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Whooping
Cough or Pertussis
Whooping
cough or pertussis is a contagious respiratory disease caused by
the B. pertussis bacterium. The disease is spread by coughing or
sneezing. Thick mucous builds up in the lungs and clogs air passages,
triggering violent coughing spells. It can be quite serious, especially
for young infants with tiny air passages. The fatality rate is highest
in infants under six months of age. The effects of toxins in the
B. pertussis bacteria can produce high fever, convulsions, brain
damage and death. Permanent damage can include continuing seizure
conditions, mental retardation, learning disabilities, and chronic
illness.
Severe
cases of whooping cough may require hospitalization, respiratory
support, and nutritional and rehydration therapy. There is no medicine
to cure whooping cough but antibiotics are often used to reduce
the spread of the disease to others as well as treat secondary infections
such as pneumonia, bronchitis, and otitis media (inner ear infections).
In the past, these secondary infections often caused many of the
deaths, which occurred after a child had whooping cough.
A 1982 health bulletin summarized the dangers of whooping cough:
In
its early stages, pertussis is indistinguishable from the many colds
common in children. However, after one or two weeks, the illness
gets progressively worse. Thick mucous builds up in the lungs, triggering
severe coughing spells as children try to clear their clogged up
airways. Children can cough so long and hard that they literally
cannot 'catch their breath;'. Their faces turn blue when they are
unable to get fresh oxygen into their system. As the coughing spell
ends, children gasp for their next breath with a characteristic
crowing sound, or whoop. These coughing spells can occur up to 40
times a day and can last two to three months.
What is the
Risk of Dying from Whooping Cough?
In 1934, more than 265,000 cases of pertussis were reported in the
U.S. with nearly 8,000 deaths. Whooping cough in the underdeveloped
Third World countries is still the killer it once was throughout
the world in the early part of this century. However, in modern
countries, such as Europe and the U.S., today whooping cough is
a much more manageable disease that causes death or injury less
frequently. This is due to improved sanitation, nutrition, and medical
care; the use of antibiotics to control secondary infections; the
employment of modern resuscitation methods to start a baby breathing
again after choking; and rehydration techniques to counter the loss
of body fluids from high fever, vomiting, or diarrhea.
In 1977, Britain
had more than 99,000 pertussis cases reported with 23 deaths and
no cases of encephalitis, which resulted in a case fatality ratio
of approximately 1 in 4,300 cases. A 1985 British report placed
the risk of death for infants under 1 year from pertussis at 1 in
69,000.
How Prevalent
is Whooping Cough in America?
Today between 1,000 and 4,000 cases of whooping cough are reported
to the Centers for Disease Control (CDC) annually. However, there
actually may be 20,000 to 60,000 cases each year because the CDC
estimates that the disease is underreported in America by as much
as 20 times. Since publicity about pertussis vaccine reactions has
become more widespread and more physicians are looking for and reporting
the disease, periodically there is corresponding publicity about
mini-epidemics of whooping cough in different states. The state
of Washington reported 162 cases in ten months in 1984; there were
no deaths, no cases of brain damage, and 49 percent of the cases
aged 3 months to 6 years had been appropriately vaccinated for their
age with DPT. In 1993, Cincinnati reported that 40% of children
who caught pertussis were vaccinated appropriately for their age.
Because the
U.S. has a 95% vaccination rate with pertussis vaccine, it is possible
these reported increases are not real increases in the incidence
of whooping cough but are simply a result of increased reporting
of a portion of the 20,000 to 60,000 pertussis cases that are estimated
to occur every year but have historically remained unreported.
What is the
DPT or DTaP Vaccine?
The DPT vaccine is given to children to prevent diphtheria, pertussis
(whooping cough) and tetanus. The pertussis portion of the DPT shot
is composed of killed B. pertussis bacteria, the same bacteria that
cause whooping cough. In the bacteria are toxins which are responsible
for the neurological complications of both the vaccine and the disease.
The DTaP vaccine contains a purified acellular version of the pertussis
vaccine and has fewer B. pertussis toxins in it. The DTaP vaccine
is associated with fewer reactions but can still cause injuries
and death.
Since its development in the mid 1930's and its widespread use by
the late 1950's, there have been repeated reports by parents and
medical researchers that children were dying or being left with
medication resistant convulsions, mental retardation, learning disabilities,
and physical handicaps after reacting severely to pertussis vaccine.
