A 3-month-old infant receives her second dose of DPT-HepB-Hib pentavalent vaccine. Six hours later, she develops persistent inconsolable crying (>3 hours duration), high-pitched cry, temperature of 39.2°C, and a hypotonic-hyporesponsive episode lasting approximately 15 minutes. Which of these adverse events is classified as a contraindication to further doses of whole-cell pertussis-containing vaccines?

• A Temperature of 39.2°C within 48 hours of vaccination
• B Persistent inconsolable crying >3 hours within 48 hours
• C Injection site induration >3 cm within 48 hours
• D Hypotonic-hyporesponsive episode (HHE) within 48 hours ✓

Explanation

A hypotonic-hyporesponsive episode (HHE) — characterized by sudden onset of hypotonia, pallor or cyanosis, and reduced responsiveness within 48 hours of pertussis-containing vaccine — is classified as a precaution/relative contraindication to further doses of whole-cell pertussis vaccine (wP). While the evidence shows HHE is self-limiting and no deaths have been attributable to it, the standard practice is to switch to acellular pertussis (aP) vaccine if available for subsequent doses. High fever (≥40°C within 48 hours), persistent screaming, and convulsions are also recognized adverse events, but HHE specifically is the recognized severe adverse event that prompts vaccine type change.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.