Are We Sweeping DTP Contraindications Under the Rug?-Reply

Abstract

In Reply .—In expressing concern about the widespread use of prophylactic acetaminophen in children receiving DPT vaccine, Dr Brauer speculates on the possibility that acetaminophen might mask a harbinger of a subsequent severe reaction. However, as he correctly implies, no relationship between certain reactions to pertussis vaccine, such as fever and temporally associated neurological events (other than febrile convulsions), has been established. In fact, the risk of giving DPT vaccine to a child who has had a prior severe febrile reaction, ie, temperature greater than 40.5°C, has not been evaluated, and in all probability never will be. The reason DPT vaccine is contraindicated in such circumstances is based on the unproved but reasonable presumption that children with severe adverse reactions following immunization are more likely to have similar reactions on repeated vaccination. While acetaminophen may lessen the likelihood of a severe febrile reaction and prevent some convulsions, postvaccination seizures have not been