Fifty years of scientific literature in medical journals and books
has documented the history of these reports.
How Common
are Pertussis Reactions in America?
Some three and a half million American children receive pertussis
vaccine every year and most react mildly. But an unknown number
react more severely with high-pitched screaming, persistent crying
for 3 or more hours, fever over 103F., excessive sleepiness, convulsions
or collapse/shock that may lead to either death or permanent brain
damage.
The only large
study ever conducted in the U.S. to determine DPT vaccine reaction
rates found that 1 in 875 DPT shots is followed by a convulsion
or shock/collapse episode. The rate of permanent damage or death
following DPT reactions is a hotly debated subject. One study surveying
215,000 Swedish children whom had received DPT shots showed a rate
of permanent brain damage or death in 1 in 17,000 children. Many
vaccine authorities rely on the 1981 British study that reported
that 1 in 110,000 DPT shots results in a serious neurological reaction
and that permanent brain damage occurs in 1 in 310,000 shots. (These
figures are often misquoted by U.S. physicians as 1 in 110,000 children.This
is a significant error because a child may receive 3 to 5 doses
of vaccine.) It is misleading to apply these risk estimates to the
U.S. population because:
- Britain uses
a different whole cell pertussis vaccine that appears to be less
potent;
- High risk
children were excluded from the study even though these categories
of high-risk children are routinely vaccinated in the U.S.
- All reactions
were not counted. The study only counted those children who were
hospitalized or who had a convulsion lasting 30 minutes or longer.
Children can have serious vaccine reactions and not be hospitalized
or have convulsions lasting less than 30 minutes and still die
or become brain damaged.
Even the study's
authors cautioned against using the reaction rate figures for other
countries. It is probable they greatly underestimate the actual
risk for American children.
How Effective
is the Vaccine?
The pertussis vaccine is estimated to be 63% to 94% effective in
the DPT shot and 59% to 90% effective in the DTaP shot. Despite
a very high vaccination rate in the U.S., thousands of cases occur.
CDC officials have stated that a growing number of pertussis cases
are occurring in vaccinated adults and older children. Often adults
and teenagers can have atypical whooping cough and only exhibit
symptoms similar to a bad cold or flu. The undiagnosed adult and
teenage carriers of whooping cough, most of who have been fully
vaccinated, spread the disease to vulnerable newborn infants and
young children.
In 1984, Swedish epidemiologist B. Trollfors concluded that whole
cell pertussis vaccines are only effective for 2 to 5 years. He
pointed out that even countries with a 90-95 percent vaccination
rate (such as the U.S.) could not completely prevent the disease.
However, most scientists maintain that if pertussis vaccine is used
on a widespread basis in a population, it appears to lessen the
overall incidence of the disease and some vaccinated children have
less severe cases of whooping cough.
When pertussis vaccination rates fell to about 30 percent in Sweden,
West Germany, England, and Japan in the 1970's, these countries
saw major increases in reported cases of the disease within three
years of that drop in use. (Epidemiologically it takes three years
after a sudden decrease in vaccination rates for a population to
lose "herd immunity" and develop real increases in whooping
cough cases.) There is good reason to believe that if pertussis
vaccine use fell to about 30 percent in the U.S. there would be
a substantial increase in cases of whooping cough within three years
of that fall in vaccine use.
What is a High Risk Child?
Until 1982 when WRC-TV in Washington, D.C. aired a documentary on
pertussis vaccine reactions, most American parents (and most doctors)
were unaware that the vaccine could cause death and permanent brain
damage. Few parents were informed about the definition of a high-risk
child or a severe reaction.
There are three "official" vaccine policy-making authorities
in America making recommendations for the use of vaccines administered
to children by physicians. These vaccine policy makers state the
official definition of a high-risk child, a severe reaction, and
a contraindication to vaccination.
Vaccine Manufacturers. Several private drug companies currently
produce and distribute the pertussis vaccine as well as the Health
Departments of Michigan and Massachusetts. Each manufacturer includes
product information circulars in packages of DPT vaccine containing
information on what the manufacturers consider to be severe reactions
and contraindications.
American Academy of Pediatrics. The American Academy of Pediatrics
(AAP) publishes a Report of the Committee on Infectious Diseases
(also referred to as the Red Book) every four years with periodic
updates in Pediatrics to serve as a guide for pediatricians in private
practice.
