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