We know that pregnant women are supposed to get a flu vaccine.
Although recommendations on exactly when to get it have changed over the years, it has been a universal recommendation since at least the 1994-95 flu season.
How Does a Mother’s Flu Shot Protect a Newborn Baby?
One obvious way that a flu shot provides protection during pregnancy is that it reduces your risk of getting the flu while you are pregnant.
That’s good, as having the flu while you are pregnant can lead to preterm labor, a premature birth, birth defects, or a miscarriage. And of course, the flu can be life-threatening for pregnant women.
Getting a flu shot while you are pregnant can also help to make sure that you don’t get the flu after your baby is born, which not only keeps you healthy, but decreases the chance that your baby will be exposed to the flu. After all, if you get the flu, no matter how much you try to cover your cough and wash your hands, there is a good chance that you will give it to your baby.
And since babies can’t get flu shots of their own until they are at least six months old, a flu shot during pregnancy helps to make sure that your baby gets some of antibodies to protect them from the flu.
“When you get a flu shot, your body makes antibodies that also pass to your fetus. This means your baby has protection against the flu after birth. This is important because infants less than 6 months of age are too young to get the flu shot.”
Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy
Do you have to wait until late in your pregnancy to make sure that the most antibodies get passed to your baby?
While that might seem like a good idea, especially since that’s what we do for the Tdap vaccine and protection against pertussis, there are several reasons that we don’t do that with the flu vaccine, including that:
pregnant mothers need the protection before flu season hits, so waiting would not be safe and could mean that you get sick with the flu before getting your shot
protection from the flu vaccine shouldn’t wane or wear off so quickly that you need to get it later, after all, the earliest that you can get vaccinated is when flu vaccines first become available in August or September and that should provide good protection past the peak of flu season
When you get your flu shot while pregnant is going to have more to do with when you got pregnant in relation to the start of flu season more than anything else.
“The flu shot can be safely given during any trimester. Pregnant women can get the flu shot at any point during the flu season (typically October through May). Pregnant women should get the shot as soon as possible when it becomes available. If you are pregnant, talk with your obstetrician–gynecologist (ob-gyn) or other health care provider about getting the flu shot.”
Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy
Most importantly, remember that flu shots are considered an “essential component of prenatal care.”
While everyone should get a flu vaccine each year, since pregnant women are in a high risk group for flu complications, you should especially make sure that you get vaccinated and protected if you are pregnant. Everyone around you should get vaccinated too!
These CDC reports should even take away any last idea that they are.
If there was any association with vaccines, then why are autism rates so widely different in the 11 states that are tracked by ADDM?
Are immunization rates different in those states?
Autism and Developmental Disabilities Monitoring (ADDM) Network
Anyone who has read the latest report on autism rates understands that it “is not a representation of autism in the United States as a whole, but is instead an in-depth look at the 11 communities in the ADDM Network.”
Those communities have changed for each report, but this time they were in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.
Even then, the ADDM Network doesn’t look at all of the children in those states. They are mostly looking at children near large institutions that are hosts for the ADDM Network, such as the University of Arkansas for Medical Sciences, Johns Hopkins University, and Rutgers University, etc.
The 325,483 8-year-olds in the latest ADDM Network report were born in 2006 and live in:
part of Maricopa County in metropolitan Phoenix, Arizona
75 counties in Arkansas
Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties in Colorado
Clayton, Cobb, DeKalb, Fulton, and Gwinnett counties in Georgia
Baltimore County, Maryland
parts of two counties (Hennepin and Ramsey) including the large metropolitan cities of Minneapolis and St. Paul, Minnesota
Franklin, Jefferson, St. Charles, St. Louis, and St. Louis City counties in Missouri
Essex, Hudson, Union, and Ocean counties in New Jersey
Alamance, Chatham, Forsyth, Guilford, Orange, and Wake counties in North Carolina
Bedford, Cheatham, Davidson, Dickson, Marshall, Maury, Montgomery, Rutherford, Robertson, Williamson, and Wilson counties in Tennessee
Dane, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth, and Waukesha counties in Wisconsin
“Autism prevalence among black and Hispanic children is approaching that of white children,” said Dr. Stuart Shapira, associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”
It shows that “there continue to be many children living with ASD who need services and support, now and as they grow into adolescence and adulthood.”
Immunization Rates and the Autism and Developmental Disabilities Monitoring Network
It also helps to dispell any last ideas that vaccines are associated with autism…
Just look at the immunization rates in the ADDM Network counties (4 doses of DTaP, 3 doses of IPV, one dose of MMR, 3 doses of Hib, 3 doses of HepB, 1 dose of Varicella, 4 doses of Prevnar, flu shot, and 1 dose of HepA by age 36 months) and compare them to the autism rates in those same counties.
