Seizures following childhood immunizations

doi:10.1016/S0022-3476(83)80278-9

The Journal of Pediatrics

Volume 102, Issue 1, January 1983, Pages 14-18

https://doi.org/10.1016/S0022-3476(83)80278-9 Get rights and content

In 1.4% of children who experienced a seizure during the first seven years of life, the seizure followed within two weeks of an immunization procedure. We report 40 postimmunization seizures in 39 children enrolled in the Collaborative Perinatal Project. Ten seizures followed diphtheria-pertussis-tetanus (DPT) immunization, and 10 followed measles immunization. All but one of the seizures were associated with fever, often high. Thirty-seven seizures lasted less than 30 minutes. More than half of the children had a personal or immediate-family history of febrile seizures. One of the children had a right focal seizure lasting six hours after DPT immunization and had a significant speech deficit on long-term follow-up. No child developed epilepsy, and results in all children with brief seizures were normal on neurologic and cognitive examination at 7 years of age. Both in clinical presentation and generally benign outcome, these immunization-related seizures closely resemble febrile seizures, which are common in early childhood.

References (30)

EhrengutW
Whooping cough vaccination: Comment on report from Joint Committee on Vaccination and Immunization
Lancet
(1978)
StephensonJBP
Pertussis immunisation convulsions are not evidence of encephalopathy
Stuart-HarrisC
Benefits and risks of immunizations against pertussis
Dev Biol Stand
(1979)
GriffithAH
Development of the pertussis vaccination programme in England and Wales and its effects on whooping cough morbidity and mortality
Dev Biol Stand
(1979)
RobinsonRJ
The whooping-cough immunization controversy
Arch Dis Child
(1981)
PrenskyAL
Pertussis vaccination
Dev Med Child Neurol
(1974)
KulenkampffM et al.
Neurological complications of pertussis inoculation
Arch Dis Child
(1974)
AllerdistH
Neurological complications following measles vaccination
Dev Biol Stand
(1979)
EhrengutW et al.
Convulsions following oral polio immunisation
Dev Biol Stand
(1979)
ShawEB
Commentary on immunization
Am J Dis Child
(1980)

FulginitiVA

Controversies in current immunization policy and practices: One physician's viewpoint

Curr Prob Pediatr

(1976)

StromJ

Further experience of reactions, especially of a cerebral nature, in conjunction with triple vaccination: A study based on vaccinations in Sweden 1959–65

Br Med J

(1967)

MalmgrenB et al.

Complications of immunization

Br Med J

(1960)

GriffithAH

Reactions after pertussis vaccine: A manufacturer's experiences and difficulties since 1964

Br Med J

(1978)

StewartGT

Toxicity of pertussis vaccine: Frequency and probability of reactions

J Epidemiol Community Health

(1979)

Cited by (77)

