Tag: DTaP

What Are Hypotonic-Hyporesponsive Episodes?

Just about any side effect after a vaccine can be scary for parents.

What if your child suddenly became limp, wasn’t responsive, and was pale?

That would be scary for any parent.

What Are Hypotonic-Hyporesponsive Episodes?

But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.

HHE is much more rare since we switched to a new pertussis vaccine.
HHE is much rarer since we switched to a new pertussis vaccine.

Fortunately, although they certainly do sound scary, the episodes stop on their own and  don’t cause any permanent harm.

Hypotonic-hyporesponsive episodes were even removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.

“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.

What to Know About Hypotonic-Hyporesponsive Episodes

Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.

More About Hypotonic-Hyporesponsive Episodes

Vaccine Reactions – Is This Normal?

Vaccines are very safe.

They are not 100% safe though and they can have some side effects.

“Considering that the vaccines in the infant schedule are administered to millions of children each year, the list of known adverse events, even rare ones, is impressively short.”

O’Leary et al on Adverse Events Following Immunization: Will It Happen Again?

Fortunately, most of these side effects are harmless and don’t have any long term risks. And of course, the great benefits of vaccines outweigh those risks.

Common Vaccine Reactions

Although most kids don’t have any reactions at all, some do have mild reactions.

Among the possible vaccine reactions or side effects that can occur include:

  • fussiness
  • headache
  • fever
  • body aches
  • redness or swelling at the injection site
  • soreness or tenderness at the injection site
  • tiredness
  • poor appetite
  • chills and sore joints
  • rash
  • diarrhea
  • vomiting
  • swelling of glands in the cheeks or neck

How commonly do they occur?

In this 2011 report, the IOM concluded that few health problems are caused by or clearly associated with vaccines.
In this 2011 report, the IOM concluded that “few health problems are caused by or clearly associated with vaccines.”

These side effects depend on the vaccine that was received and can range from 1 in 3 kids for some fussiness all the way down to 1 in 75 kids for kids who have swelling of their glands.

And they usually begin 1 to 3 days after the vaccine was given and last for 1 to 7 days.  Fortunately, fever and fussiness don’t last that long, typically going away after just a day or two.

Keep in mind that some reactions are more delayed though. This is especially true for the MMR vaccine, in which mild reactions, like a fever, rash, or swelling of glands might not occur until 6 to 14 days after a child got his vaccine.

What can you do if your child has a mild vaccine reaction?

Consult your health care provider, but keep in mind that treatment is often symptomatic, typically with a cold pack or cool cloth/compress for local reactions and pain reliever.

Fainting also commonly occurs after vaccines, especially in teens, but it is thought to be due to the vaccination process itself and not the vaccines. Still, it is something to be aware of.

What About More Moderate Reactions?

More moderate reactions after vaccines are fortunately more uncommon.

“There is low public tolerance of vaccine adverse reactions. Vaccines are therefore only licensed when the frequency of severe reactions is very rare and when only minor, self-limiting reactions are reported.”

WHO on Adverse events following immunization

Some of these moderate reactions might include:

  • febrile seizures
  • high fever
  • persistent crying for 3 or more hours
  • swelling of the entire arm or leg where the shot was given (especially after the 4th or 5th dose of DTaP)
  • a temporary low platelet count (idiopathic thrombocytopenic purpura or ITP)

Like the more common, mild reactions, these less common moderate reactions are also temporary and don’t usually have any lasting risks or consequences.

Then there are the more severe reactions, which thankfully are even more rare. These are the 1 in a million dose type reactions, such as life-threatening allergic reactions.

Of course, you should seek medical attention if you think that your child is having a more moderate or severe reaction to a vaccine.

And lastly, there are the so-called vaccine induced diseases, which are simply made up.

All of these reactions, as well as the risks of getting a natural infection, are listed in each vaccine’s VIS. The Vaccine Information Statements also includes information on how to report all possible vaccine side effects to VAERS.

What to Know About Common Vaccine Reactions

While most kids don’t have any reactions at all after their vaccines, those that do typically have mild reactions, including some fever, soreness, or swelling at the injection site. More moderate and severe reactions are rare.

More About Common Vaccine Reactions

 

DTaP Vaccine Reactions – Is This Normal?

Vaccines are very safe.

They are not 100% safe though and they can have some side effects.

Fortunately, most of these side effects are harmless and don’t have any long term risks. And of course, the great benefits of vaccines outweigh those risks.

Common DTaP Vaccine Reactions

Although 75% of kids don’t have any reactions at all, some do have mild reactions.

Among the vaccine reactions or side effects that can occur most commonly include:

Vaccine Information Statements from the CDC highlight the risks of each vaccine.
The DTaP Vaccine Information Statement from the CDC highlight all of the vaccine’s possible risks.
  • fussiness
  • fever
  • redness or swelling at the injection site
  • soreness or tenderness at the injection site
  • tiredness
  • poor appetite
  • vomiting

How commonly do they occur?

They range from 1 in 3 kids for some fussiness all the way down to 1 in 50 kids for vomiting.

And they begin 1 to 3 days after the vaccine was given and last for 1 to 7 days.  Fortunately, fever and fussiness don’t last that long, typically going away after just a day or two.

Treatment is symptomatic, with a cold pack or cool cloth/compress and pain reliever

What About More Extensive Swelling and Redness?

