Recommendation of the Immunization Practices Advisory Committee
Pertussis Immunization; Family History of Convulsions and
Use of Antipyretics -- Supplementary ACIP Statement
The Immunization Practices Advisory Committee (ACIP) has
reviewed
available data concerning the risks and benefits of pertussis
vaccine
for infants and children with a family history of convulsions.
Based
on this review, the ACIP does not believe that a family history of
convulsions should be a contraindication to vaccination with
diphtheria and tetanus toxoids and pertussis vaccine (DTP). In
addition, the ACIP believes that antipyretic use in conjuction with
DTP vaccination may be reasonable in children with personal or
family
histories of convulsions. Consequently, the following statement
updates some of the previous recommendations regarding pertussis
vaccine (1).
Vaccination of Children with Family Histories of Convulsions with
Pertussis Vaccine
The risk of neurologic events after DTP vaccination is very
small. Most neurologic events (primarily febrile seizures, but
including nonfebrile seizures, encephalopathy, or other neurologic
symptoms) that occasionally follow DTP vaccination occur in
children
without known risk factors. However, recent studies suggest that
infants and children with a history of convulsions in first-degree
family members (i.e., siblings and parents) have a 3.2-fold
increased
risk for neurologic events compared with those without such
histories
(CDC, unpublished data). Nevertheless, these children are still at
very low risk for serious neurologic events following DTP
vaccination. Convulsions within 3 days of DTP vaccination may be
unrelated to vaccination, induced by vaccine components, or
initiated
by vaccine-associated fever in those children prone to febrile
convulsions. Although children with a family history of seizures
have
an increased risk for developing idiopathic epilepsy, febrile
seizures
(including those following vaccinations) do not themselves increase
the probability of epilepsy or other neurologic disorders (2,3).
After careful deliberation, the ACIP has concluded that a
family
history of convulsions in parents and siblings is not a
contraindication to pertussis vaccination and that children with
such
family histories should receive pertussis vaccine according to the
recommended schedule (1,4). The committee reached this decision
after
considering 1) the risks of pertussis disease, 2) the large number
of
children (5%-7%) with a family history of convulsions, 3) the
clustering of these children within families, and 4) the low risk
of
convulsions following pertussis vaccination (1-3,5).
The ACIP believes that parents of infants and children with
family
histories of convulsions should be informed of their children's
increased risk of seizures following DTP vaccination. In
particular,
they should be told, before the child is vaccinated, to seek
immediate
medical evaluation in the unlikely event of a seizure. The child's
permanent medical record should document that the small risk of
postvaccination seizure and the benefits of pertussis vaccination
have
been discussed.
Antipyretic Use in Children with Personal or Family Histories of
Convulsions
There are no data on whether the prophylactic use of
antipyretics
following DTP vaccine can decrease the risk of febrile convulsions.
However, preliminary information suggests that acetaminophen given
at
a dose of 15\mg/kg at the time of DTP vaccination and again 4 hours
later will reduce the incidence of postvaccination fever (6).
Thus,
it is reasonable to consider administering antipyretics (such as
acetaminophen) at age-appropriate doses at the time of vaccination
and
every 4 to 6 hours for 48 to 72 hours to children at higher risk
for
seizures than the general population.
References
ACIP. Diphtheria, tetanus, and pertussis: guidelines for
vaccine
prophylaxis and other preventive measures. MMWR
1985;34:405-14,
419-26.
Nelson KB, Ellenberg JH. Prognosis in children with febrile
seizures. Pediatrics 1978;61:720-7.
Hirtz DG, Nelson KB, Ellenberg JH. Seizures following
childhood
immunizations. J Pediatr 1983;102:14-8.
ACIP. New recommended schedule for active immunization of
normal
infants and children. MMWR 1986;35:577-9.
Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CD. Nature
and
rates of adverse reactions associated with DTP and DT
immunizations in infants and children. Pediatrics
1981;68:650-60.
Ipp MM, Gold R, Greenberg S, et al. Acetaminophen prophylaxis
of
adverse reactions following vaccination of infants with
DTP-polio. Pediatr Infect Dis (In press).
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