The Public Health Service makes recommendations on the use of vaccines
for physicians administering vaccines in the public health clinics.
Guidelines formulated by the Advisory Committee on Immunization
Practices (ACIP) periodically appear in the Morbidity and Mortality
Report published by the CDC.
The AAP, ACIP and manufacturers all consider the following circumstances
to put a child at high risk of reacting to the pertussis vaccine
and are considered reasons to NOT VACCINATE WITH pertussis vaccine:
- Child is
acutely sick with fever or respiratory infections
- Child is
taking medication that may suppress the immune system
- Child has
a personal history of convulsions or neurological disease
- Child is
past the seventh birthday
- Child has
had severe reactions to a previous dose.
Connaught Laboratories
lists the following additional contraindication:
- Child is
known to be sensitive to thimerosal.
Are Other
Children at High Risk?
There are other circumstances which may put a child at high risk
of reacting to the pertussis vaccine but have been cited in the
medical literature and reported by researchers and are not officially
recognized by the AAP, the ACIP, and vaccine manufacturers. A good
library, particularly a medical library at a community hospital
or university, will give you access to the medical literature.
Child is ill with anything including a runny nose, cough, ear infection,
diarrhea, or has recently recovered from an illness.
Several scientific
articles have suggested that serious vaccine reactions are more
likely to occur if children have current viral and bacterial infections.
One article suggests that as long as "a four week interval
between illness and vaccination may be advisable" and warns
that while "it is a matter of clinical judgment how long the
vaccine should be deferred….in administering the vaccines of
any kind care should be taken to exclude the likelihood of infection
in the child, his family, or other close contacts." The product
information circular accompanying DPT vaccine manufactured by Connaught
Laboratories in 1989 stated, "Immunization should be deferred
during the course of any acute illness."
In order to insure that your child is healthy at the time of vaccination,
make sure a doctor gives your child a careful physical exam before
each DPT shot. This should include taking a temperature and a thorough
exam of your child's throat and ears to make sure that there is
no infection present.
Be sure to report any illness, however slight, that your child has
had in the previous months. Mention any viral or bacterial infections
that you or a member of your family may currently have or to which
your child may have been exposed.
Child
has a family member who has reacted severely to a DPT shot.
In
1946, Werne and Garrow reported the deaths of identical twins within
24 hours of their second diptheria-pertussis shot. The same outcome
in identical twins is strong evidence of genetic predisposition
to reacting to the vaccine and the possibility of such genetic predisposition
has been frequently cited in the scientific literature. Additionally,
there have been reports of two, three and four pertussis vaccine
damaged children in one family.
Child has
a family history of convulsions of neurological disease.
Many European countries including England, the Netherlands, and
Sweden have advised that the pertussis vaccine is contraindicated
if a member of the child's immediate family (brother, sister, mother
or father) has a history of convulsions or neurological disease.
Once again, the reason for this contraindication is based on the
genetic predisposition factor. The product information circular
accompanying DPT vaccine manufactured by Lederle Laboratories in
1985 state, "Routine immunization with this product should
not be attempted if the child has a personal or family history of
central nervous system disease or convulsions." The product
information circular accompanying DPT vaccine manufactured by Connaught
Laboratories in 1989 stated, "Use of this product is also contraindicated
if the child has a personal or family history of a seizure disorder.
In 1975, a World Health Organization sponsored international meeting
of pertussis vaccine experts recommended that "children from
families with a history of neurological disorders should not be
vaccinated." In 1977, the Department of Health and Social Security
in England stated that children should not be given pertussis vaccine
if they have a "family history of epilepsy or other diseases
of the central nervous system.
In a 1987 recommendation published in the MMWR, the CDC stated "recent
studies suggest that infants and children with a history of convulsions
in the first degree family members (i.e. siblings and parents have
a 3.2 fold increase risk for neurologic events compared with those
without such histories (CDC, unpublished data)." The CDC went
on to recommend, however, that these children should receive pertussis
vaccine even though the pertussis vaccine is known to cause neurologic
events such as convulsions.
Child was
born prematurely or with low birth weight.
