The unfortunate death of a child in Matara following a Rubella vaccination caused much heartburn and anxiety particularly among parents. The cause of death was most likely due to Anaphylaxis.
What is anaphylaxis?
It is an abnormal reaction by the body's immune system to a foreign substance (antigen). This is a well-known condition in the medical field.
Symptoms and signs
Collapse (fainting) which is associated with low blood pressure and weak or absent pulse, wheezing, breathlessness and airway obstruction with secretions similar to bronchial asthma.
What precipitates
anaphylaxis?
Insect bites- especially bee and wasp bites-
Antibiotics- mainly intravenous and intra muscular-eg- penicillin. Even oral antibiotics
Certain foods - eg. peanuts
Transfusions of blood and blood products
Antivenin given after a snake bite
It is not possible to prevent anaphylactic reactions, though rare, but they could be treated successfully if recognized early and treated immediately
How to treat anaphylaxis?
1/1000 Adrenaline given intramuscularly is the drug of choice as soon as the anaphylaxis occurs. This should be repeated every 3-5 minutes depending on the progress of the patient. Any doctor or nurse could give this injection as soon as possible before sending the patient to hospital.
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| One of the young girls who fell sick following the Rubella vaccination in Matara |
Delay is fatal. The patient should be kept flat. Oxygen and intravenous fluid should be given as soon as possible if facilities are available. Sucking out secretions and nebulising should be done if symptoms of wheezing and breathlessness are present. In hospital the patient should be treated in an intensive care unit if this facility is available.
This is the ideal time to teach immunization teams about anaphylaxis and how to recognize and treat it. All immunization centres should have an emergency tray with 1/1000 adrenaline and other relevant drugs.
It is standard practice in all hospitals to have an emergency tray to treat anaphylaxis. When immunizations are carried out parents should ask whether emergency treatment is available before their children are immunized. Sri Lankan patients are reluctant to ask about the availability of emergency treatment as some doctors and nurses are rude to them.
It is common to get a mild allergic reaction like itching, a few red patches and fever following vaccinations but these symptoms are mild and could be treated by oral drugs. The symptoms disappear in a few days.
All government and private hospitals should be equipped to treat anaphylaxis in an emergency and for this the emergency tray should be available at all times. If not, unfortunate preventable deaths may occur.
The unfortunate incident at Matara should not deter parents from immunizing their children against Rubella as anaphylaxis is a rare occurrence.
If a pregnant mother gets Rubella in the first three months of her pregnancy there is a high risk of congenital deformity in the baby especially heart disease and hearing impairment.
The immunization programme in Sri Lanka is one of the best in the world and has prevented a large number of deaths in children. This rare occurrence should not discourage the relevant authorities in continuing their good work.
(The writer is a Consultant Paediatrician) |
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