Hypotonic-hyporesponsive episode

Hypotonic-hyporesponsive episode (HHE)
Symptoms	Hypotonia, hyporesponsiveness, pallor, cyanosis.[1][2]
Usual onset	1 minute to 48 hours post-vaccination.[1]
Duration	1 minute to 14 days (median 10 hours).[1]
Causes	Vaccination, most commonly pertussis vaccine.[1]
Diagnostic method	Based on symptoms.[1][3]
Differential diagnosis	Vasovagal syncope, seizure
Prevention	Those who experience an HHE after pertussis vaccination may avoid further pertussis vaccines.[1][4]
Treatment	Usually resolves on its own, management involves checking the airway, breathing, and circulation, and hospitalization for observation and to rule out other conditions.[5][1][6]
Deaths	None reported

A hypotonic-hyporesponsive episode (HHE) is defined as sudden onset of poor muscle tone, reduced consciousness, and pale or bluish skin occurring within 48 hours after vaccination, most commonly pertussis vaccination.[2] An HHE is estimated to occur after 1 in 4,762 to 1 in 1,408 doses of whole cell pertussis vaccine, and after 1 in 14,286 to 1 in 2,778 doses of acellular pertussis vaccine.[3]

References

"Hypotonic, hyporesponsive episode (HHE)" (PDF). 7 January 2006. Retrieved 2018-01-24.
"Hypotonic–Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996–1998 | ELECTRONIC ARTICLE". Pediatrics. Retrieved 2018-01-22.
"Hypotonic-hyporesponsive episode (HHE) as an adverse event following immunization in early childhood: Case definition and guidelines for data collection, analysis, and presentation | Jan Bonhoeffer". Academia.edu. Retrieved 2018-02-01.
"Pinkbook | Pertussis | Epidemiology of Vaccine Preventable Diseases". CDC. Retrieved 2018-01-24.
http://www.medsafe.govt.nz/profs/puarticles/8.htm
"Hypotonic–Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996–1998 | ELECTRONIC ARTICLE". Pediatrics. Retrieved 2018-01-24.

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[tide-1] "Hypotonic, hyporesponsive episode (HHE)" (PDF). 7 January 2006. Retrieved 2018-01-24.

[aappublications-2] "Hypotonic–Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996–1998 | ELECTRONIC ARTICLE". Pediatrics. Retrieved 2018-01-22.

[academia.edu-3] "Hypotonic-hyporesponsive episode (HHE) as an adverse event following immunization in early childhood: Case definition and guidelines for data collection, analysis, and presentation | Jan Bonhoeffer". Academia.edu. Retrieved 2018-02-01.

[cdc-4] "Pinkbook | Pertussis | Epidemiology of Vaccine Preventable Diseases". CDC. Retrieved 2018-01-24.

[5] ttp://www.medsafe.govt.nz/profs/puarticles/8.htm

[aappublications2-6] "Hypotonic–Hyporesponsive Episodes Reported to the Vaccine Adverse Event Reporting System (VAERS), 1996–1998 | ELECTRONIC ARTICLE". Pediatrics. Retrieved 2018-01-24.