vaccine strain was unidentified). Apparently, all 12 children had adverse reactions and 6 survived. The ages of those who died ranged from 9 to 18 months. This extraordinary mortality rate was attributed by the author to TSS and, specifically, the use of unhygienic conditions in administering the vaccine. A second incident involved the death of the only child (age 8 months) immunized at a particular location. Death occurred within 24 hours of vaccine administration and was attributed to TSS. In a third incident, 1 of 33 immunized children died following measles vaccination. This child was 23 months old and died of TSS 17 hours after immunization. A fourth incident involved the death of one of seven immunized children. The 16-month-old child became semiconscious within 30 minutes of receiving the vaccine and died approximately 40 hours later. The death was attributed to underlying hemorrhagic diathesis.

Deaths Temporally Associated with Vaccine Administration, and the Cause of Death Is Other Than Those Listed Above Miller (1982) described a case series of 10,035 children who were vaccinated between 1970 and 1980 in Oxford, England, with the Beckenham 31 and Schwarz measles vaccine strains. One 12-month-old child died 36 hours after the vaccination. The report indicated that the coroner's death certificate stated "sudden death in infancy and acute bronchiolitis" (Miller, 1982, p. 535).

Causality Argument

The data relating death and measles or mumps vaccine are from case reports and case series. The largest series comes from India, but TSS caused by the unhygienic conditions involved in the immunization program was the apparent cause of death reported for eight of nine patients. Evidence based on RNA sequencing techniques has linked measles vaccine and measles infection to subsequent death in some severely immunocompromised children. In contrast, studies of the immunogenic response to measles vaccine in children infected with human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), have not recorded any deaths from measles vaccine-strain viral infection.

The evidence favors the acceptance of a causal relation between measles vaccine and anaphylaxis. The evidence establishes a causal relation between MMR and thrombocytopenia and anaphylaxis (see Chapter 6). Anaphylaxis and thrombocytopenia can be fatal. Although there is no direct evidence of death as a consequence of measles vaccine-related anaphylaxis or of MMR-related thrombocytopenia or anaphylaxis, in the committee's judgment measles vaccine could cause fatal anaphylaxis and MMR could cause fatal thrombocytopenia or anaphylaxis. There is no evidence or reason to believe that the case fatality rate from measles vaccine-related



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