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September 1994

Well-Child Services for the Child Who Is Never 'Well': Implications for Clinical Practice-Reply

Arch Pediatr Adolesc Med. 1994;148(9):990-991. doi:10.1001/archpedi.1994.02170090103020

We thank Dr Rappo for his comments and appreciate the opportunity to respond.

The use of pertussis vaccine in children with neurologic problems has been hotly debated since the vaccine was introduced. In 1949, Dr Toomey1 evaluated the risk of neurotoxic reaction to pertussis vaccine and recommended that children with a family or personal history of seizures or any central nervous system problem not receive the pertussis vaccine. In 1953, Dr Melin2 suggested that Dr Toomey's seizure restrictions were too severe and that the risk of pertussis outweighed the risk of the vaccine in children with a seizure disorder. There are few additional data beyond these anecdotal reports about the risk of pertussis vaccine in neurologically impaired children, although we know the risk of pertussis vaccine is very low in healthy children.3 The introduction of new acellular vaccine products may further lower the risk.

Dr Rappo describes