Journal of Pediatrics
March 2015 Volume 166, Issue 3, p507-782
http://www.jpeds.com/current

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Explaining alleged pertussis vaccine associated neurologic disorders
Sarah S. Long, MD
DOI: http://dx.doi.org/10.1016/j.jpeds.2015.01.010
Extract
In 1986, the National Childhood Vaccine Injury Act established the Vaccine Injury Compensation Program to compensate children and adults or to adjudicate claims of injury related to vaccines. Along with such benefits, healthcare providers who administer vaccines are mandated to maintain vaccination records and to report certain adverse events associated with covered immunizations. In this issue of The Journal, investigators from Children’s National Medical Center, the Division of Vaccine Injury Compensation of the Department of Health and Human Services, and the National Institute of Neurologic Disorders of the National Institutes of Health report the findings of 165 claims of children younger than 2 years of age with seizures or encephalopathy as an alleged vaccine-related injury from 1995 through 2005.

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Post-Licensure Monitoring to Evaluate Vaccine Safety
Annabelle de St Maurice, MD
Division of Infectious Diseases, Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee
Kathryn M. Edwards, MD
Division of Infectious Diseases, Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee
DOI: http://dx.doi.org/10.1016/j.jpeds.2014.12.031
Extract
Pertussis, or whooping cough, is caused by a gram-negative rod, Bordetella pertussis. Typically, pertussis causes a respiratory illness characterized by prolonged cough in adults and children. In infants, it can be complicated by apnea, pneumonia, pulmonary hypertension, and neurologic symptoms, including encephalopathy and seizures. Prior to the introduction of pertussis vaccine in the US, there were about 157 cases of pertussis per 100 000 people each year, with 1.5 deaths per 1000 infants less than 1 year of age.

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Seizures, Encephalopathy, and Vaccines: Experience in the National Vaccine Injury Compensation Program
Tarannum M. Lateef, MD, MPH, Rosemary Johann-Liang, MD, Himanshu Kaulas, MD, Rakibul Hasan, MD, Karen Williams, MS, Vito Caserta, MD, Karin B. Nelson, MD
Received: May 20, 2014; Received in revised form: September 12, 2014; Accepted: October 22, 2014; Published Online: December 02, 2014
DOI: http://dx.doi.org/10.1016/j.jpeds.2014.10.054
Abstract
Objectives
To describe the demographic and clinical characteristics of children for whom claims were filed with the National Vaccine Injury Compensation Program (VICP) alleging seizure disorder and/or encephalopathy as a vaccine injury.
Study design
The National VICP within the Department of Health and Human Services compensates individuals who develop medical problems associated with a covered immunization. We retrospectively reviewed medical records of children younger than 2 years of age with seizures and/or encephalopathy allegedly caused by an immunization, where a claim was filed in the VICP between 1995 through 2005.
Results
The VICP retrieved 165 claims that had sufficient clinical information for review. Approximately 80% of these alleged an injury associated with whole-cell diphtheria, pertussis (whooping cough), and tetanus or tetanus, diphtheria toxoids, and acellular pertussis vaccine. Pre-existing seizures were found in 13% and abnormal findings on a neurologic examination before the alleged vaccine injury in 10%. A final diagnostic impression of seizure disorder was established in 69%, of whom 17% (28 patients) had myoclonic epilepsy, including possible severe myoclonic epilepsy of infancy. Specific conditions not caused by immunization, such as tuberous sclerosis and cerebral dysgenesis, were identified in 16% of subjects.
Conclusion
A significant number of children with alleged vaccine injury had pre-existing neurologic or neurodevelopmental abnormalities. Among those developing chronic epilepsy, many had clinical features suggesting genetically determined epilepsy. Future studies that include genotyping may allow more specific therapy and prognostication, and enhance public confidence in vaccination.