Page 19

of immunization, the first published report of serious adverse effects after pertussis vaccination. In the same year, Sauer of Northwestern University Medical School in Chicago described minor reactions to a whole-cell pertussis vaccine being used in the United States (Sauer, 1933a,b).

In the late 1940s, the first published reports of irreversible or chronic neurologic damage following vaccination against pertussis appeared (Brody and Sorley, 1947; Byers and Moll, 1948). Brody and Sorley reported only one case, but their report led to the first warnings that pertussis vaccine should not be administered to those with a known neurologic disorder.

In Britain in 1974, questions about the safety of pertussis vaccines were widely publicized in the popular press after newspaper accounts of a study suggesting adverse reactions (Kulenkampff et al., 1974), and an Association of Parents of Vaccine Damaged Children was formed (Alderslade et al., 1981). Between 1974 and 1978, the proportion of British children vaccinated against pertussis fell from 80 to 30 percent, on average, dropping as low as 9 percent in some areas (British Medical Journal, 1981). An epidemic of pertussis subsequently occurred; between 1977 and 1979, more than 100,000 cases and 36 deaths were reported (Koplan and Hinman, 1987).

The controversy over the safety of pertussis vaccines reached the U.S. public in 1982, when the television program, "DPT: Vaccine Roulette," was first broadcast by NBC affiliate WRC-TV in Washington, D.C. The program depicted children with severe injury allegedly caused by pertussis vaccines (Griffith, 1989; Koplan and Hinman, 1987). Following broadcast of that program, an advocacy group, Dissatisfied Parents Together, was formed in the United States. Its members called for research toward a safer pertussis vaccine and mandatory reporting of adverse reactions. Some members of the group called for a cessation of the use of whole-cell vaccines (Coulter and Fisher, 1985; Koplan and Hinman, 1987).

For additional information on the controversy surrounding pertussis wholecell vaccines, see Appendix B, Pertussis and Rubella Vaccines: A Brief Chronology.

RUBELLA VACCINES

Epidemiology of the Disease Rubella

Clinical Description

Rubella is commonly a mild disease; it afflicts children and young adults. It is characterized by an erythematous, maculopapular, discrete rash; postauricular and suboccipital lymphadenopathy; and minimal fever (American Academy of Pediatrics, 1986). The disease is caused by an RNA virus belonging to the togavirus family. It can be transmitted transplacentally to the fetus, sometimes with devastating results (Berkow, 1987).