Babies who are born prematurely may not have neurological, respiratory,
and immunological systems that are as fully developed as those who
are full-term. A 1994 study of two-month old babies in a special
care nursery for premature/low birthweight babies in Dallas showed
19% had either new or increased episodes of apnea (stopped breathing)
in the 24-48 hours after being vaccinated with DPT and HIB vaccines
and some required oxygen and other support to begin breathing again.
Child has had cerebral irritation in the neonatal period (such as
head trauma at birth from a difficult delivery; high-pitched screaming
with arching of the back; meninigitis).
A child who
has had signs of cerebral irritation after birth may be manifesting
evidence of a damaged or weakened neurological system that could
be especially vulnerable to the effects of the pertussis vaccine.
The British department of Health and Social Security states that
pertussis vaccination "should not be carried out in children
who have … a history of cerebral irritation or damage in the
neonatal period."
Child has
a personal or family history of severe allergies (such as eczema,
asthma and, especially, allergy to cow's milk.
Throughout the scientific literature dealing with pertussis vaccine
during the past 40 years, there have been reports by some researchers
that a history of severe allergies in a child or his family may
predispose a child to reacting to the pertussis vaccine. In England
in past decades, a personal or family history of allergies was considered
a contraindication.
Dow Chemical Company's DPT product insert in the 1960's stated "fractional
doses are recommended in infants with cerebral injury, asthma, a
strong family history of allergy …" In 1961, Hopper found
that in a group of babies who reacted violently to the pertussis
vaccine, there was twice as much eczema, asthma, hay fever, and
allergic skin rashes in the child, his brothers and sisters, parents,
and grandparents as there was in a control group of the same size.
In 1969, Hannik found a positive family history of allergies in
a significant proportion of infants who reacted with high-pitched
screaming, shock and convulsions.
A 1982 study by Steinman concluded that genetic predisposition may
play a role in pertussis vaccine reactions and suggests that a personal
or family history of allergies, particularly milk allergy, may be
a warning sign. Steinman's work has been reinforced by reports from
parents whose children are allergic to milk and have reacted to
the vaccine. An allergy to milk may be manifested by severe constipation,
diarrhea, projectile vomiting or frequent spitting up of significant
amounts of milk after bottle or breast feeding, persistent crying
after feedings (colic), eczema or recurrent skin rashes. Often after
baby has been placed on soybean formula or other cow's milk substitutes,
these symptoms will disappear.
What is a Severe Reaction to the DPT or DTaP Shot?
It is important for parents to know what constitutes a severe reaction
to the DPT or DTaP shot because it is generally agreed by vaccine
policy makers that those who react severely should not receive the
"P" or pertussis portion of the DPT or DTaP shot again.
For subsequent boosters, only the "D" (diphtheria) and
"T" (tetanus) portion of the shot should be given.
Many children react to the DPT or DTaP shot to some degree and appear
to recover without any permanent effect. A 1979 study reported that
more that 50% of DPT vaccine recipients had temperatures of at least
100 F. and another study found that local redness, pain and swelling
at the injection site were reported following 37.7%, 40.7% and 50.9%
of DPT vaccinations, respectively.
An unknown number of children reacted more severely to a DPT or
DTaP shot with temperatures over 103 F., high pitched screaming,
excessive sleepiness, persistent crying for more than 3 hours, convulsions,
and shock/collapse. In some children these reactions can be followed
by permanent brain damage or death. The frequency of more serious
pertussis vaccine reactions in America is unknown, as is the rate
of death and brain damage associated with severe reactions.
The one large controlled study conducted in the U.S. to determine
DPT reaction rates in America was held at UCLA with FDA funding
in 1979. The UCLA/FDA study showed that 1 in 875 DPT shots results
in a convulsion or collapse/shock reaction. Two babies in the study
died following DPT reaction symptoms, but their deaths were classified
as sudden infant death syndrome (SIDS or crib death).
The Pertussis Vaccine, Death, and SIDS
Death was the first reaction to be associated with pertussis vaccine.
In 1933, the Danish vaccine researcher Madsen described the deaths
of two babies within a few hours after they had been vaccinated.
It is not known how many pertussis vaccine deaths occur in the U.S.
each year because often the deaths of babies, who receive DPT or
DTaP shots and then die shortly after exhibiting classic pertussis
vaccine reactions, are misclassified as SIDS. The incidence of SIDS
increases after the first month of life, rises to a peak at two
and three months, and declines after the age of four months.
