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November 14, 1990

Pertussis Vaccine Encephalopathy

JAMA. 1990;264(18):2385. doi:10.1001/jama.1990.03450180039019

To the Editor.—  We read with interest the article by Griffin et al1 that recently appeared in JAMA and concur with the authors that the incidence of encephalopathy with permanent neurological sequelae after diphtheria-tetanus-pertussis (DTP) immunization is low, and is probably lower than that calculated from the often-quoted British National Childhood Encephalopathy Study.2 These data reinforce the conclusion that DTP vaccination is safe in an overwhelming number of children. We believe, however, that it is hazardous to draw the conclusion, as the authors do, that DTP immunization might never cause permanent neurological disease. The absence in this population of unexplained encephalopathy does not help to reconcile the reports of such events in the case literature and of their continued observation by individual pediatricians. It has been suggested that most of these events are coincidental occurrences,3 but none were observed in this prospective study: their absence does not