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Hypotonic-hyporesponsive episode

MedGen UID:
810616
•Concept ID:
C0549384
•
Pathologic Function
Synonym: Hypotonic-Hyporesponsive Episode
SNOMED CT: Hypotonic-hyporesponsive episode (890091002)

Definition

Acute onset of unresponsiveness or diminished level of consciousness, associated with loss of muscle tone and pallor or cyanosis, that occurs within 48 hours after childhood immunizations. It is primarily associated with pertussis-containing vaccines administered to children under two years of age. [from NCI]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVHypotonic-hyporesponsive episode

Professional guidelines

PubMed

ADVANCE system testing: Benefit-risk analysis of a marketed vaccine using multi-criteria decision analysis and individual-level state transition modelling.
Bollaerts K, Ledent E, de Smedt T, Weibel D, Emborg HD, Danieli G, Duarte-Salles T, Huerta-Alvarez C, Martín-Merino E, Picelli G, Tramontan L, Sturkenboom M, Bauchau V
Vaccine 2020 Dec 22;38 Suppl 2:B65-B75. Epub 2019 Oct 31 doi: 10.1016/j.vaccine.2019.09.034. PMID: 31677947
The Australian College of Paediatrics Policy Statement. Contraindications to immunization against pertussis.
J Paediatr Child Health 1994 Aug;30(4):310-1. PMID: 7946540

Recent clinical studies

Etiology

Hypotonic-hyporesponsive Episodes After Diphtheria, Tetanus and Acellular Pertussis Vaccination.
Hansen J, Decker MD, Lewis E, Fireman B, Pool V, Greenberg DP, Johnson DR, Black S, Klein NP
Pediatr Infect Dis J 2021 Dec 1;40(12):1122-1126. doi: 10.1097/INF.0000000000003308. PMID: 34420008Free PMC Article
Recurrence risk of a hypotonic hyporesponsive episode in two Australian specialist immunisation clinics.
Crawford NW, McMinn A, Royle J, Lazzaro T, Danchin M, Perrett KP, Buttery J, Elia S, Orr K, Wood N
Vaccine 2018 Oct 1;36(41):6152-6157. Epub 2018 Sep 6 doi: 10.1016/j.vaccine.2018.08.062. PMID: 30197281
Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review.
Zafack JG, De Serres G, Kiely M, Gariépy MC, Rouleau I, Top KA; Canadian Immunization Research Network
Pediatrics 2017 Sep;140(3) doi: 10.1542/peds.2016-3707. PMID: 28847985
Frequently asked questions on seven rare adverse events following immunization.
D'alò GL, Zorzoli E, Capanna A, Gervasi G, Terracciano E, Zaratti L, Franco E
J Prev Med Hyg 2017 Mar;58(1):E13-E26. PMID: 28515627Free PMC Article
Hypotonic-hyporesponsive episodes following pertussis vaccination: a cause for concern?
Gold MS
Drug Saf 2002;25(2):85-90. doi: 10.2165/00002018-200225020-00003. PMID: 11888351

Diagnosis

Non-ketotic hyperglycinaemia masquerading as a hypotonic-hyporesponsive episode following vaccination in an infant.
Prasad A, Kumar P, Marithammanahalli Faneesha G, Kumar C
BMJ Case Rep 2024 May 23;17(5) doi: 10.1136/bcr-2023-257093. PMID: 38782422
Surveillance of adverse events following immunization of 13-valent pneumococcal conjugate vaccine among infants, in Zhejiang province, China.
Hu Y, Pan X, Chen F, Wang Y, Liang H, Shen L, Chen Y, Lv H
Hum Vaccin Immunother 2022 Dec 31;18(1):2035141. Epub 2022 Mar 3 doi: 10.1080/21645515.2022.2035141. PMID: 35240930Free PMC Article
Hypotonic hyporesponsive episode and the 13-valent pneumococcal vaccine.
Fotis L, Vazeou A, Xatzipsalti M, Stamoyannou L
Turk J Pediatr 2014 Jul-Aug;56(4):427-9. PMID: 25818964
Hypotonic-hyporesponsive episodes following pertussis vaccination: a cause for concern?
Gold MS
Drug Saf 2002;25(2):85-90. doi: 10.2165/00002018-200225020-00003. PMID: 11888351
Report of a US public health service workshop on hypotonic-hyporesponsive episode (HHE) after pertussis immunization.
Braun MM, Terracciano G, Salive ME, Blumberg DA, Vermeer-de Bondt PE, Heijbel H, Evans G, Patriarca PA, Ellenberg SS
Pediatrics 1998 Nov;102(5):E52. doi: 10.1542/peds.102.5.e52. PMID: 9794982