One SIDS study concluded that 17 of 23 vaccinated SIDS infants (or
about 52%) died within one week of a DPT shot after 6 (or about
11%) died within 24 hours of the shot. Another researcher concluded
that a "relationship between SIDS and immunization accounts
for less than 6.3% of the total SIDS death." However, a large
government sponsored NICHD study concluded that DPT immunization
is not a factor in the etiology of SIDS.
Severe Reactions Recognized by U.S. Vaccine Policymakers
The AAP, ACIP and vaccine manufacturers consider the following to
be reactions to the pertussis vaccine. As stated previously, in
most cases, those children who react severely to a DPT or DTaP shot
may be given the DT (diphtheria and tetanus) portion of the shot
for future booster doses.
Allergic Hypersensitive Reaction. Most allergic hypersensitive
reactions occur within minutes or an hour of the shot and may include
hives, sudden swelling of the mouth or throat, difficulty breathing,
hypertension and shock. This can be an immediate life threatening
reaction which requires immediate medical assistance.
Shock/Collapse. The terms "collapse" and "shock-like
episode" and "hypotonic hyporesponsive episode" are
used to describe a serious neurological reaction which appears to
be peculiar to the pertussis vaccine. British physician George Dick,
M.D. described the shock/collapse reaction to a DPT shot in a 1967
study: "About three hours after inoculation, the baby suddenly
becomes marble white, cold and collapsed and remains like this for
about 15 to 30 minutes; after recovery, it often remains pale and
listless for a few hours. Some mothers have said that their babies
become unconscious at the onset of the collapse, others thought
their baby was dead. When babies developing this syndrome were followed
up a year later, they seemed healthy and appeared to have passed
the usual milestones normally. It is, however, difficult to exclude
the possibility of permanent damage. On observing these reactions,
parents quite naturally urgently summoned a doctor, but by the time
he arrived the baby had usually recovered the severe episode and
some mothers were quite unable to convince their physicians that
anything really serious had happened. Because of the unavoidable
delay in getting to the patients, very few doctors have seen the
early stage of this syndrome (except in their own infants). It is
quite possible that it is more frequent than is generally believed,
for it could well pass unobserved even by the mother."
In the 1979 UCLA/FDA study of DPT reactions, the authors described
shock/collapse: "All such reactions observed occurred within
ten hours of immunization and usually within four hours. Characteristically,
the infant or child was pale, hypotonic, and unresponsive to his
parents for a period ranging from ten minutes to 36 hours."
The authors went on to observe that "Collapse or shock like
state following pertussis immunization has been reported on numerous
occasions. The majority of these hypotonic hyporesponsive episodes
seem to be self-limited with no residue. However, there have been
reports of death from apparent shock following pertussis immunization."
High Pitched Screaming or Persistent Crying for 3 or More Hours.
George Dick, M.D., in his 1967 study stated: the reaction of
persistent and uncontrollable screaming comes on about two hours
after inoculation. It starts with a bout of screaming and the baby
cannot be comforted or quieted. This screaming often lasts for about
one hour and usually terminates with a period of exhaustion lasting
for about 30 minutes, during which time the baby is restless but
quiet. Screaming bouts then commence again and eventually the baby
falls into a deep sleep for as long as twelve hours."
The authors of the UCLA/FDA study defined high pitched screaming
as "a cry of unusual character, usually described by the parents
as a high pitched scream. It was a cry that the parents claimed
they had never heard their child produce before.
In a 1980 article, Edward Mortimer, M.D., observed: "Neurologic
reactions, particularly in infants, are always worrisome, but two
of the four that may be classified as such are really of unknown
origin and are only presumed to be neurologic. One is an episode
of prolonged, uncontrollable crying that begins within a few hours
of the injection and lasts for at least an hour (sometimes for as
long as six hours or more); this persistent screaming syndrome has
been referred to by some investigators as "high pitched crying"
which is reminiscent of the "encephalitic cry" sometimes
associated with brain damage, but others have reported that the
crying associated with pertussis vaccination is simply protracted."
If your child begins to scream with a high pitched cry, or cries
uncontrollably with a normal pitched cry for several hours, you
should immediately have your baby examined by your physician or
by a physician in the emergency room of your local hospital.
High Temperature. The product information inserts of one
vaccine manufacturer considers a temperature of more than 103 F
to be a contraindication and another manufacturer lists 102 F. But
the AAP's Red Book and the ACIP recommendations state that the temperature
must be 105 F. (40.5C) or more to be a contraindication to further
pertussis vaccine.
