Defining the Key Parameters for Comparing Reactions Among Acellular and Whole-Cell Pertussis Vaccines
1 Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY
2 Departments of Preventive Medicine, Medicine (Infectious Diseases), Vanderbilt University School of Medicine, Nashville, TN
3 Departments of International Health and Pediatrics, Johns Hopkins University, Baltimore, MD
4 Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
5 Department of Pediatrics and the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
6 Department of Medicine, St Louis University School of Medicine, Houston TX
7 Departments of Microbiology and Immunology and Pediatrics, Baylor College of Medicine, Houston, TX
Objective. To facilitate future vaccine reaction data collection and analysis, we sought to determine the minimum data set required to describe accurately and to compare common reactions after the administration of acellular (DTaP) or whole-cell (DTP) pertussis vaccine with diphtheria and tetanus toxoids combined.
Methods. Thirteen DTaP and 2 DTP vaccines were studied in a multicenter trial involving 2342 infants who received a primary series of vaccinations at 2, 4, and 6 months of age. Temperature, fussiness, redness, swelling and pain at the injection site, antipyretic use, drowsiness, loss of appetite, and vomiting were evaluated. Reactions were assessed at 3 hours and (if not immunized in the evening) 6 hours after immunization, at bedtime each evening for 7 evenings, and on the 14th evening after immunization.
Results. Two reaction assessment approaches were compared: (1) analysis of all reactions, regardless of the degree of severity; and (2) a condensation of the data to five key reactions (fever >100°F, moderate or more fussiness, any local redness, any local swelling, and moderate or more local pain). We found that the onset of reactions was infrequent beyond the second evening, and that collection and analysis of reaction data beyond that time did not further discriminate among the vaccines. Information regarding antipyretic use, loss of appetite, drowsiness, or vomiting did not assist in differentiating among these vaccines.
Conclusion. Monitoring the occurrence of fever greater than 100°F, moderate or severe fussiness, injection site redness or swelling, and moderate or severe injection site pain occurring through the second evening after immunization will provide the minimum data set needed to discriminate among DTaP and DTP vaccines with respect to the common adverse reactions.
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