Fever pertussis vaccine

The whole cell pertussis vaccine has been highly associated with temperature elevations however, the prevalence has significantly decreased since the introduction of the acellular pertussis vaccine. Live virus vaccines are also associated with fever. 

From 1991 to 1993 about 27 million doses of DTP vaccine and 5 million doses of DTaP (that is acellular) vaccine were distributed in the USA. The results of a postmarketing comparison of the safety of acellular pertussis vaccines with whole-cell pertussis vaccines have been published. The rates of reported adverse events per 100 000 immunizations were significantly lower after the administration of DTaP vaccine than after DTP vaccine for the following outcomes aU reports (2.9 versus 9.8) fever (1.9 versus 7.5) seizures (0.5 versus 1.7) and hospitalizations (0.2 versus 0.9) (18). 

A randomized, controlled comparison of two-component, three-component, and five-component acellular pertussis vaccines and a whole-cell pertussis vaccine has been carried out in 82 892 infants who were immunized either at age 3, 5, and 12 months, or at 2, 4, and 6 months. High fever and seizures occurred more often after whole-cell vaccine than after any of the acellular vaccines. Hypotonic-hyporesponsive episodes also occurred significantly more often in the whole-cell group and were more frequent in the acellular groups than previously reported (SEDA-22, 342). 

Future immunizations are likely to rely less on whole virus or bacterial vaccines and more on acellular or subunit vaccines. Side effects resulting from the pertussis vaccine, generally mild fever or inflammation but occasionally a more serious problem, led to the development of an acellular pertussis vaccine using only bacterial proteins. Similar vaccines, some containing only genetic information for production of viral proteins, are likely to be used s ainst other diseases in the future. 

In the early 1980s there were concerns about the safety of whole cell pertussis vaccines in particular, it was claimed by some that the vaccine was associated with sudden infant death syndrome and encephalopathy [21 ]. Immunization rates fell, and many vaccines were withdrawn from the market. However, epidemiological studies have consistently failed to identify an association. It has been recently argued that such reactions may have occurred in metaboli-cally vulnerable children, specifically those with defects in fatty acid oxidation, in whom the combination of anorexia and fever due to the vaccine may have resulted... 

Systemic reactions, such as moderate fever, occur in 3% to 5% of those receiving vaccines. Very rarely, high fever, febrile seizures, persistent crying spells, and hypotonic hyporesponsive episodes occur after vaccination. There are only two absolute contraindications to pertussis administration an immediate anaphylactic reaction to a previous dose or encephalopathy within 7 days of a previous dose, with no evidence of other cause. 

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