thrombocytopenia or anaphylaxis would differ from the case fatality rates for these adverse events associated with any other cause.

Conclusion

The evidence establishes a causal relation between vaccine-strain measles virus infection and death. The conclusion is based on case reports in immunocompromised individuals and not on controlled studies. No relative risk can be calculated. However, the risk of death from measles vaccine-strain infection would seem to be extraordinarily low.

The evidence establishes a causal relation between MMR and death from complications associated with severe thrombocytopenia. The evidence establishes a causal relation between MMR and death from anaphylaxis. There is no direct evidence for this; the conclusion is based on the potential of severe thrombocytopenia and anaphylaxis to be fatal. The risk would seem to be extraordinarily low.

The evidence favors acceptance of a causal relation between measles vaccine and death from anaphylaxis. There is no direct evidence for this; the conclusion is based on the potential of anaphylaxis to be fatal. The risk would seem to be extraordinarily low.

The evidence is inadequate to accept or reject a causal relation between measles and mumps vaccines and death from causes other than those listed above.

Risk-Modifying Factors

There is evidence that some severely immunocompromised children, such as those with severe combined immunodeficiency syndrome, dysgamma-globulinemia, or leukemia, are susceptible to overwhelming measles infection and subsequent death, even from attenuated measles vaccine. Infection with HIV has not been associated with death from measles vaccine-strain viral infection.

Polio Vaccines

Deaths Classified as SIDS

For many years, the standard immunization schedule in the first year of life (the period in which SIDS occurs) included only DPT and polio vaccine. The research on SIDS has focused on DPT. A few studies that primarily investigated the role of DPT in SIDS also looked at polio vaccine (Bouvier-Colle et al., 1989; Hoffman et al., 1987; Taylor and Emery, 1982; Walker et al., 1987). Only Hoffman and colleagues (1987) report odds ratio



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