Pertussis encephalopathy

Introduction
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By Ravindra Kumar Garg MD

Pertussis encephalopathy is also known as or subsumes Whooping cough encephalopathy. -ed.

Bordetella pertussis causes some 20 to 40 million cases of pertussis per year and an estimated 200,000 to 400,000 fatalities each year. Severe complications include pneumonia, encephalopathy, and meningoencephalitis. Several neurologic complications have been associated with the pertussis vaccines. The whole-cell vaccines may lead to acute encephalopathy, seizures, hypotonic-hyporeactive episodes, inconsolable crying, or anaphylactic reactions. Whole-cell pertussis vaccines are more frequently associated with neurologic complications in comparison to more recent acellular vaccine. However, experts now believe that there is no convincing evidence proving an association between vaccine and persistent brain damage. Vaccine encephalopathy is, in fact, an inherited genetic defect of the SCN1A gene that codes for the voltage-gated neuronal sodium channel. Pertussis vaccination might trigger earlier onset of Dravet syndrome because of an SCN1A mutation. In fact, children who presented with earlier diagnoses of alleged vaccine encephalopathy in infancy were diagnosed years later with Dravet syndrome. Based on review of current literature, Dr. Ravindra Kumar Garg presents an overview focusing on pertussis encephalopathy and vaccine encephalopathy; in addition, he also discusses epidemiology, pathogenesis, pathology, diagnosis, and treatment of pertussis.

Key Points

  • Encephalopathy is a rare complication of pertussis.
  • Several neurologic complications have been described with the pertussis vaccines, particularly with whole-cell vaccines.
  • There is no convincing evidence proving an association between vaccine and persistent brain damage.
  • Vaccine encephalopathy is, in fact, an inherited genetic defect of the voltage-gated neuronal sodium channel gene.