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November 14, 1990

Pertussis Vaccine Encephalopathy

Author Affiliations

East Williston, NY

East Williston, NY

JAMA. 1990;264(18):2385. doi:10.1001/jama.1990.03450180039018

7b the Editor.—  It seems that Dr Cherry1 almost misses the point of the pertussis vaccine controversy. In the last line of his editorial he states, "New vaccines are needed... to decrease the many disquieting reactions such as high fever, persistent uncontrollable crying, and hypotonic, hyporesponsive state, that do occur...."That is the point. Because an infant cannot ever describe an awful headache, the infant would behave in exactly the "disquieting" manner that Dr Cherry describes. Like most diagnoses in medicine, encephalopathy is a clinical diagnosis. At this point in medicine, no computed tomographic scan, magnetic resonance imaging, or spinal tap could really prove the diagnosis. What is clear is that those babies reacting to the pertussis vaccine are sick and probably do have an encephalopathy. Most physicians do recognize that a sequence of events does not mean that one event caused a subsequent event, but clinical diagnosis is