Sometimes the swelling and redness after a DTaP vaccine can be more than you expect though. It might even make you think your child has developed a skin infection.

“Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1–7 days (up to about 1 child in 30).”

DTaP Vaccine Vaccine Information Statement

This more extensive local reaction, while scary looking, is not dangerous, and will also go away without long term effects.

It is also not an allergic reaction, so your child can finish the DTaP series if he or she still needs another dose.

Call your pediatrician or seek medical attention if you think your child has developed a skin infection after a vaccination, but keep in mind that bacterial cellulitis after getting a vaccine is an extremely rare, almost unheard of, complication.

Other more moderate and severe DTaP vaccine reactions are uncommon or rare.

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

What about hypotonic-hyporesponsive episodes (HHE) and seizures? These were removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And remember that some so-called vaccine induced diseases are simply made up.

Most of these reactions, as well as the risks of getting natural diphtheria, tetanus, and pertussis infections, are listed in the DTaP VIS.

What to Know About Common DTaP Vaccine Reactions

While most kids don’t have any reactions at all after their DTaP vaccines, those that do typically have mild reactions, including some fever, soreness, or swelling at the injection site.

More About Common DTaP Vaccine Reactions

 

Are Vaccines Tested Together?

If you are on the Fence about vaccines, one issue that might have you scared is that the idea that vaccines aren’t tested together.

So maybe they tested the Prevnar vaccine, but did they test it with the Hib vaccine?

And did they test the Prevnar and Hib vaccine with the Pediarix vaccine?

After all, kids get all of those vaccines at their two, four, and six month well child checkups.

Vaccines Are Tested Together

It is not hard to find evidence that most combinations of vaccines are in fact tested together.

For example (and this is not a complete list):

  • Rotarix was tested with Pediarix (DTaP-HepB-IPV), Prevnar, and Hib
  • Prevnar 13 was tested with DTaP, IPV, hepatitis B and Hib
  • Prevnar 13 was tested with MMR, Varicella, and hepatitis A
  • MenC with DTaP-IPV-HepB-Hib
  • MenC with MMR
  • MMR and Varicella with Hib, Hepatitis B, and DTaP
  • hepatitis A and hepatitis B with either MMR or DTaP-IPV-Hib
  • HPV vaccine for babies
  • Flumist with MMR and Varicella
  • Kinrix (DTaP-IPV) with MMR and Varicella
  • HPV9 with Tdap and Meningococcal vaccines
  • Tdap with influenza vaccine
  • Meningococcal vaccine with influenza vaccine

And even after a vaccine is added to the immunization schedule and it is given together with other vaccines, our post-licensure vaccine safety monitoring systems, from VAERS to the Vaccine Safety Datalink, kick in to make sure that they are indeed safe and effective.

The Myth That Vaccines Aren’t Tested Together

If it is clear that vaccines are in fact tested together, then why do some folks still believe that they aren’t?

Bob Sears appeared on Fox & Friends in 2010 for the segment
Bob Sears appeared on Fox & Friends in 2010 for the segment Vaccines: A Bad Combination?

Hopefully everyone sees the irony in Dr. Bob saying something about vaccines being untested, as he is infamous for pushing his own made up and completely untested alternative vaccine schedule.

“Babies get as many as 6 or 7 vaccines altogether…and the CDC is admitting that they don’t always research them that way.”

Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?

When did they admit that???

“We’ve researched the flu vaccine in great detail and it seems safe when it’s given alone, but the CDC has never researched the flu vaccine when you give it in conjunction with all the other infant shots…and that’s what we’re worried about. ”

Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?

So, what about the flu vaccine?

A 2013 report from the Institute of Medicine found that there was no evidence that vaccines caused ADHD.
A 2013 report from the Institute of Medicine stated that “Each new vaccine considered for inclusion in the immunization schedule is tested within the context of the existing schedule and reviewed by clinical researchers, who analyze the balance of demonstrated benefits and risks.”

While most kids get their flu vaccine by itself, just before the beginning of flu season, some might get it when they see their pediatrician for a regular checkup, at the same time they are due for other vaccines.

Not surprisingly, Dr. Bob was wrong, and several studies have shown that the flu vaccine can be safely given with other vaccines.

And don’t forget, any problems with co-administration of vaccines would show up in post-licensure vaccine safety testing.

That’s how a very small increased risk of febrile seizures was found during the 2010-11 flu season in toddlers who received either DTaP or Prevnar and a flu shot at the same time.

The very small extra risk doesn’t mean that you still can’t get the vaccines at the same time if your child needs them all though. Remember that febrile seizures “are temporary and do not cause any lasting damage.”

It will be even more reassuring to some parents that another study “examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010-2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP)” and found no extra risk for febrile seizures.

“Vaccines can generally be co-administered (i.e. more than one vaccine given at different sites during the same visit). Recommendations that explicitly endorse co-administration are indicated in the table, however, lack of an explicit co-administration recommendation does not imply that the vaccine cannot be co-administered; further, there are no recommendations against co-administration.”

Summary of WHO Position Papers – Recommendations for Routine Immunization

Also remember that “there are no recommendations against co-administration of vaccines,” unless of course, you are getting your advice from Bob Sears…

 

What To Know About Vaccines Being Tested Together

Vaccines are thoroughly tested for both safety and efficacy and they are also tested in many of the different combinations on the routine childhood immunization schedule.

More On Vaccines Being Tested Together