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Deaths reported following vaccination most often unrelated
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The majority of deaths reported to the Vaccine Adverse Event Reporting System appear to show no link between these fatalities and vaccinations, according to data recently published in Clinical Infectious Diseases.
“When a death occurs shortly following vaccination, it is important to assess whether it was related to vaccination,” Pedro L. Moro, MD, MPH, epidemiologist for the immunization safety office, division of healthcare quality promotion, CDC, and colleagues wrote. “Deaths following vaccination have had negative impact on vaccination programs, particularly in low- and middle-income countries implementing large-scale infant vaccination programs, even when investigations do not find evidence of a causal relationship.”
The researchers identified 2,149 death reports in VAERS from July 1, 1997, to Dec. 31, 2013, of which 68.4% were children. Nearly 80% of these children received more than one vaccine during vaccination, with the most common vaccines being combination DTaP-hepatitis B (HepB)-inactivated polio vaccine plus Haemophilus type b vaccine plus seven-valent pneumococcal conjugate vaccine or 13-valent pneumococcal conjugate vaccine (n = 127) followed by HepB vaccine administered alone (n = 115).
The study found that sudden infant death syndrome (SIDS) accounted for 44% of deaths among children confirmed by autopsy or death certificate (n = 1,244), followed by asphyxia (6%), septicemia (4.9%) and pneumonia (4.6%). Adults with similar documentation (n = 526) died most frequently from circulatory diseases (46.9%), followed by respiratory diseases (14.6%) and certain infections and parasitic diseases (11.8%).
“There is considerable evidence that vaccination is not causally associated with SIDS, including an [Institute of Medicine] review in 2003 that rejected a causal association between the whole cell pertussis-containing vaccine (which is no longer in use in the United States) and SIDS and between exposure to multiple simultaneous vaccines and SIDS,” the researchers wrote.
Aside from rare exceptions such as anaphylaxis, researchers concluded that there is no causal relationship or increased risk of death following vaccination.
“This comprehensive review of death reports to VAERS … indicates that the most common causes of death in VAERS were consistent with the leading causes of death in the U.S. population,” according to Moro and colleagues. “Because a large number of vaccines are given to young children (often simultaneously) at scheduled well-child visits, especially during the first year of life, deaths occurring in close temporal association following vaccination are likely to occur by chance alone.” – by David Jwanier
Perspective
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C. Buddy Creech, MD, MPH, FPIDS
In this timely manuscript by Moro et al, our national Vaccine Adverse Event Reporting System (VAERS) was queried to ensure that deaths occurring in close proximity to immunization were coincidental and not causative. VAERS captures detailed accounts from providers, manufacturers, patients and their parents regarding suspected adverse events following immunization (AEFI) and showcases our immunization program’s deep commitment to safety.
Not surprisingly, the causes of death that were reported after immunization closely mirror the causes of death in the U.S. population, overall. Given these results, where is the concern?
As humans, we still equate temporal association with causation. From the Latin phrase, post hoc ergo propter hoc, we intuitively conclude that if something happens “after it” then it must be “because of it.” When pressed, we quickly recognize the intellectual flaws within this presupposition; however, it remains a common misconception among our patients and colleagues. The data from this study and others like it equip us as health care providers with the information necessary to ease unnecessary fears and concerns over the safety of vaccines. These data are even more compelling when coupled with a discussion on the number of deaths prevented through universal immunization against measles, polio and rubella, to name but a few.
Adverse events following immunization that are truly related to immunization (eg, anaphylaxis) do occur uncommonly. The work by Moro et al allow us to focus our attention on these events by assuring us that the tragic events reported here are not related to recent immunization. Vaccines save lives. It is our duty to relay this message to our patients and their families in the most effective ways possible.
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