If vaccines were associated with autism, what should you see? Higher rates of autism in the areas with the highest immunization rates. You don’t see that in any of this data though, do you?
The counties in New Jersey, with the highest rates of autism, have good immunization rates, but they aren’t much different from the immunization rates in Colorado counties or Arizona counties with much lower autism rates.
Some other things we know about vaccines and the latest autism report?
in 2006, when those kids were born, New Jersey had one of the lowest rates for getting newborns a hepatitis B shot on their first day, as recommended, at just 23%. Arizona, with a much lower rate of autism, did much better, getting 65% of newborns their birth dose of hepatitis B vaccine on time. In fact, Maricopa County had one of the highest rates, at 71%.
fewer than half of their mothers likely received a flu shot during their pregnancy, even though they had been recommended since the 1990s
extremely few of their mothers received a Tdap vaccine during their pregnancy, as this didn’t become a routine recommendation until 2011
Does any of this surprise you?
How can vaccines be associated with autism, when counties that have higher immunization rates have lower rates of autism?
What to Know About Vaccines and the Latest Autism Prevalence Report
The latest Autism and Developmental Disabilities Monitoring (ADDM) Network report on autism prevalence from the CDC shows a rate that has increased to 1 in 59 children. And as county level trends in vaccination coverage show no correlation to those autism prevalence rates, folks will hopefully stop trying to associate vaccines with autism.
More on Vaccines and the Latest Autism Prevalence Report
That’s why the focus on controlling pertussis outbreaks is usually looking at close contacts – those who were within about 3 feet for at least 10 hours a week or who had direct face-to-face contact with the person when they were contagious.
So when you get a letter about a possible case of pertussis in your child’s school, it may be a a general warning and not that your child is at risk.
How do you get pertussis?
“Persons with pertussis are infectious from the beginning of the catarrhal stage through the third week after the onset of paroxysms or until 5 days after the start of effective antimicrobial treatment.”
Manual for the Surveillance of Vaccine-Preventable Diseases
Spread by respiratory droplets (coughing and sneezing), pertussis symptoms usually start about 5 to 10 days after being exposed to someone else who is in the early stage of their pertussis infection.
While pertussis symptoms can linger for up to 10 weeks, someone who has pertussis is most contagious during the first 2 or 3 weeks of symptoms.
Is Your Child Protected Against Pertussis?
Two pertussis vaccines, DTaP and Tdap, help protect us against pertussis.
In the Unites States, they are routinely given as a primary series (DTaP) at 2, 4, and 6, and 15 to 18 months, with a booster dose at age 4 years. And then a booster of Tdap at age 11 to 12 years. Later, Tdap is given again during each pregnancy, between 27 and 36 weeks gestation. Adults who have never had a dose of Tdap should get caught up, especially if they will be around a baby.
Protection from the pertussis vaccines wanes or wears off, so even fully vaccinated children and adults can still get pertussis. Of course, you are much more likely to get pertussis if you are unvaccinated and you will likely have more severe illness if you are unvaccinated.
Postexposure Antimicrobial Prophylaxis for Pertussis
Fortunately, as with meningitis was caused by Neisseria meningitidis and Haemophilus influenzae type b (Hib), taking antibiotics after being exposed to someone with pertussis can help prevent you from getting sick.
There are only specific situations for which this type of postexposure antimicrobial prophylaxis is recommended though, so for example, you wouldn’t usually give everyone in a school antibiotics because a few kids had pertussis.
Why not give antibiotics to everyone who might have been exposed to someone with pertussis?
“…there are no data to indicate that widespread use of PEP among contacts effectively controls or limits the scope of pertussis outbreaks.”
Postexposure Antimicrobial Prophylaxis
In addition to the fact that it likely wouldn’t stop our pertussis outbreaks, overuse of antibiotics can have consequences.
Situations in which postexposure antibiotics (azithromycin, clarithromycin, and erythromycin, or Bactrim) likely would be a good idea include:
household contacts of a known pertussis case
to help control an outbreak in a limited closed setting, like a daycare
contacts of a pertussis cases who are at high risk for severe pertussis, including pregnant women, infants, especially infants less than 4 months old, and people with chronic medical problems
contacts of a pertussis cases who are also contacts of someone who is at high risk for severe pertussis
What if you were exposed to someone with pertussis and have already gotten sick?
