Virchows Archiv

, Volume 448, Issue 1, pp 100–104 | Cite as

Sudden infant death syndrome (SIDS) shortly after hexavalent vaccination: another pathology in suspected SIDS?

  • Giulia Ottaviani
  • Anna Maria Lavezzi
  • Luigi Matturri
Case Report

Abstract

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.

Keywords

Sudden infant death SIDS Hexavalent vaccine Arcuate nucleus hypoplasia Cardiac conduction system Prolonged external cardiac massage 

Notes

Acknowledgements

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.

References

  1. 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
  2. 2.
    Brotherton JM, Hull BP, Hayen A, Gidding HF, Burgess MA (2005) Probability of coincident vaccination in the 24 or 48 hours preceding sudden infant death syndrome death in Australia. Pediatrics 15:e643–e646CrossRefGoogle Scholar
  3. 3.
    National Health Federation (2001) Crib death (SIDS): are vaccinations the cause? National Health Federation, Monrovia, CAGoogle Scholar
  4. 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
  5. 5.
    Essery SD, Raza MW, Zorgani A, MacKenzie DA, James VS, Weir DM et al (1999) The protective effect of immunization against diphtheria, pertussis and tetanus (DPT) in relation to sudden infant death syndrome. FEMS Immunol Med Microbiol 25:183–192PubMedCrossRefGoogle Scholar
  6. 6.
    Filiano JJ, Kinney HC (1994) A perspective on neuropathologic findings in victims of sudden infant death syndrome: the triple risk model. Biol Neonate 65:194–197PubMedCrossRefGoogle Scholar
  7. 7.
    James TN (1968) Sudden death in babies: new observations in the heart. Am J Cardiol 22:479–506PubMedCrossRefGoogle Scholar
  8. 8.
    Jonville-Bera AP, Autret-Leca E, Barbeillon F, Paris-Liado J (2001) Sudden unexpected death in infants under 3 months of age and vaccination status—a case control study. J Clin Pharmacol 51:271–276CrossRefGoogle Scholar
  9. 9.
    Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T, Cutz E, Hanzlick R, Keens TG, Mitchell EA (2004) Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics 114:234–238PubMedCrossRefGoogle Scholar
  10. 10.
    Lavezzi AM, Ottaviani G, Rossi L, Matturri L (2004) Hypoplasia of the parabrachial/Kölliker-Fuse complex in perinatal death. Biol Neonate 86:92–97PubMedCrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Matturri L, Ottaviani G, Alfonsi G, Crippa M, Rossi L, Lavezzi AM (2004) Study of the brainstem, particularly the arcuate nucleus, in sudden infant death syndrome (SIDS) and sudden intrauterine unexplained death (SIUD). Am J Forensic Med Pathol 25:44–48PubMedCrossRefGoogle Scholar
  14. 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
  15. 15.
    Matturri L, Ottaviani G, Benedetti G, Agosta E, Lavezzi AM (2005) Unexpected perinatal death and sudden infant death syndrome (SIDS): anatomo-pathological and legal aspects. Am J Forensic Med Pathol 26:155–160PubMedGoogle Scholar
  16. 16.
    Matturri L, Ottaviani G, Lavezzi AM (2005) Techniques and criteria in pathologic and forensic-medical diagnostics of sudden unexpected infant and perinatal death. Am J Clin Pathol 124:259–268PubMedCrossRefGoogle Scholar
  17. 17.
    Matturri L, Ottaviani G, Rossi L (2003) External cardiac massage in infants. Intensive Care Med 29:1199–1200PubMedCrossRefGoogle Scholar
  18. 18.
    Olsezewski J, Baxter D (1982) Cytoarchitecture of the human brain stem. Karger, BaselGoogle Scholar
  19. 19.
    Ottaviani G, Lavezzi AM, Rossi L, Matturri L (2004) Sudden unexpected death of a term fetus in an anticardiolipin positive mother. Am J Perinatol 21:79–83PubMedCrossRefGoogle Scholar
  20. 20.
    Ottaviani G, Matturri L, Bruni B, Lavezzi AM (2005) Sudden infant death syndrome “gray zone” disclosed only by a study of the brain stem on serial sections. J Perinat Med 33:165–169PubMedCrossRefGoogle Scholar
  21. 21.
    Ottaviani G, Matturri L, Rossi L, James TN (2003) Crib death: further support for the concept of fatal cardiac electrical instability as the final common pathway. Int J Cardiol 92:17–26PubMedCrossRefGoogle Scholar
  22. 22.
    Ottaviani G, Rossi L, Matturri L (2005) Myocardial injury attributable to external cardiac massage in infants. Cardiology 1:25–29Google Scholar
  23. 23.
    Rossi L (1999) Bulbo-spinal pathology in neurocardiac sudden death of adults: a prognostic approach to a neglected problem. Int J Legal Med 112:83–90PubMedCrossRefGoogle Scholar
  24. 24.
    Silvers LE, Ellenberg SS, Wise RP, Varricchio FE, Mootrey GT, Salive ME (2001) The epidemiology of fatalities reported to the vaccine adverse event reporting system 1990–1997. Pharmacoepidemiol Drug Saf 10:279–285PubMedCrossRefGoogle Scholar
  25. 25.
    Willinger M, James LS, Catz C (1991) Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health Development. Pediatric Pathol 11:677–684CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Giulia Ottaviani
    • 1
  • Anna Maria Lavezzi
    • 1
  • Luigi Matturri
    • 1
  1. 1.Institute of PathologyUniversity of MilanMilanItaly

Personalised recommendations