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Epilepsy and Immunizations
Q: Is it safe for a child diagnosed with idiopathic epilepsy and taking seizure medication to receive his five-year-old immunization?
A: This is a very good question as the DTP vaccine has stimulated lots of discussion and controversy over the years. Pertussis, also known as whooping cough, still occurs in the United States, so the benefits of giving the shot must be weighed against any perceived risks. There is believed to be no direct causal relationship between seizures and pertussis vaccine.
Your child carries the diagnosis of epilepsy and he/she apparently is well controlled from a seizure perspective. Although there is an increased risk of post-vaccination seizures after DTP, there is no evidence that pertussis immunization causes permanent brain damage or epilepsy. DTaP is now more commonly used than DTP because it is less likely to cause side effects like fever. This is important because most DTP-associated seizures after vaccine occur with fever.
In general, one might also choose to NOT give any further pertussis immunization to children who have had any of the following reactions -- an immediate anaphylactic (severe allergic) response, those who develop a disease of the central nervous system without a definite cause (encephalopathy) within seven days, those who had a seizure within three days, those with severe, inconsolable screaming or crying for three or more hours within two days, those with fever to 104.90F or higher within 48 hours, or those with a shocklike state within 48 hours.
For kids with certain types of underlying neurologic disorders, a joint decision between a child's parent(s) and the child's doctor should be made. If a child's neurologic problem is advancing; I would recommend not getting it. If it is stable or the symptoms are actually improving over time, I would reconsider.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.