Febrile seizure and related syndromes
2018, Neurology Psychiatry and Brain Research
Citation Excerpt :
Based on many studies, it becomes clear that febrile seizures have a major genetic predisposition (Camfiel & Camfield, 2015). It has been demonstrated that there is an increased risk of febrile seizures shortly after many childhood vaccinations, including acellular pertussis (Chung, 2014; Hirtz, Nelson, & Ellenberg, 1983). It is now understood that this association is simply based on vaccine-induced fever in a susceptible child (Brown, Berkovic, & Scheffer, 2007).
Febrile seizures (FS) are the result of particular sensitivity to fever in the developing brain, have a major genetic predisposition, and nearly always have a benign outcome. Febrile seizures are the most common for of seizures in childhood. They have been observed in 2–6% of children before the age of 5 years, but in some populations this figure increase to 15%. Febrile seizures could be the first manifestations of epilepsy. About 13% of epileptic patients have a history of febrile seizures, and 30% have had recurrent febrile seizures Their phenotypic characteristics allow, in the majority of cases, a classification of the seizure, an elaboration of a prognosis and to assume a specific therapeutic attitude. It is possible to describe a spectrum according to their severity, from the benign simple seizure to the more complex, febrile seizure plus (GEFS+), Dravet syndrome, Epilepsy syndrome related infection febrile FIRES and Idiopatic Hemiconvulsion Hemiplegia and Epilepsy syndrome (IHHE). FS has a multifactorial inheritance, suggesting that both genetic and environmental factors are causative. Five areas of the genome have shown to be linked to FS in some ways. Two of them, FEB1 and FEB2 found on chromosomes 8 and 19p, are only involved in FS. During the past decade, molecular genetic studies have contributed to identification of genetic factors involved in febrile seizure and related disorders marking the necessary of careful follow up of the patients in order to detect risk factor earlier. We have reviewed the medical literature to update current knowledge of febrile seizures, their prognosis and their relation to new epileptic syndromes.
Pertussis Vaccines
2017, Plotkin's Vaccines
When vaccination turns to tragedy: Medicolegal aspects. About two autopsy cases
2015, Revue de Medecine Legale
La vaccination est considérée comme l’un des moyens les plus efficaces de protection dont dispose l’humanité. Bien que très rares, les accidents de vaccination peuvent parfois se révéler dramatiques. Le médecin légiste se trouve parfois confronté à des situations de mort subite dans un délai variable après la vaccination. Sa mission serait dans ces cas la détermination de la relation entre les deux évènements. Nous discutons, à travers l’analyse de deux cas autopsiques, le lien d’imputabilité entre la mort subite et la vaccination contre respectivement l’hépatite virale B et la diphtérie, tétanos, coqueluche, poliomyélite (DTCP).
Cas 1 : un nourrisson, âgé de 3 mois, en bon état de santé apparente, décède quelques heures après la vaccination contre DTCP. L’autopsie et l’histologie ont conclu à la présence d’une encéphalite lymphocytaire. Cas 2 : il s’agit d’un jeune étudiant âgé de 22 ans, qui a consulté aux urgences pour douleurs thoraciques, survenues trois heures après une vaccination contre l’hépatite B. Le diagnostic de myocardite aiguë a été retenu. L’évolution a été marquée par l’aggravation de son état de santé aboutissant au décès. L’examen histologique a confirmé le diagnostic de myocardite. La recherche virale est revenue négative.
Vaccination is considered as one of the most effective means of protection, available to humanity. Accidents due to vaccination can sometimes be dramatic, despite their rarity. The pathologist deal sometimes with sudden death occurred after vaccination. His mission, in this case, is the determination of the relation between the two events. We discuss, through the analysis of two autopsy cases, the imputability between sudden death and vaccination against viral hepatitis B and diphtheria, tetanus, pertussis, polio (DTCP).
Case 1: a 3-month-old infant, with apparently good health, died few hours after vaccination against DTCP. Autopsy and histology concluded on lymphocytic encephalitis. Case 2: a 22-year-old student was admitted to the emergency chest pain, three hours after vaccination against hepatitis B. The diagnosis of acute myocarditis was retained. Death occurred after few hours. Histological examination confirmed the diagnosis of myocarditis. Viral research was negative.
Agreement between medical record and parent report for evaluation of childhood febrile seizures
2013, Vaccine
Citation Excerpt :
However, the large sample size required for this study and the low frequency of FS following immunizations precluded the analysis of FS due to fever following vaccine administration only. Nonetheless, FS following vaccination are thought to be due to fever associated with vaccination not the vaccine itself, and have indistinguishable characteristics and identical prognosis to FS due to fever from other sources [22–25]. Serious sources of fever and seizures, such as meningitis and encephalitis, preclude the diagnosis of FS and hence, were not included in our analysis.
