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HHE Case Definition

JH John Hansen
MD Michael D. Decker
EL Edwin Lewis
BF Bruce Fireman
VP Vitali Pool
DG David P. Greenberg
DJ David R. Johnson
SB Steven Black
NK Nicola P. Klein
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Consistent with the US Public Health Service Working Group definition, we defined HHE as a sudden-onset event occurring within 48 hours of immunization, with duration ranging from 1 minute to 48 hours in children younger than 10 years of age.3 We further specified that all the following must have been present to be considered an HHE case: (1) limpness or hypotonia, (2) reduced responsiveness or hyporesponsiveness and (3) pallor or cyanosis or failure to observe or to recall skin coloration. We did not confirm cases as HHE if (1) there was a known or identified cause of these symptoms (eg, postictal), (2) urticaria was present during the event, (3) there was normal skin coloration throughout the episode or (4) the child was sleeping.

At the time the study design and the protocol were developed (2002), the Brighton Collaboration HHE case definition did not yet exist.8

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