If your child was exposed to pertussis and is now coughing, then in addition to antibiotics, pertussis PCR testing and/or culture will also likely be done to confirm that they have pertussis. And remember that their contacts might need postexposure antibiotics.
Kids who have been exposed to pertussis and who have been coughing for more than 3 weeks won’t need antibiotics or testing, as it is too late for the antibiotics to be helpful and likely too late for testing to be accurate. Fortunately, after 3 weeks, they should no longer be contagious.
What to Do If Your Unvaccinated Child Is Exposed to Pertussis
Unvaccinated kids who are exposed to pertussis should follow the postexposure antimicrobial prophylaxis guidelines.
They should also get caught up on their immunizations, including DTaP if they are between 2 months and 6 years, or Tdap if they are older.
What to Do If Your Vaccinated Child Is Exposed to Pertussis
Since protection from the pertussis vaccines wanes, even kids who are fully vaccinated should follow the postexposure antimicrobial prophylaxis guidelines if they are exposed to pertussis.
Then why get vaccinated?
Again, being vaccinated, your child will be much less likely to get pertussis than someone who is unvaccinated. Even though the pertussis vaccine isn’t perfect, it has been shown that children who had never received any doses of DTaP (unvaccinated children) faced odds of having pertussis at least eight times higher than children who received all five doses.
What to Know About Getting Exposed to Pertussis
Talk to your pediatrician if your child gets exposed to pertussis to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.
Folks who are intentionally unvaccinated often have a hard time understanding why the rest of us might be a little leery of being around them.
That’s especially true if we have a new baby in the house, younger kids who aren’t fully vaccinated and protected, or anyone with a chronic medical condition who can’t be vaccinated.
Why? Of course, it is because we don’t want them to catch measles, pertussis, or other vaccine-preventable diseases.
“How can you spread a disease that you don’t even have?”
It’s true, you can’t spread a disease that you don’t have.
But infectious diseases don’t magically appear inside our bodies – we catch them from other people. And if you have skipped or delayed a vaccine, then you have a much higher chance of getting a vaccine-preventable disease than someone who is vaccinated and protected.
So, just avoid other people when you are sick, right?
“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”
Medical Advisory Committee of the Immune Deficiency Foundation
That works great in theory, but since you are often contagious before you show signs and symptoms and know that you are sick, you can very easily spread a disease that you don’t even know that you have.
There’s the trouble:
being unvaccinated, you or your child are at higher risk to get sick
when you get sick, you can be contagious several days before you have obvious symptoms
you can spread the disease to others before you ever know that you are sick, or at least before you know that you have a vaccine preventable disease
This makes intentionally unvaccinated folks a risk to those who are too young to be vaccinated, are too young to be fully vaccinated, have a true medical exemption to getting vaccinated, or when their vaccine simply didn’t work.
In fact, this is how most outbreaks start. Tragically, kids too young to be vaccinated get caught up in these outbreaks.
Keep in mind that these parents didn’t have a choice about getting them protected yet. Someone who decided to skip their own vaccines made that choice for them.
And remember that while you can’t spread a disease that you don’t even have, you can certainly spread a disease that you don’t realize that you have.
What to Know About The Unvaccinated Spreading Disease
If you aren’t going to get vaccinated or vaccinate your kids, understand the risks and responsibilities, so that you don’t spread a vaccine-preventable diseases to others that you might not even know that you have yet.
We often focus on what vaccines a baby will need once they are born, but it is also important that folks around your new baby get vaccinated too.
What Shots Do You Need to Be Around a Newborn?
Of course, all of your vaccines should be up-to-date, especially if you plan to be around young kids. That’s how we maintain herd immunity levels of protection for those who can’t be vaccinated and protected, including newborns who are too young to be vaccinated.
In addition to routine vaccines, it is especially important that teens and adults who are going to be around a newborn or younger infant have:
a dose of Tdap – now routinely given to kids when they are 11 to 12 years old and to women during each pregnancy (to protect newborns against pertussis), others should get a dose if they have never had one. There are currently no recommendations for a booster dose.
a flu shot – is it flu season? Then anyone who is going to be around your baby should have had a flu shot. And for the purposes of keeping a newborn safe from the flu, you can assume that flu season extends from September through May, or anytime that flu shots are still available.
Only two shots?
Yes, only two shots assuming you are either immune or are up-to-date on your other vaccines. If you have been delaying or skipping any vaccines, then you might need an MMR, the chicken pox vaccine, and whatever else you are missing.
Just because everyone is vaccinated and protected, that doesn’t mean that you should have a party welcoming your baby home and invite everyone in the neighborhood. Besides the flu, we get concerned about other cold and flu-like viruses, especially RSV.
