Abstract
Background: The Hypotonic-Hyporesponsive Episode (HHE) is characterized by the sudden onset of reduced muscle tone, hyporesponsiveness and change of skin colour (pallor or cyanosis). It is reported mainly after the first doses of pertussis component vaccines and less frequently with other vaccines. The recognition and diagnosis are essential for correct management. Methods & Materials: Descriptive study of a retrospective case series was performed. All children diagnosed with HHE according to the Brighton Criteria, who consulted at the immunization area of a pediatric hospital between January 2010 and August 2017, were included. Variables analyzed: age, sex, medical history, vaccines received, dose, interval between immunization and HHE, symptoms, medical resources and the vaccination schedule follow up. Results: There were 13 cases, one of which was excluded due to insufficient data (category 4). The mean age was 3.5 months (range: 2-18). Ten of the episodes occurred after the 1st dose (83.3%). Eleven patients received pentavalent whole-cell vaccine (DTwPHibHB) and one, hexavalent (DTaPHibHBSalk). Symptoms were onset immediately in 3 patients; < 1 h in 1; 2- < 3hs in 1; 3- < 4hs in 2; 4- < 5hs in 2; 6- < 12hs in 1, 12 - < 24 hours in 2. Brighton Classification: category 1: five, 2: four and 3: three cases. Most frequent concomitant symptoms were: fever in 4 cases and irritability in 3. History of prematurity 2/12 cases, required medical consultation 10/12 and hospitalization 8/12. Evolution: 11 recovered completely and from 1 data were missed. Eight of the patients who were followed up continued with acellular vaccine, one with pentavalent whole-cell vaccine. None presented complications. Conclusion: All patients presented the EHH within 24 hours after the administration of pertussis component vaccines. HHE has been observed most frequently during the primary immunization series, mainly after the first dose (83.3%) and pentavalent vaccine. The recovery was complete and without sequelae in all cases. More than 80% required medical consultation and 67% hospitalization. The follow up of the schedule was not associated with recurrences of HHE or other complications
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