A 3-month-old infant receives the third dose of pentavalent vaccine (DTwP+HiB+HepB). Two hours later, the infant develops a high-pitched inconsolable cry lasting 4 hours, fever of 40.5°C, and the limbs become flaccid (hypotonic hyporesponsive episode). What is the appropriate action for subsequent vaccination?
- A Permanently discontinue all pertussis-containing vaccines; complete schedule with DT only
- B Continue with DTwP for remaining doses but premedicate with paracetamol
- C Switch to acellular pertussis (DTaP)-containing vaccines for remaining doses; whole-cell pertussis is contraindicated ✓
- D Give DTaP + IPV as a replacement; HiB and HepB components are contraindicated
Correct answer: C. Switch to acellular pertussis (DTaP)-containing vaccines for remaining doses; whole-cell pertussis is contraindicated
Explanation
A hypotonic-hyporesponsive episode (HHE) following whole-cell pertussis (DTwP) vaccine is a precaution — not an absolute contraindication — to further whole-cell pertussis vaccination. The recommended approach is to switch to acellular pertussis (DTaP) for all subsequent doses, as DTaP has a significantly lower incidence of HHE, fever, and local reactions. Permanently discontinuing all pertussis vaccine is not recommended as pertussis protection is essential. There is no contraindication to HiB or HepB components.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.