November 14, 1990

Pertussis Vaccine Encephalopathy

Author Affiliations

Beverly Hills, Calif

Beverly Hills, Calif

JAMA. 1990;264(18):2384-2385. doi:10.1001/jama.1990.03450180039017

To the Editor. —  There is scarcely a subject in pediatric neurology that has evoked more controversy among both professional and lay groups than the neurological complications that have been encountered following pertussis immunization. It would therefore have been prudent on the part of The Journal to provide its readers with more than one point of view.Cherry,1 in his editorial, calls for an end to the "myth of pertussis vaccine encephalopathy." Before we heed his call, the following facts must be considered.Pertussis toxin, whose concentration in pertussis vaccine varies from one batch to the next, is not a harmless substance. It can attach itself to neuronal membrane receptors and by adenosine diphosphate—ribosylation modify the adenylate cyclase system in such a way as to impair the action of inhibitory neurotransmitters and enhance the action of excitatory neurotransmitters.2,3 Whereas in the vast majority of instances the blood-brain barrier