An improperly mixed measles vaccine has killed as many as 50 children in insurgent-held areas of northwestern Syria, volunteer medical organizations and physicians reported Wednesday, forcing the suspension of a large-scale United Nations vaccination campaign intended to stop the spread of measles, rubella and polio. http://www.nytimes.com/2014/09/18/world/middleeast/syrian-children-die-after-vaccinations.html?ref=world
The victims, some of them infants, apparently all died Tuesday, mostly concentrated in the cities of Jarjanaz and Sinjar in Idlib Province, an area controlled by forces opposed to President Bashar al-Assad. These opposition forces have sought to function as an interim government and provide basic health care, including inoculations and vaccinations to children, given the collapse of Syria’s public health care system since the civil war began more than three years ago.
There were conflicting accounts on the precise number of deaths, with some doctors reporting at least 15, and others saying 35 or perhaps 50. Dozens of other children in Idlib were reported to have been sickened by the suspect vaccine.
Dr. Abdulla Ajaj, a physician who helped administer the vaccine, said the suspect batch of doses had been received three days before they were used. “This is the first time we have had such a problem,” he said in a Skype interview.
The provenance of the vaccine also was not immediately clear. Dr. Ajaj speculated that the doses might have been stored at improperly high temperatures, but other physicians discounted that possibility, partly because the same vaccine had been used on many other children with no ill effects. Some speculated that toxins or other contaminants might have been introduced when the vaccine, which comes in multiple-dose vials, was diluted for individual injections.
Another Syrian physician in the affected area, Mohammad Hamadi, the secretary of a group called the Free Doctors Union, said medics who diluted the vaccine might have mixed it with Atracurium, a muscle relaxant used in surgery. Dr. Hamadi said the Atracurium bottles looked similar to the bottles of vaccine diluent. “We are investigating if it’s a mistake by the medical crew or a criminal act,” he said.
The Syrian American Medical Society, which organizes medical missions to Syria and runs a hospital in Idlib, said recipients of the bad vaccine began displaying symptoms within minutes, including tightness of breath, slowed heart rate, wheezing and inflammation of the larynx. The group’s own facility saw at least 65 patients, it said in a statement, and 15 were already dead upon arrival, all under the age of 1.
The statement said the reason the vaccine had turned deadly was unclear, “though local staff speculate that the vaccinations may have been compromised by the storage location in Jarjanaz or potential tampering.”
Residents of Jarjanaz and Sinjar described scenes of panic and despair among parents who watched as their vaccinated children succumbed. Ahmah Doughaim, a nurse in Jarjanaz, vaccinated his 8-month-old daughter, who died 10 minutes later. “The father is collapsed now,” said a cousin, Hussein.
The interim government posted a statement on its website that it had suspended the vaccination campaign and was investigating “in order to learn the truth behind this humanitarian disaster.”
The World Health Organization and Unicef, which helped to organize the mass vaccination, confirmed in a statement that at least 15 children had died, expressing shock and vowing to help investigate the disaster, which now threatens to upend the entire campaign.
Dr. Annie Sparrow, an assistant professor in the Department of Global Health at Mount Sinai in New York and an expert on the Syrian health crisis caused by the war, said that doctors in Syria had told her the symptoms from the bad vaccine included convulsions, an atypical reaction for a vaccine and more consistent with the effects of a neurotoxin. “If it’s expired it wouldn’t have caused that kind of issue,” she said in a telephone interview.
She cautioned that it was premature to conclude that the cause was sabotage and might be an instance of negligence.