Mohammed Ali Al-Bayati, PhD, DABT, DABVT
Toxicologist & Pathologist
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PAGE 2 CONTENTS:
(cont.) Review of Alan Ream Yurko’s Medical
Records From the Time of Birth on September
16th, to November 24, 1997, and Analysis of
His Health Problems
III. Review of Alan Ream Yurko’s
Medical Records During His Hospitalization on November 24 Through 29,
1997, and Analysis of His Health Problems
Case history of baby Alan from one week of age to the time of his hospitalization
on November 24, 1997
Despite Alan’s multiple health problems, as described above, and the five-week premature birth, he was administered six vaccines simultaneously on November 11, 1997, at approximately 8 weeks of age, and sent home without monitoring and medical supervision. The vaccines included DTaP, Hib, OPV and Hepatitis B. The compositions of the vaccines, as reported in the Physicians’ Desk Reference , are presented in Table 5.
His mother stated that the baby developed a high-pitched cry, that his skin became warm to touch, and there was increasing lethargy at about l0 or 11 days following receiving these vaccines (3-4 days prior to his cardiac arrest on November 24, 1997). She had been told by his doctor that he might experience these symptoms, and this led her not to worry about her baby’s symptoms and not to call his doctor [4, 16]. These vaccines have been known to cause serious health problems, especially in premature infants. A detailed description of adverse reactions of vaccines given to baby Alan in premature and healthy children is presented below.
Adverse reactions to vaccines in premature and healthy children
1. Case histories of 45 preterm babies who were vaccinated with DTP/Hib
(diphtheria, tetanus toxoids, and pertussis/Haemophilus influenzae type
B conjugate) in the neonatal intensive care unit of the Royal Gwent Hospital,
Newport, UK between January 1993 and December 1998 were studied retrospectively
. Apparent adverse events were noted in 17 of 45 (37.8%) babies: 9
(20%) had major events, i.e., apnea, bradycardia or oxygen desaturations,
and 8 (17.8%) had minor events, i.e., increased oxygen requirements, temperature
instability, poor handling and feeding intolerance. Age at vaccination
of 70 days or less was significantly associated with increased risk (p
< 0.01). Of 27 babies vaccinated at 70 days or less, 9 (33.3%) developed
major events compared with none when vaccinated over 70 d. The authors
concluded that vaccine-related cardiorespiratory events are relatively
common in preterm babies. Problems were much more common if vaccine is
administered at or before 70 d. These babies should therefore be monitored
postvaccination. Baby Alan was vaccinated at 57 days of age and sent
home without monitoring and medical supervision.
2. Apnea is a respiratory pause of 20 seconds or longer, usually
associated with bradycardia, heart rate less than 80 beats/min. After
the occurrence of apnea in two preterm infants following immunization
with DTP and Hib, Sanchez et al. conducted a prospective surveillance
of 97 preterm infants (50 girls, 47 boys) younger than 37 weeks of gestation
who were immunized with DTP (94 also received Hib at the same time) in
a neonatal intensive care unit in Texas, USA to assess the frequency of
adverse reactions, and, in particular, the occurrence of apnea. For each
infant, data were recorded for a 3-day period before and after receipt
of the immunization . Their study showed that apneic episodes occurred
in 34 infants (34%) after immunization. Twelve infants (12% of total)
experienced a recurrence of apnea, and 11 (11%) had at least a 50% increase
in the number of apneic and bradycardiac episodes in the 72 hours after
immunization. This occurred primarily among smaller preterm infants who
were immunized at a lower weight (p = 0.01), and who had experienced more
severe apnea of prematurity (p = 0.01), and had chronic lung disease (p
= 0.03). Some of these infants required new medical intervention for the
increased episodes .
3. Botham et al. conducted a prospective study of 98 preterm infants
(53 males, 45 females), of gestational age 24-31 weeks who were immunized
at approximately 2 months postnatal age with diphtheria-tetanus-whole-cell
pertussis vaccine (DTPw) in the neonatal intensive care unit (NICU) at
King George V Hospital in Sydney, Australia. Half the infants also received
Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously.
All infants were monitored for apnea and bradycardia in the 24 hr. periods
pre- and post-immunization. The study showed that only one infant had
apnea and/or bradycardia pre-immunization, compared with 17 post-immunization.
For 12 infants these events were brief, self-limiting and not associated
with desaturations (oxygen saturation < 90%). However, for five infants
(30%), these events were associated with oxygen desaturation, and two
of these infants required supplemental oxygen. When considering immunization
for preterm infants, the benefits of early immunization must be balanced
against the risk of apnea and bradycardia .
4. Slack et al., 1999 from the United Kingdom stated that four
premature infants developed apneas severe enough to warrant resuscitation
after immunization with diphtheria, tetanus, pertussis (DTP), and Haemophilus
influenzae B (Hib). One required intubations and ventilation. They also
reported that although apneas after immunization are recognized they are
not well documented. They concluded that it is time for further research
to elucidate the best time to immunize such infants .
