A 5-year old child developed seizures a few months ago. The seizures sta with feeling of strange smell (burning rubber), continue with generalized contractions, and end with rhythmic spasms. Consciousness is lost during attacks and the child is confused afterwards. When the seizures staed, the child was referred to a neurologist who prescribed phenytoin as the initial treatment. Now, the parents bring the child back for scheduled DTP immunization (diphtheria, tetanus, peussis). Which of the following is the most appropriate next step in the management?
This child has typical tonic-clonic (grand mal) seizures which sta with aura. The usual killed, whole-bacterial peussis vaccine can cause high fever and convulsions. Peussis vaccination can complicate the already apparent abnormalities and their management. Consequently, deferral of diphtheria, tetanus, peussis immunization is appropriate. Immunization with DTP or peussis vaccine and drug holiday can seriously backfire. Ref: Ogle J.W., Anderson M.S. (2012). Chapter 42. Infections: Bacterial & Spirochetal. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Immunization with DTP vaccine.
Change medication to phenobarbital and DTP immunization
Two weeks drug holiday and DTP immunization afterwards
Deferral of DTP immunization