Therapy

Hypotonic-hyporesponsive Episodes After Diphtheria, Tetanus and Acellular Pertussis Vaccination.
Hansen J, Decker MD, Lewis E, Fireman B, Pool V, Greenberg DP, Johnson DR, Black S, Klein NP
Pediatr Infect Dis J 2021 Dec 1;40(12):1122-1126. doi: 10.1097/INF.0000000000003308. PMID: 34420008Free PMC Article
Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review.
Zafack JG, De Serres G, Kiely M, Gariépy MC, Rouleau I, Top KA; Canadian Immunization Research Network
Pediatrics 2017 Sep;140(3) doi: 10.1542/peds.2016-3707. PMID: 28847985
Frequently asked questions on seven rare adverse events following immunization.
D'alò GL, Zorzoli E, Capanna A, Gervasi G, Terracciano E, Zaratti L, Franco E
J Prev Med Hyg 2017 Mar;58(1):E13-E26. PMID: 28515627Free PMC Article
Hypotonic hyporesponsive episode and the 13-valent pneumococcal vaccine.
Fotis L, Vazeou A, Xatzipsalti M, Stamoyannou L
Turk J Pediatr 2014 Jul-Aug;56(4):427-9. PMID: 25818964
Hypotonic-hyporesponsive episodes following pertussis vaccination: a cause for concern?
Gold MS
Drug Saf 2002;25(2):85-90. doi: 10.2165/00002018-200225020-00003. PMID: 11888351

Prognosis

Non-ketotic hyperglycinaemia masquerading as a hypotonic-hyporesponsive episode following vaccination in an infant.
Prasad A, Kumar P, Marithammanahalli Faneesha G, Kumar C
BMJ Case Rep 2024 May 23;17(5) doi: 10.1136/bcr-2023-257093. PMID: 38782422
Hypotonic-hyporesponsive episode in a 7-month-old infant after receipt of multiple vaccinations.
McPherson P, Powell KR
Pediatr Infect Dis J 2005 Nov;24(11):1010-1. doi: 10.1097/01.inf.0000183758.15605.68. PMID: 16282941
Clinical experience of a tricomponent acellular pertussis vaccine combined with diphtheria and tetanus toxoids for primary vaccination in 22,505 infants.
Schmitt HJ, Schuind A, Knuf M, Beutel K, Schulte-Wissermann H, Gahr M, Schult R, Folkens J, Rauh W, Bogaerts H, Bork HL, Clemens R
J Pediatr 1996 Nov;129(5):695-701. doi: 10.1016/s0022-3476(96)70152-x. PMID: 8917236
Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation.
Baraff LJ, Shields WD, Beckwith L, Strome G, Marcy SM, Cherry JD, Manclark CR
Pediatrics 1988 Jun;81(6):789-94. PMID: 3259305

Clinical prediction guides

Acute adverse events following immunization with DTP-HB-Hib pentavalent vaccine in the first year of life.
Izadi S, Mohammadi M, Sartipi M, Karami M, Karimi H
East Mediterr Health J 2023 Jan 19;29(1):6-14. doi: 10.26719/emhj.23.002. PMID: 36710609
Surveillance of adverse events following immunization of 13-valent pneumococcal conjugate vaccine among infants, in Zhejiang province, China.
Hu Y, Pan X, Chen F, Wang Y, Liang H, Shen L, Chen Y, Lv H
Hum Vaccin Immunother 2022 Dec 31;18(1):2035141. Epub 2022 Mar 3 doi: 10.1080/21645515.2022.2035141. PMID: 35240930Free PMC Article
Adverse Events Following Immunization in Brazil: Age of Child and Vaccine-Associated Risk Analysis Using Logistic Regression.
Lopes SRC, Perin JLR, Prass TS, Carvalho SMD, Lessa SC, Dórea JG
Int J Environ Res Public Health 2018 Jun 1;15(6) doi: 10.3390/ijerph15061149. PMID: 29865181Free PMC Article
Report of a US public health service workshop on hypotonic-hyporesponsive episode (HHE) after pertussis immunization.
Braun MM, Terracciano G, Salive ME, Blumberg DA, Vermeer-de Bondt PE, Heijbel H, Evans G, Patriarca PA, Ellenberg SS
Pediatrics 1998 Nov;102(5):E52. doi: 10.1542/peds.102.5.e52. PMID: 9794982
Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation.
Baraff LJ, Shields WD, Beckwith L, Strome G, Marcy SM, Cherry JD, Manclark CR
Pediatrics 1988 Jun;81(6):789-94. PMID: 3259305

Recent systematic reviews

Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review.
Zafack JG, De Serres G, Kiely M, Gariépy MC, Rouleau I, Top KA; Canadian Immunization Research Network
Pediatrics 2017 Sep;140(3) doi: 10.1542/peds.2016-3707. PMID: 28847985

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