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Pathophysiology of reactions associated with pertussis vaccine
D A Blumberg1, C M Mink, K Lewis
1Kaiser-Permanente, Panorama City, CA.
Insights
Severe reactions after diphtheria-tetanus-pertussis (DTP) immunization in children were studied. Biologically-active lipopolysaccharide protamine (LPF) and altered glucose metabolism were not found to cause these DTP vaccine reactions.
Area of Science:
- Pediatric immunology
- Vaccine safety research
- Clinical toxicology
Background:
- Adverse clinical events following pertussis immunization are common in children.
- The underlying pathophysiology of these reactions remains poorly understood.
- Biologically-active lipopolysaccharide protamine (LPF) and endotoxin in DTP vaccines have been implicated.
Purpose of the Study:
- To investigate the potential role of biologically-active LPF and altered insulin/glucose metabolism in severe DTP vaccine-associated reactions.
- To determine if LPF is present in children experiencing seizures post-immunization.
Main Methods:
- Studied 56 children with severe reactions (fever ≥40.5°C, seizures, persistent crying, or hypotonic-hyporesponsive episodes) within 48 hours of DTP immunization.
- Assessed acute and follow-up serum samples for leukocytosis, neutrophilia, insulin, and glucose levels.
- Utilized the Chinese Hamster Ovary (CHO) cell assay to detect biologically-active LPF in acute sera of children with seizures.
Main Results:
- Acute leukocytosis with neutrophilia was observed post-vaccination compared to follow-up.
- No significant changes in insulin or glucose levels were detected.
- The CHO cell assay did not detect biologically-active LPF in the acute sera of children who experienced DTP-associated seizures.
Conclusions:
- The study found no evidence linking biologically-active LPF or altered insulin/glucose metabolism to severe DTP vaccine-associated reactions in children.
- The observed acute leukocytosis and neutrophilia warrant further investigation into their role in post-vaccination events.
Abstract:
Many adverse clinical events occur after pertussis immunization in children, but the pathophysiology is not well understood. It has been suggested that some of these adverse events may be due to biologically-active LPF and endotoxin present in DTP vaccines. Fifty-six children were studied who experienced severe reactions (fever greater than or equal to 40.5 degrees C, seizures, persistent crying greater than or equal to 3 hours or hypotonic-hyporesponsive episodes) within 48 hr of DTP immunization. Leukocytosis with neutrophilia was noted acutely (after vaccination) compared to follow-up (approximately one month later). No changes in insulin or glucose values were noted. Utilizing the CHO cell assay, no biologically-active LPF was found in the acute sera of children who had DTP-associated seizures. We found no evidence that biologically-active LPF or altered insulin/glucose metabolism were related to severe DTP-associated reactions.