Sudden infant death syndrome (SIDS) shortly after hexavalent vaccination: another pathology in suspected SIDS?
Experts from panels of the European Agency for the Evaluation of Medical Products have investigated whether there might be a link between hexavalent vaccines and some cases of deaths that occurred. Participants included pathologists with experience in the field of vaccines and sudden infant death syndrome who conducted autopsies. However, to the best of our knowledge, little, if any, attention was paid to examination of the brainstem and the cardiac conduction systems on serial sections, nor was the possibility of a triggering role of the vaccine in these deaths considered. Herein we report the case of a 3-month-old female infant dying suddenly and unexpectedly shortly after being given a hexavalent vaccination. Examination of the brainstem on serial sections revealed bilateral hypoplasia of the arcuate nucleus. The cardiac conduction system presented persistent fetal dispersion and resorptive degeneration. This case offers a unique insight into the possible role of hexavalent vaccine in triggering a lethal outcome in a vulnerable baby. Any case of sudden unexpected death occurring perinatally and in infancy, especially soon after a vaccination, should always undergo a full necropsy study according to our guidelines.
KeywordsSudden infant death SIDS Hexavalent vaccine Arcuate nucleus hypoplasia Cardiac conduction system Prolonged external cardiac massage
The authors wish to express their gratitude to Mrs. Graziella Alfonsi for skillful technical cooperation.
This study was supported by the “Lino Rossi” Research Center for the study and prevention of unexpected perinatal death and sudden infant death syndrome (SIDS) funding (Rectorial Decree no. 225678 of 23/04/04) and by the Ministry of Foreign Affairs (joint project of particular relevance no. 269/P/0085087, “Anatomopathologic and genetic study of the unexplained perinatal death and SIDS”), Italy.
- 1.Atkinson JB, Virmani R (1991) The endomyocardial biopsy: techniques, indications and limitations. In: Virmani R, Atkinson JB, Fenoglio J (eds) Cardiovascular pathology. Saunders, Philadelphia, p 210Google Scholar
- 3.National Health Federation (2001) Crib death (SIDS): are vaccinations the cause? National Health Federation, Monrovia, CAGoogle Scholar
- 4.EMEA (2003) EMEA reviews hexavalent vaccines: Hexavac and Infarnix Hexa. EMEA public statement, EMEA/8519/03, London, 28 April 2003. http://www.emea.eu.int
- 11.Mallet E, Belohradsky BH, Lagos R, Gothefors L, Camier P, Carriere JP et al (2004) A liquid hexavalent combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type B and hepatitis B: review of immunogenicity and safety. Vaccine 22:1343–1357PubMedCrossRefGoogle Scholar
- 12.Matturri L, Lavezzi AM, Rossi L (2002) Proposal to modify the definition of SIDS, with regard to the post-mortem exam. In: Proceedings of the 7th International Conference on SIDS, Florence, 31 August 31–4 September 2002, p 103Google Scholar
- 14.Matturri L, Ottaviani G, Alfonsi G, Rossi L, Lavezzi AM (2005) Guidelines in pathological and forensic-medical diagnostics of sudden unexpected infant (SIDS) and fetal death. Lombardy Region Project for Reduction of the Risk for SIDS and/or Sudden Fetal Death. http://users.unimi.it/∼pathol/sids/linee_guida_e.html. Accessed 1 June 2005
- 18.Olsezewski J, Baxter D (1982) Cytoarchitecture of the human brain stem. Karger, BaselGoogle Scholar
- 22.Ottaviani G, Rossi L, Matturri L (2005) Myocardial injury attributable to external cardiac massage in infants. Cardiology 1:25–29Google Scholar