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Contaminated vaccine deaths a serious setback for Syria

2014; Elsevier BV; Volume: 384; Issue: 9949 Linguagem: Inglês

10.1016/s0140-6736(14)61710-4

1474-547X

Sophie Cousins,

Migration, Health and Trauma

Experts say that the deaths of several children from a contaminated measles vaccine will have a devastating effect on future immunisation and health efforts in Syria. Sophie Cousins reports. At least 15 children died last week after being vaccinated against measles in northern Syria, an incident that is likely to have serious ramifications for future vaccination campaigns in opposition-held areas. According to a preliminary investigation by a Syrian opposition group, the vaccine was accidentally mixed with atracurium, a muscle relaxant used in surgery, rather than a diluent. The vaccine was then given to 75 children in Idlib province, northwest Syria, which is under opposition control. “While someone was preparing the vaccines, instead of putting the regular diluent for the vials, he mixed it with atracurium, which has the same colour bottle and same patch on it”, said Khaled Almilaji, health department manager at the Assistance and Coordination Unit, which was instrumental in organising the measles campaign. “An investigation is underway to specify who this person was.” All the children who died were aged between 6 and 18 months and were given 5 mg of the drug, a statement by the investigation board said. The drug is usually fatal when given to infants, but when given to older children, survival is more likely because of their heavier bodyweight. Doctors said children began having symptoms such as convulsions and low oxygen only 10 minutes after receiving the vaccine. Children were also treated for anaphylactic shock. Dozens were admitted to hospital and several were transported to southern Turkey for treatment. “Many were given a symptomatic treatment, dexamethasone and atropine, and are currently stable. Some of the children are still being treated in the intensitve care unit”, Zaher Sahloul, president of the Syrian American Medical Association, said. Parents initially accused medics of incorrectly storing the vaccines or using out-of-date ones while some doctors accused the Syrian Government of sabotaging the vaccination campaign. The campaign was suspended after the deaths. WHO said it had sent experts to investigate the tragedy, but stressed that it was vital for immunisation efforts to resume in Syria as soon as possible. The more than 3-year-old civil war in Syria, which has led to the widespread destruction of its health-care system, has resulted in the outbreak and aggravation of many diseases including polio, measles, hepatitis, pertussis, and multidrug-resistant tuberculosis. However, against the odds, an independent polio vaccination campaign implemented by the Polio Control Task Force (PCTF) throughout northern Syria reached 1·4 million children with its network of more than 8200 volunteers, said Bashir Taj Aldin, the technical coordinator of the PCTF. But despite its success, Taj Aldin said the vaccine faced major parental challenges, including rumours it caused AIDS and impotence. Such challenges are only going to be harder to combat when the measles vaccination campaign eventually resumes in Idlib and Deir ez-Zor. Health experts warned that the vaccine mix-up would severely damage trust in health services in opposition-held areas. “It's a catastrophe”, said Annie Sparrow, public health expert and deputy director of the Human Rights Program at Icahn School of Medicine, NY, USA. “It's hard to see any parent letting their child be vaccinated in Syria ever again. It is just awful on so many levels.” She added that whatever the outcome of the investigation, it wouldn't address the fear the incident had instilled. Policy consultant and public health expert, Adam Coutts, said: “No one trusts anyone in a conflict situation and medics are usually the only ones with any form of trust. As our research colleagues on the ground say, it will make it even more difficult to convince parents to bring their children to centres to be immunised for all diseases, which provides the conditions for diseases to increase and spread, particularly given that wash conditions have deteriorated everywhere in opposition areas.” He added: “The case reflects how bad the situation is on the ground, with a lack of staff with medical training and knowledge. The volunteers are doing their best but medical mistakes happen and continue to do so.” Meanwhile, according to WHO, the broader health situation in Syria is continuing to deteriorate. Insufficient access to safe blood is increasingly exposing locals to the risk of bloodborne diseases such as hepatitis B and severe shortages in surgical supplies and frequent power cuts mean that hospitals are not able to cope with the demand for surgical treatment. Doctors on the ground say that they feel like there is no end in sight for the systematic attack on health facilities and health-care workers.