PEDIATRICS Vol. 85 No. 3 March 1990, pp. 294-302
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Longitudinal Study of Adverse Reactions Following Diphtheria-Tetanus-Pertussis Vaccine in Infancy

Sarah S. Long MD1, Adamadia Deforest PhD1, David Gary Smith MD1, Carlos Lazaro 1, Steven G. F. Wassilak MD1, and Pennridge Pediatric Associates

1 From the Department of Pediatrics, St Christopher's Hospital for Children, and the Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania; Pennridge Pediatric Associates, Sellersville, Pennsylvania; and the Centers for Disease Control, Atlanta, Georgia

A prospective study of immunogenicity and adverse effects of 1553 doses of diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP) was performed in 538 children observed longitudinally from 2 months to 20 months of age. Subjects were randomized to the standard four-dose immunization schedule or to a three-dose schedule (with a saline injection substituted for DTP at 6 months of age). The three-dose schedule could not be recommended on the basis of serologic data. Compliance for completing a clinical observation form in the 48 hours following injections was >99%. Fever, local reactions, or adverse behavioral effects were described in association with 96% of DTP doses and 36% of placebo injections. Contraindications to DTP immunization developed in 3% of study children. No convulsion, hypotonic hyporesponsive episode, encephalopathy, or temperature >40.5°C occurred. Behavioral and local imflammatory effects occurred maximally in the first 6 hours following vaccine but fever peaked later. There was no interrelationship between occurrence of local reaction and fever. Data suggest that age has more effect on the type and rate of adverse clinical events than does vaccine dose number. Existing antibody levels to vaccine components, lot of vaccine, breast-feeding, or gestational age did not affect rate or type of clinical reactions. Neither occurrence of reactions nor the use of acetaminophen affected antibody response to vaccine.

Key Words: pertussis • diptheria-tetanus-pertussis vaccination

Submitted on October 13, 1988
Accepted on April 19, 1989




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