You should ask your physician to give you instructions on how to
take immediate steps to lower your infant's high fever if it should
occur. A high temperature is of particular concern because in infants
and children it can trigger febrile convulsions. If your child runs
a prolonged high fever, you should immediately call your physician
or your local hospital emergency room. If your child's fever nears
105 F., your child should be immediately examined by a physician.
Excessive Sleepiness. Children exhibiting this reaction usually
lapse into a deep sleep from which they cannot be easily awakened.
This has also been referred to as excessive somnolence or a "severe
alteration of consciousness." Leonard Rome, M.D., points out
that "excessive somnolence, for instance, refers to a state
of sleep from which the infant cannot be aroused; a drowsy child
who wakes up to eat is not experiencing this reaction."
Convulsions. A convulsion is defined by Webster's Third International
Dictionary as a "spasmodic contraction of the muscles."
There are different kinds of convulsions and they can occur with
or without a fever: a clonic convulsion is "marked by alternating
contracting and relaxing of muscles"; a tonic convulsion is
a "prolonged contraction of the muscles"; and a local
(or focal) convulsion is "any minor spasm affecting but one
muscle or one part of members (of the body).
Petit mal convulsions are "attacks of brief impairment of consciousness
often associated with flickering of the eyelids and mild twitching
of the mouth" or "a brief loss of consciousness, lasting
a few seconds. A few 3-per-second blinks or jerks of eyelids and
sometimes arms may be conjoined." Petit mal convulsions may
be as subtle as staring episodes with slight drooling.
A generalized grand mal convulsion "begins with a sudden loss
of consciousness, a cry, a fall to the ground, tonic then clonic
movements of the muscles of the cranium and limbs, sometimes sphincter
incontinence, and other autonomic disorders. The motor activity
soon terminates, leaving the patient in a state of coma, which lasts
for many minutes of even as long as a half-hour. As a coma recedes,
mental confusion, drowsiness and headache become evident.
Encephalopathy or brain involvement which may lead to mental retardation,
learning disabilities, behavior disorders, paralysis, or other mental
and physical disability can occur following a severe DPT shot reaction.
The Public Health Service ACIP recommendations state that the pertussis
vaccine can cause "Encephalopathy, with or without convulsions,
manifested by bulging fontanel, changes in the level of consciousness,
or focal neurologic signs, the encephalopathic reaction if he or
she exhibits the following signs after an encephalopathy may lead
to permanent neurologic deficit."
Your baby may be having an encephalopathic reaction if he or
she exhibits the following signs after a DPT shot: sudden eye
crossing; unusual unresponsiveness to parents, siblings or visual
or auditory stimuli; inability to move an arm or leg; strange, repetitive
movements of any part of the body; a pronounced, negative change
or regression in physical, emotional or intellectual behavior.
If you observe any of these symptoms shortly after your child receives
a DPT shot, you should contact your physician immediately and have
your child immediately examined by your physician or by a physician
in the emergency room of your local hospital. If you have any questions
regarding your baby's unusual behavior in the weeks following a
DPT shot, you should consult a pediatric neurologist promptly.
Any time you contact a physician or a hospital about a suspected
severe reaction your child may be having to a vaccination, make
sure the date and time of the vaccination and the symptoms your
child is having are recorded in your child's medical record. Make
sure you do not leave the office or hospital without written record
that your child has been examined.
Suspected Severe Reactions
Several reports in the vaccine literature as well as by parents
of vaccine damaged children suggest that a severe local reaction
or a general systemic reaction may be a warning that the child is
at high risk of reacting more strongly to subsequent doses of pertussis
vaccine.
Severe Local Reaction. The most common reaction to a DPT shot is
a local one which includes mild pain, redness, soreness or swelling
around the site of the injection. A 1979 survey of four pediatric
practices in Colorado revealed that 72 percent of the children had
local reactions, which included redness, swelling and tenderness
after DPT shots.
However, some children experience a severe local reaction characterized
by a large, red, hard, hot and swollen lump at the site of injection
that may remain for several weeks. In the 1980's in England, "any
severe local reaction to a preceding dose" was contraindicated
to further pertussis vaccination. There have been reports by parents
of vaccine damaged children that a severe local reaction after a
DPT shot was followed by more involved systemic or neurological
reactions after a subsequent shot.
