| A child in Matara is dead after being administered the rubella vaccine. Any death, particularly of a child, is an emotional and sensitive issue. Facts, however, need to be sifted from emotion and hasty and drastic decisions which may have disastrous consequences on thousands of children should be reviewed immediately.
What has been established so far is that the child died of anaphylactic shock, which in lay terms is a widespread and very serious allergic reaction. The symptoms of such a shock, which can be brought on not only by certain medications, food such as nuts, shellfish, dairy products etc., and insect bites are dizziness, laboured breathing, swelling of the tongue and breathing tubes, loss of consciousness, low blood pressure, heart failure and finally death.
While stressing that inquiries by The Sunday Times reveal that immediate emergency treatment such as administration of adrenalin and also CPR on the spot, until taken to hospital, help save the lives of most who go into an anaphylactic shock, the need right now is to take stock of the facts.Facts, without emotion, are essential, as otherwise there is the imminent danger of Sri Lanka’s much-lauded National Expanded Immunization Programme collapsing, in the wake of which the health of the country’s children, considered on top when compared to others in the region, will be endangered.
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| A student who fell sick after the vaccination |
“There is nothing wrong with the vaccine,” stressed Health Ministry Secretary Dr. Athula Kahandaliyanage, when contacted by The Sunday Times. “This particular rubella vaccine stock has been given not only to many children in our country but also to those in five others. All these vaccinations are pre-qualified by the World Health Organization (WHO) which has in fact checked out the vaccination and found nothing wrong with it.”
Pointing out that immunizing girls and women between the ages 11-44 years against rubella began after there were many babies born with Congenital Rubella Syndrome (see box for devastating effects) in 1994 and 1995, Chief Epidemiologist Dr. Paba Palihawadana said that since 1996, five million doses of rubella have been administered in Sri Lanka. “There has not been a single death from the rubella vaccination or any other vaccination,” she said.
This is a WHO pre-qualified vaccine used in 20 other countries including some developed countries, according to Dr. Palihawadana. It is imported after approval from the Drug Control Authority in Sri Lanka from the Serum Institute in India, the sole global manufacturer.
Firmly dismissing speculation that expired stocks were used, Health Secretary Dr. Kahandaliyanage assured that the expiry was only in November 2009 and also explained that rigid checks on potency of the vaccine are carried out. Echoing the same view, Chief Epidemiologist Dr. Palihawadana said they are extra-careful about the cold chain throughout the distribution process, storage and up to the injection site.
The Deputy Director-General of Public Health Services, Dr. Palitha Mahipala underlining the importance of the immunization programme begun over a hundred years ago, in 1886, said smallpox which killed millions worldwide and hundreds of thousands in Sri Lanka was eradicated through vaccination.
Pointing out landmarks in the programme such as the last case of polio being reported in Sri Lanka as way back as 1993, no cases of diphtheria being reported in 10 years, no cases of neonatal tetanus being reported in the last few years, only a very few cases of whooping cough being reported and the number of cases of measles being brought down, he asks why the life expectancy of Sri Lankans was only about 45 years in the 1940s, but now 76 years for females and 72 years for males.
There are two reasons for Lankans living longer, he answers, adding that one was the introduction of DDT in the 1940s to control malaria and the other the introduction of the vaccination programme. In Sri Lanka, the programme has 100% coverage.
Vaccines are safe and vaccination is one of the best interventions for disease prevention, stresses Dr. Mahipala.
In a situation where emotions could easily cloud important decisions, facts and reason must prevail. Facts must be the only basis on which any decision with regard to the National Immunization Programme including the rubella vaccinations, is taken. Don’t jeopardize the programme and the lives of children, is the plea of many including parents.
Why is the rubella vaccine important?
Although rubella or German measles is a mild febrile viral disease, if any pregnant mother catches it especially during the first trimester, the impact on the foetus is devastating. While many mothers will have miscarriages or stillbirths, if the foetuse survive, 85% will succumb to Congenital Rubella Syndrome (CRS).
Babies with CRS will be born with multiple birth defects and may have blindness, deafness, cardiac malformations, a small brain (microcephaly), mental retardation and behavioural problems. Those who survive the neonatal period, may face serious developmental disabilities and have an increased risk of developmental delays including autism, diabetes mellitus and thyroiditis, The Sunday Times learns.
There was a CRS epidemic in Sri Lanka during 1994-95, explains Dr. Mahipala, adding that 275 babies were born with the disease in 1994 and another 169 in the early part of 1995.
Sri Lanka now administers the measles-rubella vaccine when a child is three years old and at around 13 years as a booster to gain life-long immunity.
In 2007 and 2008, not a single case of CRS has been reported in Sri Lanka, Health Ministry Secretary Dr. Kahandaliyange pointed out.
Important questions that need answers
The WHO handed over its report on this incident to the Health Ministry on Friday night and the findings will be discussed and analyzed, said a ministry source, adding that the internal departmental inquiry has not been completed because the RMO who headed the vaccination team is unwell.
“His statement has not been recorded yet as he was in hospital,” the source said, assuring that as soon as it is done the inquiry would be concluded.
When asked whether an RMO is not eligible to administer the vaccine, the source pointed out that it was a misconception as even Public Health Nurses give the injections at the clinics all over the country. “They are all trained,” the source said.A consensus among medical circles is that there are important issues that the inquiry must ascertain:
- Was there negligence on the part of the vaccinating team in not heeding the letter about the allergies sent by the child’s parents? Was the RMO present on the spot when the vaccinations were being given?
- Were all the vaccinated children, including Peshala, kept at the vaccination site for about 10 minutes to spot any adverse reaction immediately?
- Why did the team not have an emergency tray with adrenalin etc? Was it due to lack of resources, if so who is responsible for not providing such a vital requirement?
- Was the child who showed adverse reactions administered Cardio-Pulmonary Resuscitation (CPR) immediately? If not why? Is the staff trained to give CPR?
- Was the child rushed to hospital immediately or was there a delay? If so, why?
Timeline on tragedy
The events before the death of Peshala Hansini of St. Thomas’ Girls’ High School, Matara were:
- the children were informed about the school rubella vaccination programme;
- Peshala’s parents give a letter instructing that she should not be given the rubella injection because she is prone to severe allergies;
- the letter is allegedly disregarded by the team headed by a Registered Medical Officer (RMO) carrying out the vaccinations;
- Peshala is vaccinated around 10.30 a.m. and allegedly sent back to class immediately;
- by about 10.40 she says she feels giddy and puts her head down on her desk;
- the medical team is informed;
- she is sent to the Matara Hospital by about 11.10 a.m. in a critical condition and even after all efforts by the hospital staff dies.
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