(II-C) 5. Botham et al. conducted a prospective study of 97 preterm infants who were immunized with diphtheria-tetanus-pertussis to document respiratory and cardiac events . The mean gestational age at birth was 28.1 weeks (range 24-34) and the mean age at immunization was 80.6 days (range 44-257). They found that nineteen (20%) infants developed apnea or bradycardia within 24 h of immunization. The infants who developed apnea and/or bradycardia had a younger gestational age at birth than those who did not (P = 0.03), were artificially ventilated for longer (P = 0.01), and were more likely to have a diagnosis of chronic lung disease (P = 0.006). Two infants who developed concurrent upper respiratory tract infections required additional oxygen, and one of them was treated with oral theophylline. They stated that cardiorespiratory function should be monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.
Adverse reactions of vaccines that were administered to baby Alan are not limited to preterm infants. They have also been reported in full term infants. Below are brief descriptions of selective studies that describe the incidence of illnesses associated with vaccinations in children. Some of these studies are described in the Physicians’ Desk Reference .
In the USA, reports to the Vaccine Adverse Event Reporting System (VAERS),
concerning infant immunization against pertussis between January 1, 1995
and June 30, 1998 were analyzed. During the study, there were 285 reports
involving death, 971 nonfatal serious reports (defined as events involving
initial hospitalization, prolongation of hospitalization, life-threatening
illness, or permanent disability), and 4,514 less serious reports after
immunization with any pertussis-containing vaccine .
Systemic adverse events occurring within 3 days following vaccination
of 4,696 Italian infants with DTP at 2, 4, and 6 months of age were recorded.
These included fever of more than 100.4 F in 7% of total; irritability
in 36.3%; drowsiness in 34.9%; loss of appetite in 16.5%; vomiting in
5.8%; and crying for 1 hour or more in 3.9% [17, p. 3063].
The whole-cell DTP vaccine has been associated with acute encephalopathy
. A large case-control study that included children 2 to 35 months
of age who suffered from serious neurological problem was conducted in
England. Acute neurological disorders, such as encephalopathy or complicated
convulsion(s) occurred in children who were more likely to have received
DTP vaccine the 7 days preceding onset than their age-matched controls.
Among children presumed to be neurologically normal before entering the
study, the relative risk (estimated by odds ratio) of a neurological illness
occurring within 7-day period following receipt of DTP dose, compared
to children not receiving DTP vaccine in the 7-day period before onset
of their illness, was 3.3 (p< 0.001).
Three hundred sixty-five infants were inoculated with Hib, and some of
them developed systemic adverse reactions. The following adverse reactions
and their percentages occurred in two-month-old infants during the 48
hours following inoculation: Fever > 100.8 F (0.6%); irritability (12.6%);
drowsiness (4.9%); diarrhea (5.2%); and vomiting (2.7%) [17, p. 2318].
above selected studies clearly show that serious health problems and even
death can result from vaccinating infants and children, especially among
the premature infants. The authors of these studies emphasized that premature
infants should be monitored following the administration of vaccines.
The Physicians’ Desk Reference stated that physicians should
inform the parents or guardians about the potential for adverse reaction
of pertussis-containing vaccines (17, p. 3062). The parent or guardian
should be given the Vaccine Information Materials, which are required
by the National Childhood Vaccine Injury Act of 1986 to be given prior
is unfortunate that baby Alan was given six vaccines (Table
5) and sent home without any consideration of being born five
weeks premature and suffering from multiple health problems. His mother
stated that the baby developed a high-pitched cry, his skin became warm
to touch, and there was an increasing lethargy with a falling-off feeding
pattern at about l0 or 11 days following the vaccines (3-4 days prior
to his cardiac arrest on November 24, 1997). She was told that these symptoms
might result following these vaccinations. On November 24th, the father
was alone at home with the baby and his 4-year old sister. The father
observed that, in rapid succession the baby began wheezing, next spit
up, and then stopped breathing. While attempting to restore breathing,
and going (daughter in tow) to a neighbor's house to borrow a car, the
father rushed the baby to Princeton Hospital in Orlando, Florida where
the baby was eventually resuscitated.
The baby stayed five days in Florida Hospital. Review of the hospital charts from Princeton and Florida hospitals revealed that, at the time of admission on November 24, 1997, baby Alan suffered from diabetes and complications of diabetes, such as metabolic acidosis, gastric ulcer, hypokalemia, apnea, cardiac arrest, hypotension, respiratory acidosis, and infections. Unfortunately, his doctor overlooked the fact that his symptoms resulted from diabetes, and the baby was treated with excessive amount of sodium bicarbonate and heparin, which caused severe hypoxia, cerebral edema, and hemorrhage in brain, lungs, and spinal cord. Detailed description of the hospital events and my analysis of these events are presented in the next section (III). The medical evidence indicates that Alan’s diabetes had resulted from infections induced by the vaccines received on November 11, 1997.
III. Review of Alan Ream Yurko’s Medical Records During His Hospitalization on November 24
Through 29, 1997, and Analysis of His Health Problems
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