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The Brighton Collaboration (BC) HHE Working Group - in developing a case definition for HHE - described diagnostic algorithms with three levels of certainty based on clinical observations at the time of the episode:"],"label":[],"synonym":[],"obsolete":false,"prefixIRI":null,"subClassOf":[],"xref":null,"inScheme":[],"created":null,"modified":null,"memberOf":[],"altLabelXl":[],"hiddenLabelXl":[],"parents":[],"prefLabelXl":[],"isInActiveScheme":[null],"isInActiveCollection":[],"properties":{"http://purl.bioontology.org/ontology/MEDDRA/SMQ_STATUS":["A"],"http://www.w3.org/1999/02/22-rdf-syntax-ns#type":["http://www.w3.org/2002/07/owl#Class"],"http://bioportal.bioontology.org/ontologies/umls/tui":["T185"],"http://www.w3.org/2004/02/skos/core#notation":["20000211"],"http://purl.bioontology.org/ontology/MEDDRA/SMQ_LEVEL":["1"],"http://bioportal.bioontology.org/ontologies/umls/hasSTY":["http://purl.bioontology.org/ontology/STY/T185"],"http://purl.bioontology.org/ontology/MEDDRA/SMQ_ALGO":["A or (B and C and D)"],"http://purl.bioontology.org/ontology/MEDDRA/SOS":["NOTE: The Brighton Collaboration (BC) definition specifically states that there are no laboratory studies that are helpful in confirming the diagnosis of HHE. 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Hypotonic-hyporesponsive episode (HHE) as an adverse event following immunization in early childhood: case definition and guidelines for data collection, analysis, and presentation. Vaccine 2007; 25: 5875 - 5881. DuVernoy, TS, Braun, MM and the VAERS Working Group. Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998. Pediatrics 2000; 106(4): e52. Cody CL, Baraff LJ, Cherry JD, Marcy SM, Manclark CR. Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children. Pediatrics. 1981;68(5):650-659. Daptacel(r) [package insert]. Toronto, Ontario, Canada: Sanofi Pasteur Limited; 2008. Recombivax(r) [package insert]. Whitehouse Station, NJ: Merck & Co, Inc.; 2007"],"http://www.w3.org/2004/02/skos/core#definition":["Hypotonic-hyporesponsive episode (HHE) is characterized by:sudden onset of reduced muscle tone; hyporesponsiveness (to verbal or other stimuli)' changed skin color (pallor, cyanosis). 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