Czajka Hanna, Wysocki Jacek
Wojewódzka Poradnia Szczepień Ochronnych, Krakowski Szpital Specjalistyczny im. Jana Pawła II w Krakowie.
Neurol Neurochir Pol. 2004;38(1 Suppl 1):S17-24.
The combined vaccine against diphtheria, tetanus and pertussis containing the whole cell component of pertussis (DPTw) is characterized by high effectiveness but is also one of the most reactogenic vaccines. Adverse events following this vaccine includes a hypotonic-hyporesponsive episode, however this episode is not well known to general practitioners and pediatricians, so the data about its incidence are not reliable. The aim of this study was to characterize the clinical features of HHE following DTPw vaccine, to estimate the ability to diagnose this syndrome by GPs and pediatricians and to assess the registration system of HHE in Poland. The studied group consisted of 49 children, patients of the Regional Consultation Polyclinic in Kraków in the years 1997-2002, in whom HHE was diagnosed. The following were analysed: sex and age, interval between vaccination and HHE, relationship to the number of DTPw doses, duration of HHE and, based on the referral, the diagnosis made by a GP. The average age of children at the moment of HHE was 3.4 months, but 46/49 children were under 6 months. The symptoms of HHE occurred after a few minutes to 48 hours after vaccination and in two children similar episodes were observed on the 6th day after vaccination, which is not consistent with the definition of HHE. Most often HHE was observed after the first (21/49) and the second (16/49) dose of DTPw. In two children HHE occurred twice, after two consecutive doses of DTPw. In four cases only GPs referring patients have diagnosed HHE. Thirty children from the studied group were further vaccinated against diphtheria, tetanus and pertussis. 61 doses of DTPa (a vaccine with acellular pertussis component) were used and in no case was the adverse event observed. Based on the results obtained it has been concluded that some difficulties are observed in the diagnosis of HHE made by GPs and pediatricians, therefore the number of HHE cases registered in Poland decreased. Hypotonic-hyporesponsive episode should be taken into consideration in differential diagnosis of the nervous system diseases. Therefore, it is extremely important to ask parents about the history of vaccinations in their children.
含有百日咳全细胞成分的白喉、破伤风和百日咳联合疫苗（DPTw）具有高效性，但也是反应原性最强的疫苗之一。接种该疫苗后的不良事件包括低张性低反应发作，然而，全科医生和儿科医生对这一发作并不十分了解，因此关于其发病率的数据并不可靠。本研究的目的是描述接种DPTw疫苗后低张性低反应发作（HHE）的临床特征，评估全科医生和儿科医生诊断该综合征的能力，并评估波兰HHE的登记系统。研究组由1997年至2002年期间在克拉科夫地区咨询综合诊所就诊且被诊断为HHE的49名儿童组成。分析了以下内容：性别和年龄、接种疫苗与HHE之间的间隔、与DPTw剂量数的关系、HHE的持续时间，以及根据转诊情况，全科医生做出的诊断。HHE发生时儿童的平均年龄为3.4个月，但49名儿童中有46名年龄在6个月以下。HHE症状在接种疫苗后几分钟至48小时出现，有两名儿童在接种疫苗后第6天出现了类似发作，这与HHE的定义不符。HHE最常出现在第一剂（49例中有21例）和第二剂（49例中有16例）DPTw接种后。有两名儿童在连续两剂DPTw接种后HHE发作了两次。在4例病例中，只有转诊患者的全科医生诊断出了HHE。研究组中的30名儿童进一步接种了白喉、破伤风和百日咳疫苗。使用了61剂DTPa（一种含有无细胞百日咳成分的疫苗），未观察到任何不良事件。根据获得的结果得出结论，全科医生和儿科医生在诊断HHE方面存在一些困难，因此波兰登记的HHE病例数量有所下降。在神经系统疾病的鉴别诊断中应考虑低张性低反应发作。因此，询问家长孩子的疫苗接种史极其重要。