That means to protect them, you should keep your baby away from:
large crowds, or even small crowds for that matter – in general, the more people that your baby is exposed to, the higher the chance that they will catch something
people who are sick
cigarette smoke – second hand smoke increases the risk of infections, like RSV
And make sure everyone, even if they don’t seem sick, washes their hands well before handling your baby.
“Parents or relatives with cold sores should be especially careful not to kiss babies—their immune systems are not well developed until after about 6 months old.”
AAP on Cold Sores in Children: About the Herpes Simplex Virus
Because you can sometimes be contagious even if you don’t have an active cold sore (fever blister), some parents don’t let anyone kiss their baby. Most of this fear comes after news reports of babies getting severe or life-threatening herpes infections after a probable kiss from a family member or friend.
When Can I Take My Newborn Out in Public?
When can you take your baby out in public? Most people try to wait until they are at least two months old.
Not really, as your baby won’t really be protected until they complete the primary series of infant vaccinations at six months.
Two months is a good general rule though, because by that age, if your baby gets a cold virus and a fever, it won’t necessarily mean a big work-up and a lot of testing. Before about six weeks, babies routinely get a lot of testing to figure out why they have a fever (the septic workup), even if it might be caused by a virus. That’s because younger infants are at risk for sepsis, UTI’s, and meningitis and they often have few signs when they are sick.
Keep in mind that going out in public is much different from going out. You can go for a walk with your baby at almost any time, as long as they are protected from the sun, bugs, and wind, etc., as long as there aren’t people around.
What to Know About Protecting Newborn Babies
Protect your baby by making sure everyone around them is vaccinated and protected, especially with a dose of Tdap and the flu vaccine.
Pertussis has been known since at least the Middle Ages, although the bacteria that causes pertussis, Bordetella pertussis, wasn’t discovered until 1906.
That discovery led to the later development of the first pertussis vaccines, but before then, pertussis was a big killer, with epidemic cycles every 2 to 5 years.
During one of these cycles in the United States, from 1926 to 1930, there were:
909,705 cases, and
Unfortunately, even natural infection doesn’t provide life-long immunity, so adults would get pertussis and give it to susceptible kids, who were most likely to die during these epidemics.
But even in non-epidemic years, a lot of folks got pertussis. The number of reported cases ranged from “just” 161,799 in 1928 to 202,210 in 1926. And during one of the biggest years, 1934, there were 265,269 cases!
Post-Vaccine Era Pertussis Outbreaks
That changed in the vaccine era.
The first pertussis vaccines were developed in the 1930s and became more widely used in the 1940s when it was combined into the whole-cell DTP vaccine.
This was replaced with the acellular DTaP vaccine in 1997, with the Tdap vaccine being added to the vaccine schedule in 2006.
These vaccines helped to greatly reduce how many people got pertussis and how many people died from pertussis:
1940 – 183,866 cases
1950 – 120,718 cases and 1, 118 deaths
1960 – 14,809 cases and 118 deaths
1970 – 4,249 cases and 12 deaths
1980 – 1,730 cases and 11 deaths
1990 – 4,570 cases and 12 deaths
2000 – 7,867 cases and 12 deaths
2010 – 27,550 cases and 26 deaths
They never eradicated pertussis though, and as you can see, recently, pertussis cases have started to rise again.
In 2012, there were 48,277 cases of pertussis in the United States, the most since 1950, when we had 68,687 cases. Unfortunately, with the rise in cases, we are also seeing the tragic consequences of this disease – 20 deaths in 2012, mostly infants under age 3 months.
Pertussis cases remained steady, but high, in 2013 and 2014, at around 30,000 cases in the United States.
In California, pertussis reached epidemic levels. The California Department of Public Health reported at least 11,114 cases in 2014 – the highest numbers of pertussis cases in the state in 70 years!
And as expected with the rise in cases, there were 3 pertussis related deaths in California that year – all infants who had contracted pertussis when they were less than 8 weeks old. Two of the infants became sick in 2013, but the third, a 5-week-old baby, got infected in 2014.
Another baby, only 25 days old died in early 2015, but will be counted as the 2nd death of 2014 since that is when the illness started. About 383 patients, mostly infants who are less than 4 months old, were hospitalized in California that year, including 80 who required intensive care. And according to the California Department of Public Health, about 82% of the cases in infants were born to mothers who did not receive a dose of Tdap during their third trimester of pregnancy.
What’s happened since then?