The monitoring of vaccine safety is critical to maintaining the public acceptance of vaccines required to ensure their continued success. Methods used to assess adverse events following immunization (AEFI) must accurately reflect their occurrence. Assessment of AEFI is often done via medical record review (MR) or via patient report (PR). However, these sources of data have not previously been compared for the analysis of AEFI. The objective of this study was to evaluate the concordance between MR and PR for young children identified as having had a febrile seizure (FS), an important AEFI, in an integrated health care system. The variables chosen for analysis were those recommended by the Brighton Collaboration Seizure Working Group for the evaluation of generalized seizure as an AEFI [1].
Parent report from phone interviews and mailed questionnaires was compared to abstracted medical records of 110 children with FS between ages 3 and 60 months. Concordance between PR and MR for characteristics and predisposing factors of FS was assessed by percent total agreement and kappa statistic.
Percent total agreement between PR and MR was between 43.6 and 100% for variables studied, with 62.5% of items having >70% agreement. However, kappa was poor to fair for all measures (−0.04 to 0.33). While some variables, such as history of seizures in a sibling or parent and several seizure characteristics, were reported more often by PR, other items, such as maximum fever and several concurrent conditions, were reported more often by MR.
These findings demonstrate the limitations of using MR or PR alone to assess febrile seizures in children. This analysis supports the practice of collecting data from both MR and PR to most accurately portray the spectrum of predisposing factors and seizure characteristics when evaluating FS in children whenever feasible.
Neuropathology of vaccination in infants and children
2011, Vaccine
Citation Excerpt :
This study was done to better understand the kinds of medical conditions that are sometimes associated with vaccination, and in some measure to address the validity of a long-held perception that vaccinations of infants/children may occasionally cause death or permanent brain damage [27–33]. Vaccines containing pertussis toxoid have most commonly been under suspicion, although aside from a temporal association, no credible pathophysiologic evidence supporting such claims has ever been forthcoming [34–50]. As an increasing number of vaccines have been developed, isolated reports of adverse neurological problems have been ascribed to them as well.
Documentation of clinical-pathological features of 37 infants/children whose parents alleged a relationship between vaccination and death or permanent central nervous system (CNS) damage, and sought compensation through the National Vaccine Injury Compensation Program.
Of the 5545 claims filed during the 10-year period (1990–1999), CNS tissue was available for evaluation by a pediatric neuropathologist in 37; 33 died and 4 had a biopsy or lobectomy.
Most commonly implicated vaccines were DTP/DTaP, followed by MMR and IPV/OPV, but almost all of the vaccines currently given to infants/children were alleged to be responsible for the illness/death.
No lesions were found in 5 of 37 (13.5%). The most frequent abnormality consisted of acute anoxic encephalopathy (14 of 37 – 37.8%), consequent to several different causes, such as positional asphyxia, cardio-respiratory arrest during status epilepticus, etc. The remaining children manifested other lesions, including inflammation (5 of 37 – 13.5%), vascular and developmental anomalies (4 each of 37 or 10.6%), cerebral edema and system degeneration (2 each of 37 or 5.4%), and one case of heavy metal exposure in a child living near an abandoned mine (2.2%).
There was no obvious relationship between type of vaccine (or vaccines simultaneously administered) to time of onset of symptoms, nature of symptoms or the lesions found.
Pertussis vaccines
2008, Vaccines

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^†: Presented in part as a poster at the annual meeting of the American Academy of Neurology, April 1982, Washington, D.C.

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Original articleSeizures following childhood immunizations†

Lancet

Benefits and risks of immunizations against pertussis

Dev Biol Stand

Development of the pertussis vaccination programme in England and Wales and its effects on whooping cough morbidity and mortality

Dev Biol Stand

The whooping-cough immunization controversy

Arch Dis Child

Pertussis vaccination

Dev Med Child Neurol

Neurological complications of pertussis inoculation

Arch Dis Child

Neurological complications following measles vaccination

Dev Biol Stand

Convulsions following oral polio immunisation

Dev Biol Stand

Commentary on immunization

Am J Dis Child

Controversies in current immunization policy and practices: One physician's viewpoint

Curr Prob Pediatr

Further experience of reactions, especially of a cerebral nature, in conjunction with triple vaccination: A study based on vaccinations in Sweden 1959–65

Br Med J

Complications of immunization

Br Med J

Reactions after pertussis vaccine: A manufacturer's experiences and difficulties since 1964

Br Med J

Toxicity of pertussis vaccine: Frequency and probability of reactions

J Epidemiol Community Health

Original article
Seizures following childhood immunizations†