Deaths That Are a Consequence of an Adverse Event That Itself Is Causally Related to a Vaccine Reviewed in This Report

The evidence favors acceptance of a causal relation between measles vaccine and anaphylaxis. The evidence establishes a causal relation between MMR and thrombocytopenia anaphylaxis (see Chapter 6). The committee identified no reports of death from these adverse events that occurred in temporal relation to vaccination.

Other Reports of Death Following Immunization

The committee does not consider the apparent increased relative risk of death following administration of high-titer Edmonston-Zagreb or Schwarz strain measles vaccine such as has been seen in clinical trials conducted in Senegal (Garenne et al., 1991) to be relevant to the United States because these high-titer vaccines are not licensed for use in the United States. The cause of the increased mortality such as that seen in Senegal is not known.

Available Data Were Insufficient to Allow a Judgment of Cause Starke and colleagues (1970) described three deaths that occurred during a mass measles immunization campaign in the former East Germany from 1967 to 1969. One child died of toxic circulatory collapse 6 days after immunization. The article stated that virologic examinations showed no proof of a pathogenic agent, but it is not clear how rigorously this was pursued. Another child died 3 days after measles vaccination. Autopsy results report cerebral edema as the cause of death. Another child died approximately 6 weeks after immunization. Autopsy results showed encephalitis as the cause of death. Haun and Ehrhardt (1973) described an 11-month-old child who developed clonic seizures and encephalitis within 12 days of receiving measles vaccine (Leningrad-16 SSW) and who died soon thereafter of probable disseminated intravascular coagulation. The authors were unsure whether vaccine-strain virus was responsible. Nader and Warren (1968) described 23 cases of neurologic disease following measles vaccination reported to the U.S. Communicable Disease Center (now CDC) between 1965 and 1967. Two deaths were reported 7 and 13 days following vaccination. Measles antibody was not detectable in either patient. One of the cases was diagnosed as encephalitis (herpes simplex virus was isolated from brain, but there were no detectable antibodies against this virus in serum) and the other was diagnosed as a sudden death. Landrigan and Witte (1973) reported on 84 cases of neurologic disorders reported to the CDC between 1963 and 1971 and diagnosed within 1 month following administration of measles vaccine. Five of these patients had extensive neurologic disorders that were ultimately fatal. They also reported five fatalities in which the



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