toms were felt to be typical of toxic shock. In one incident, 6 of the 12 children who received measles vaccine died. The six children who survived were said to have been saved by timely hospitalization and appropriate (but unspecified) treatment. Most of the incidents were felt to have been caused by contamination of the vaccines with pathogens, because the quality of the sterilization procedures was unsatisfactory. These incidents, however, were not described in sufficient detail to eliminate the possibility of anaphylactic shock.

In 1980, Aukrust et al. reported severe hypersensitivity or intolerance reactions to measles vaccine in six children. No description of the reactions was provided, although the authors felt that the children had immediate hypersensitivity reactions "most probably due to allergy." This measles vaccine was grown in monkey kidney cells (Aukrust et al., 1980). Trace amounts of calf serum proteins, but not egg antigens, were demonstrated in measles vaccine by crossed immunoelectrophoresis, but the exact cause of the untoward reactions was not identified. Four of the cases received the same lot of vaccine, suggesting the presence of an allergenic contaminant. The possibility of lot contamination also was suggested by the higher incidence of severe hypersensitivity reactions in Norway than in other countries (1 case per 15,000 to 20,000 doses versus 1 to 2 cases per 1 million doses, respectively) provided with the same vaccine by the same manufacturer.

Thurston (1987) reported two cases of anaphylaxis in his private practice. The first was an 18-month-old boy who developed bradycardia, cyanosis, periorbital edema, widespread erythema, and hypotonia 5 minutes after receiving MMR. He responded immediately to epinephrine. The second was a 16-month-old girl who started crying and who developed widespread erythema, cyanosis, decreased respiration, and wheezing 5 minutes after receiving MMR. She also responded to epinephrine.

The Swedish health authorities reported that no case with a clear picture of anaphylactic shock following administration of MMR was reported from 1982 to 1984, during which time 700,000 doses of MMR were sold in Sweden (Taranger and Wiholm, 1987). Five children had reactions that were described as anaphylactic or hypersensitivity reactions. These included a 12-year-old boy who developed urticaria with dyspnea and suspected laryngeal edema a couple of hours after immunization. He was treated with epinephrine and cortisone. Two 12-year-olds received epinephrine because of local redness and general symptoms of paleness and itching. An 18-month-old child was reported to have a diagnosis of mucocutaneous syndrome, but no further information was provided. A 5.5-year-old boy received cortisone and antihistamine orally for small urticaria.

In Germany, five reports of so-called immediate reactions were received after distribution of approximately 5.5 million doses of measles, mumps, and measles-mumps vaccines and MMR (Fescharek et al., 1990). Three

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