Encephalopathies Following Prophylactic Pertussis Vaccine

Inspection of the records of the Children's Hospital for the past ten years has disclosed 15 instances in which children developed acute cerebral symptoms within a period of hours after the administration of pertussis vaccine. The children varied between 5 and 18 months in age and, in so far as it is possible to judge children of this age range, were developing normally according to histories supplied by their parents. None had had convulsions previously. Many different lots of vaccine, made by eight different manufacturers over a period of eight years, were implicated. The inoculations were given throughout the usual geographic range of children coming to this hospital. All but one, at the time of follow-up or death, showed evidence of impairment of the nervous system, which might still have been in the healing stage in three or four. During the same period about half as many children were seen in the hospital suffering from the encephalopathy secondary to smallpox vaccination, and about twice as many from the encephalopathy complicating pertussis itself. A variety of etiologic considerations were suggested by consideration of the reported cases and references to the literature. That constitutional factors may have been involved was suggested by both the preponderance of males as opposed to females, and by the high incidence of abnormalities of the nervous system in the family histories. The clinical course and cytologic abnormalities of spinal fluids found in acute cases indicated an encephalopathy. The literature suggested that this process might have resulted from either the activity of a specific toxin or from an antigen-antibody response. Against the former of these hypotheses was the unstable nature of the heretofore recognized toxins which could hardly survive in properly aged vaccines. The rapid onset of symptoms, occasionally within minutes of the first injection, seemed strong evidence against the second. The present study has left these etiologic considerations unanswered, but it has called attention to a risk of the prophylactic use of pertussis vaccine not hitherto recognized. In view of the impressive evidence of the effectiveness of prophylactic pertussis vaccine now accumulating, it seems likely that babies are safer vaccinated than not. Further studies should be made to prove this point definitely, for the encephalopathy following pertussis vaccine seems more devastating than the vast majority of the nervous lesions following the use of smallpox vaccine.