Pertussis cases are continuing to fall each year! In fact, with about 16,000 cases in the United States, 2017 may have ended with the lowest number of pertussis cases since 2008.
Still, with just 1,830 pertussis cases in California in 2016, there were two deaths – both infants who were younger than 3 months of age when they got sick. And there was at least one death in 2017, with similar rates of disease, although reports are still preliminary.
Why So Many Pertussis Outbreaks?
Ever since a 2010 California pertussis outbreak, in which there were 9,154 cases of pertussis, the most in 63 years, and 10 infants died, many people, especially parents, began wondering why we were seeing more pertussis these days.
Is it because the pertussis vaccines simply don’t work, as the anti-vaccine movement would have you think?
A commentary, Why Do Pertussis Vaccines Fail?, by James Cherry, MD, gave us some answers.
While the title of the article might have you think that all of the blame lies with the pertussis vaccines, that certainly isn’t the case. While there can be vaccine failures with the pertussis vaccines, just like any other vaccine, that doesn’t mean that the vaccine doesn’t work for most children.
One of the problems is that the DTaP vaccine likely isn’t as effective as the older DTP vaccine. So instead of efficacy of 84 to 85%, as was once believed, it is likely closer to just 71 to 78%.
Other issues, including waning immunity, the possibility of an incorrect balance of antigens in the vaccine that could create a blocking effect, and genetic changes in the B. pertussis bacteria, could also possibly lead to increased vaccine failure rates.
So it isn’t that the pertussis vaccines don’t work.
That should be easy to see when you look at the pertussis rates in California, when the highest rates by far were in infants less than 6 months of age (434 per 100,000 people). In contrast, children who were 6 months to 6 years old had a rate of only 62 per 100,000.
And the results of a study that were presented at the 49th annual meeting of the Infectious Diseases Society of America in Boston show just how important the pertussis vaccine is, as:
vaccine effectiveness was 98.1 percent among children who received their 5th dose within the past year
long term effectiveness – children who were five or more years past their last DTaP dose – was about 71 percent
children who had never received any doses of DTaP (unvaccinated children) faced odds of having whooping cough at least eight times higher than children who received all five doses
It is also important to note that the high rates seen in 2010 in California are still well below the rates that were seen in the pre-vaccination era, when the attack rate of pertussis in the United States was as high as 157 per 100,000 people, with about 200,000 cases a year.
What’s the answer?
“The present “resurgence of pertussis” is mainly due to greater awareness and the use of PCR for diagnosis. There are also many other factors which have contributed to the “resurgence.” New vaccines are clearly needed; with our present vaccines (DTaP and adolescent and adult formulated tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)), if used correctly, severe pertussis and deaths in infants can be prevented.”
James D. Cherry, MD on The History of Pertussis (Whooping Cough); 1906 – 2015: Facts, Myths, and Misconceptions
It certainly isn’t for more kids to follow non-standard, parent-selected, delayed protection vaccine schedules or to simply skip vaccines all together. Since natural immunity isn’t going to keep newborns and infants from getting pertussis, the ages which are most at risk for life-threatening infections, they can catch pertussis from people around them, including those working on their natural immunity. Natural infections don’t even provide life-long protection against pertussis, as some people believe. That natural immunity wanes fairly quickly too.
The future of pertussis control is more likely going to be in maximizing our current vaccination program, including getting more teens and adults to get the Tdap vaccine, especially when women are pregnant.
That’s the best strategy, at least until new pertussis vaccines are developed. It provides a lot of benefits. According to the CDC, like with the flu vaccine, when you get a pertussis vaccine, in addition to protecting yourself and those people around you, “people who do catch whooping cough after being vaccinated are much less likely to be hospitalized or die from the disease.”
Unfortunately, not everyone has gotten the message. And because of waning immunity, children who aren’t vaccinated against pertussis can’t “hide in the herd” and rely on the rest of us who do vaccinate our children to provide them with protection. Instead, since they are at a higher risk, they get pertussis and get even more people sick.
In one study, Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children, researchers found that “vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors, and 11% of pertussis cases in the entire study population were attributed to vaccine refusal.” The highly contagious nature of pertussis then means every primary case is probably going to infect as many as 17 other people. That’s why it makes sense that higher rates of children using vaccine exemptions could be at least one of the factors in these outbreaks.
In fact, several studies, including, Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis, found that “geographic pockets of vaccine refusal are associated with the risk of pertussis outbreaks in the whole community.”
Many factors are responsible for the rise in pertussis outbreaks in recent years, but it is clear that being unvaccinated and unprotected put you at greatest risk for getting pertussis and passing it on to others.
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.
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.