Originally posted by aldra
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"Of the remaining 32 cases, the vaccination history was available. Of these, 7 infants (21.9%) received immunization within 7 days of death, and 8 (25.0%) received immunization from 8 to 28 days before death (Table 1). Of 11 infants younger than 6 months who received vaccination, 4 (36.4%) had received some vaccinations within 7 days."
ORIGINAL ARTICLES
Sudden Infant Death After Vaccination
Survey of Forensic Autopsy Files
Osawa, Motoki MD, PhD; Nagao, Ryoko MD, PhD; Kakimoto, Yu MD, PhD; Kakiuchi, Yasuhiro MD, PhD; Satoh, Fumiko MD, PhDAuthor Information
The American Journal of Forensic Medicine and Pathology: September 2019 - Volume 40 - Issue 3 - p 232-237
doi: 10.1097/PAF.0000000000000494
OPEN
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Abstract
Sudden infant deaths might be attributable to adverse reaction to vaccination, but separating them from coincidental occurrences is difficult. This study retrospectively investigated vaccination-related details and postmortem findings for 57 cases of sudden death in children 2 years or younger. Data were extracted from autopsy files at the Department of Forensic Medicine, Tokai University School of Medicine. Vaccination histories were available in 50 cases based on the maternity passbook. Of the 32 cases in which any vaccines were administered, 7 infants (21.9%) had received immunization within 7 days of death. The most frequent vaccine cited as the last immunization before death was Haemophilus influenzae B. Although a temporal association of vaccines with sudden death was present for two 3-month-old and one 14-month-old infants in whom death occurred within 3 days of receiving the H. influenzae type b and other vaccinations, a definitive relationship between the vaccine and death could not be identified. Histopathological examinations revealed pneumonia and upper respiratory infection as contributing to death in their cases. Moreover, all 3 cases showed hemophagocytosis in the spleen and lymph nodes, which are similar features to hemophagocytic lymphohistiocytosis. Judgment of the disorders as truly related to vaccination is difficult, but suspicious cases do exist. Forensic pathologists must devote more attention to vaccination in sudden infant death cases.
Sudden infant death (SID) usually occurs during the course of normal development and before revealing clinical symptoms, unlike cases in adults where the cause of death often can be inferred based on the clinical data and history.1 Therefore, various disorders from abuse to congenital disease must be differentiated in SID cases.2 To elucidate the etiological background, a sheet of more than 30 check points of settings has been used in Japan.3 Vaccination history is included among the major points.
For unknown causes of SID, attributable factors have been sought from various approaches. For instance, forensic autopsy cases of unexpected simultaneous twin deaths have been investigated extensively.4,5 Roberts6 demonstrated such a twin death, which occurred a couple of hours after diphtheria, tetanus and pertussis (DTP) vaccination, speculating that the immunization potentially gives a clue for the attributable factors. Another case report described twins found dead simultaneously after combined vaccine including DTP.7 Forensic autopsy has also revealed sudden death after DTP with mast cell increase as a relation to vaccination.8 By contrast, several large-scale studies have revealed that increased DTP immunization coverage is associated with decreased sudden infant mortality.9–14 Therefore, most SID syndrome (SIDS) cases are regarded as merely coincident, with no particular relation to DTP vaccination.15
Nevertheless, in 2011, 7 fatal incidents occurred in short order after combined immunization with Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in Japan.16 Because some relation was suspected, vaccination was discontinued temporarily. Based on the Preventive Vaccination Act, Japan has a system to notify the Pharmaceuticals and Medical Devices Agency when a critical side effect is suspected. Forensic pathologists receive detailed knowledge about the circumstances preceding death from police officers, but they usually do not devote much attention to the vaccination history unless parents claim adverse effects of vaccination. The number of licensed vaccines has increased to the present day, and they are administrated simultaneously.17,18 It might be difficult to show evidence of adverse effect despite their potential incidence.19 Presumably, most SIDS subjects younger than 6 months should inevitably receive vaccination. However, few data have been forthcoming related to how close to the time of death they were vaccinated and which kinds of vaccines were used.
We retrospectively extracted cases of medicolegal autopsy of death after vaccination from infant autopsy reports of the last 5 years. We first present the rate of death within 28 days after vaccination among SID cases, which include subjects younger than 2 years in the present study. In addition, 3 cases in which infants died within 3 days are described. Suspected adverse reactions are highlighted and explored.
MATERIALS AND METHODS
From autopsy cases conducted at the Department of Forensic Medicine, Tokai University School of Medicine, in 5 years (2013–2017), 57 cases of sudden death in infants younger than 2 years were reviewed, excluding deaths that were reasonably attributable to external causes such as abuse or burns. Data from clinical and laboratory examinations done in the emergency department, investigations conducted by police, the maternity record book, and other materials were used. In Japan, a record of received vaccines is noted in a maternity passbook kept by the mother, which includes all medical and welfare records of the mother and her baby. For this study, we obtained vaccination course information from these passbooks, which were available for all but 7 infants. This project was approved by the Ethics Committee of Tokai University School of Medicine as a retrospective clinical study (no. 16-281).
The series of autopsy was performed as reported previously.20,21 Briefly, tissue examination was performed for formalin-fixed organs using hematoxylin and eosin staining and microscopy, with special staining, such as Gram staining, as appropriate. Biochemical laboratory tests were applied for markers that are stable after death. However, only a few test items could be tested because of the limited amount of samples obtained from autopsy. Viral antibody titer was measured in the serum for adenovirus, influenza A and B viruses, coxsackievirus B, and cytomegalovirus. Bacterial culture was performed using laryngeal swabs, blood in the heart, or a lung section.
RESULTS
Survey of SID Cases in Forensic Autopsy
Fifty-seven cases (33 male, 24 female) of SID, which were subjected to medicolegal autopsy, were extracted, excluding those from extrinsic causes such as abuse. The age distribution is presented in Figure 1. The cause of death, as diagnosed separately by 4 forensic pathologists, was regarded as SIDS suspected in 20 cases, infectious pulmonary disorders including pneumonia in 10 cases, viral encephalopathy in 3 cases, enteritis and ileus in 3 cases, congenital heart anomaly in 2 cases, potential asphyxia in 2 cases, and unknown cause in 17 cases.
FIGURE 1
FIGURE 1: Age distribution and days after their last vaccine of 57 SID cases of autopsy for 5 years.
Their vaccination history was confirmed in 50 cases based on passbook records, but such data were not available for 7. Eighteen infants younger than 2 months received no immunization. For the remaining 32 cases, the vaccination history was available. Of these, 7 infants (21.9%) received immunization within 7 days of death, and 8 (25.0%) received immunization from 8 to 28 days before death (Table 1). Of 11 infants younger than 6 months who received vaccination, 4 (36.4%) had received some vaccinations within 7 days.
Table 2 summarizes vaccines that infants were administered within the last 7 days and last 28 days before death. It was characterized that the most frequently administered vaccine in single or combined immunizations was Hib, occurring in 5 (71%) of the 7 infants who received vaccines within 3 days of death and 12 (80%) of 15 infants who received vaccines within 28 days of death. Among these cases, a temporal relationship to vaccination was considered at the time of autopsy for 3 infants (cases 1–3) because their death occurred within 3 days after vaccination. Moreover, they all had received Hib as the last vaccination. All exhibited similar courses as described hereinafter."
https://journals.lww.com/amjforensicmedicine/Fulltext/2019/09000/Sudden_Infant_Death_After_Vaccination__Survey_of.5.aspx
