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November 14, 1990

Pertussis Vaccine Encephalopathy-Reply

Author Affiliations

Vanderbilt University School of Medicine Nashville, Tenn

Vanderbilt University School of Medicine Nashville, Tenn

JAMA. 1990;264(18):2385-2386. doi:10.1001/jama.1990.03450180039020

In Reply.—  We agree that our data do not prove DTP immunization never causes encephalopathy; our study of 38 171 children with 107154 immunizations did not have sufficient power to detect rare events. However, the consistency of our findings with those of two other recent controlled studies of this question1,2 led us to comment that if there are encephalopathies caused by DTP immunization, they must be rare. We disagree with the presumption of Tilelli and Manniello that it is established that DTP immunization can cause encephalopathies. Uncontrolled case reports and observations by individual pediatricians do not constitute a scientific basis for establishing causality. The information cited from the 1986 "Redbook"3 is based on the British National Childhood Encephalopathy Study; recent reanalysis of these data4 have cast doubt on the original finding of an association between DTP immunization and permanent neurological damage. Thus, the extant data are