General Systemic Reactions have been reported by parents of vaccine
damaged children. They can include a body rash, vomiting or diarrhea
within hours of the shot. Or the child may exhibit a sudden unusual
decline in health including loss of appetite and weight (failure
to thrive), chronic diarrhea, ear and respiratory infections, or
the development of new allergies. Children who fail to thrive or
are chronically ill for months following a DPT shot should be checked
by a physician.
The AAP, ACIP and U.S. vaccine manufacturers do not consider severe
local reactions or general systemic reactions as reasons to stop
vaccination with pertussis vaccine. However, all symptoms following
a DPT shot should be reported to the child's doctor.
Trombocytopenia
and Hemolytic Anemia are two blood disorders which have been reported
to rarely follow DPT shots. Thrombocytopenia means a reduced number
of platelets circulating in the blood and can cause "purpura"
(blotchy red patches on the child's body caused by the thinned blood
seeping into the tissues beneath the skin).
Diabetes
and Hypoglycemia. The body's glucose (sugar) metabolism is regulated
by insulin which is secreted by the pancreas. Researchers have detected
increased insulin production in infants injected with pertussis
vaccine.
In 1970, Pittman stated "the infant whose blood sugar level
is influenced by food intake may be especially vulnerable to vaccine-induced
hypoglycemia should a feeding be missed because of a feverish reaction
following vaccinations." Hannik and Cohen in 1978 concluded,
"infants who show serious reactions following pertussis vaccination
suffer from failure to maintain glucose homeostasis." A 1982
study detailed the role the DPT vaccine played in causing diabetes
in a sixteen month old girl who was genetically predisposed to diabetes
and who suffered from a viral infection that attacked her pancreas.
Monitoring Your Child After Vaccination
It cannot be overemphasized that parents should monitor their children
carefully day and night for at least 72 hours after each DPT shot
is given. The first 24 hour post-vaccination is an especially important
time to be alert. Although identifying a severe reaction to the
pertussis vaccine is the combined responsibility of parents and
doctors, only parents can be with a child 24 hours a day.
If you have any reason to believe that your child may be having
a severe reaction, notify your doctor at once and take your child
to the nearest hospital emergency room where your child can be immediately
examined by either your doctor or a doctor in the emergency room.
While the American Academy of Pediatrics has stressed that it uses
48 hours as the period during which events can be attributed to
the vaccine, the time limit has not been sustained scientifically.
One large British study found a statistical correlation between
DPT vaccination and convulsions occurring within seven days of the
shot (particularly within 72 hours). The government requires that
all reactions be reported which occur within 30 days of a vaccination
given at a public health clinic or private physician's office.
Obtain All Information
After your child receives a vaccination, you may request a written
record of :
- the date
and time of day the vaccine was given;
- the type
of vaccine and the dose number;
- the name
and title of the person who gave the shot;
- the vaccine
manufacturer's name;
- the vaccine
lot number
You should keep
information concerning any vaccine given to your child in a permanent
vaccination record, plus the details of any reactions that occur.
As mentioned previously in this booklet, if any of these events
occur after your child gets a DPT shot, immediately arrange for
an examination at the doctor's office, clinic, or emergency room.
Your doctor or public health clinic is required by law to report
all adverse events, including injuries and deaths that occur within
30 days after vaccination to federal health authorities. All reports
should be made to the Vaccine Adverse Events Reporting System (VAERS).
If you know your child's reaction was not reported, you have the
right to report the reaction yourself by calling 800-822-7967. NVIC
can provide you with the forms and assist you in reporting the reaction.
Conclusion
It is important for us, as parents, to be equally concerned and
knowledgeable about the risks of pertussis disease as we are about
the risks of pertussis vaccine. Pertussis disease has the potential
to cause seizures, brain damage, and even death, just as the vaccine
can. Most of America's medical community believes that the risk
of serious injury or death from pertussis is greater than the risk
of injury or death which can be caused by the vaccine.
However, recognition of and concern about the risks of pertussis
disease does not diminish our need and responsibility to recognize
and be concerned about the risks of the pertussis vaccine. The challenge
today is for parents, physicians, scientists, manufacturers and
health officials to recognize the risks of both the disease and
the vaccine and work to protect the health and well being of each
individual child.
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