Adacel and Neurologic disorder

The use of whole-cell pertussis vaccine has rarely been associated with the development of severe encephalopathies. Permanent brain damage and death have been reported. Although a causal relationship has not been established, caution is advised when pertussis vaccination is considered in patients with underlying neurologic disorders. The decision to administer or defer vaccination should be made on an individual basis after assessing the potential risks and benefits to the patient. Generally, the presence of a progressive, unstable, or evolving neurological disorder is considered a contraindication or reason to defer, sometimes permanently, vaccination with whole-cell pertussis vaccine. The use of acellular pertussis vaccine under these circumstances has not been evaluated but should probably be avoided as well. Infants and children with a history of seizures may be vaccinated, provided the seizures are well-controlled and not associated with a progressive or degenerative neurologic disorder. However, these patients have an increased risk of post-pertussis vaccination (within 48 hours) seizures and should receive acellular pertussis vaccine, since it is less frequently associated with moderate to high fever and thus, less likely to precipitate a seizure. Prophylactic antipyretic therapy (e.g., acetaminophen) is also recommended for the first 24 hours following vaccination. Patients with stable neurologic conditions, such as developmental delay or cerebral palsy, may receive pertussis vaccination. In any case, if pertussis immunization is withheld during the first year of life, immunization against diphtheria and tetanus may be withheld simultaneously because the risk of acquiring these conditions is low (in developed countries) in children under the age of 1 year who are nonambulatory.