Subject:
             JAPAN, SIDS, and PERTUSSIS IMMUNIZATION

Lon Morgan, DC,DABCO

FOREWARD:

  In 1992 Ms. Viera Scheibner published a book entitled "Vaccination 100 Years of Orthodox Research shows that Vaccines Represent a Medical Assault on the Immune System" wherein she repeatedly made the claim that after the Japanese changed their pertussis immunization policy in 1975 the phenomenon of SIDS (Sudden Infant Death Syndrome) completely and immediately disappeared.

  Since publication of this book opponents of immunization have seized on this claim as evidence of the purported harm of pertussis vaccination. The purpose of this paper is to examine in more detail Ms. Scheibner's claims of a pertussis vaccine/SIDS connection, especially as it applies to the Japanese experience.

BACKGROUND:

  Japan started using a whole-cell pertussis vaccine in 1947, using three doses one to two months apart beginning at about 3 months of age. Most vaccines were and still are provided free. The incidence of pertussis disease immediately started declining rapidly from an average of over 100,000 cases annually to approximately 300 cases annually by 1971.[1]

  In the winter of 1974-75 two infants died not long after having received a DTP vaccination. While these deaths were being investigated the decision was made to raise the immunization starting age from 3 months to 2 years. The delayed age of starting immunization coupled with declining immunization coverage brought a major increase in pertussis incidence, peaking at 13,105 cases and 41 deaths by 1979.  At this point coverage immunization started increasing again followed by a corresponding decline of pertussis to around 300 cases annually.[1]

  Also in 1975 a Pertussis Vaccine Study Group was formed to further research into pertussis vaccine, resulting in the introduction of an acellular pertussis vaccine in 1981. A vaccine reaction surveillance system was installed in July, 1977. The Japanese reported incidence of serious reactions from pertussis vaccine declined to a rate of 0.4 cases per million doses administered. [1]

  The Japanese also provided a compensation system for vaccine injuries with payments set at a higher rate than the routine medical system to encourage event reporting. Noble notes that the Japanese also experienced the difficulty of differentiating temporal events that occurred in proximity to vaccination but which were difficult to confirm as being vaccine related. Nonetheless, compensation was made for claimed injuries unless other causes were clearly provable.[1]

  Over a five year period from 1970-1975 some 25-30 million doses of whole-cell pertussis vaccine were dispensed. Over this five year time period 11 claims were paid for what was termed Sudden Death. In 1975 the decision was made to raise the starting immunization age from 3 months to two years. Thus, from 1975 on no further claims were paid for Sudden Death related to immunization.[1]

  Cherry refers to the JAMA study by Noble in noting: 'The category "sudden death" is also instructive in that the entity disappeared following both whole-cell and acellular vaccines, when immunization was delayed until a child was 24 months of age.'[2]

  Cherry then notes that  '. . . delaying the initial vaccination until a child is 24 months, regardless of the type of vaccine, reduces most of the temporally associated severe adverse events. Furthermore, analysis of cases with paid claims in the Japanese national compensation system indicates many of the putative cases to be related to other medical conditions.'[2]

  SIDS, by definition, is a sudden infant death under 12 months of age.   Thus, when DPT immunization is delayed until 24 months of age any SIDS cases occurring cannot be attributed to the vaccine. Cherry is clearly discussing the paid claims issue and the fact that many of the claims were in reality related to other medical conditions.

SIDS IN JAPAN:

  The Japanese have been aware of the SIDS phenomenon for some time.   By 1981 a research project team on SIDS was founded and financed by the Japanese Ministry of Health and Welfare. A Japanese SIDS Family Association was organized in 1993 where the incidence of SIDS was estimated at 0.5 per 1000 live births. [3]

  This is comparable to the reported Israeli incidence of SIDS at0.47-0.90 per 1,000 live births. [4] The incidence in one comprehensive long term US study was remarkably similar at 0.47-0.90 per 1,000 live births over a 1945 to 1992 time period in Minnesota.[5]

  The medical examination system in Japan covers four regions: Yokohama, Osaka, Kobe and Tokyo. The Japanese have kept epidemiological records on Sudden Unexpected Infant Death since 1964, with the best and most reliable records being in the Tokyo region. The Japanese consider Sudden Unexpected Death (SUD) in an infant to be from one of four causes: aspiration of stomach contents, interstitial pneumonitis, SIDS, and smothering.[6]

  Funayama examined the autopsy records of infants aged 1 week to 1 year who died during the time period of 1964-1993 in the Tokyo medical region. The Tokyo autopsy medical records reveal certain definite SIDS trends over time: (Fig. 1, p. 33)

1964-68 : 250 SUD cases, almost none were SIDS
1969-73 : 153 SUD cases, almost none were SIDS
1974-78 : 153 SUD cases, approx. 7 were SIDS *
1979-83: 104 SUD cases, approx. 25 were SIDS
1984-88: 118 SUD cases, approx. 65 were SIDS
1989-93: 144 SUD cases, approx. 90 were SIDS

* Pertussis immunization age was raised to two years in 1975

  The increase in the numbers of SIDS cases is attributable in large measure to increased recognition by forensic pathologists.

  The study specifically notes that:  "From the mid-1980s on, SIDS was most frequent, accounting for 76% of 34 SUD in 1993." And that "A relatively large number of SIDS ... still occur among children aged 7-8 months." The Japanese have also recognized the crucial role sleeping position plays in the incidence of SIDS by noting : "In 1989-1993, 67% of SIDS victims were found dead lying prone . . ."[6]

CONCLUSIONS:

  The preceding data is crucial in evaluating Ms. Scheibner's claims that SIDS disappeared from Japan following a change in their pertussis vaccination policy in 1975. In direct contradiction to Ms. Scheibner's claims, the official Japanese autopsy records on SIDS cases clearly demonstrate that the time interval from 1974-78, when pertussis immunization was delayed, saw the largest increase in the number of Japanese SIDS cases to that point in time. The annual number of SIDS cases recognized continued to climb thereafter, this despite a Japanese policy of not vaccinating children before the age of two years.

IMPORTANT POINT: 
The Japanese themselves have NEVER acknowledged or accepted Ms. Scheibner's claims. The Japanese have an advanced health care system noted for its health research contributions. It would seem reasonable to expect that if they had found the solution to the problem of SIDS they would have published this fact to the world.
* * This has never happened. * *
No Japanese study has ever made such a claim.

  Instead, the Japanese are in full agreement with the rest of world when they state:  "An inevitable conclusion of studies in the Netherlands, Great Britain, the United States and Japan is that sudden infant death syndrome (SIDS) is intimately linked to the prone sleeping position of infants."[7]

  The Japanese also consider other legitimate risks for SIDS to be ". . . low birth weight, being a male infant, low maternal age, late order of birth in multiparity and illegitimacy." [8]

  Further, it appears the Japanese have long since reversed themselves and moved to adopting the earlier infant immunization policy the rest of the world uses. The Japanese specifically recommend that "Mass administration of this vaccine (DPT) during infancy should be performed since about one-quarter of the patients with diphtheria, pertussis or tetanus were less than one year old." [9]

  Thus, the evidence clearly demonstrates that Ms. Scheibner's claims of a pertussis vaccine/SIDS connection based on the Japanese experience is completely erroneous and without foundation in fact.

  Ms Scheibner appears to have been unable to understand the simple fact that when the Japanese raised the pertussis immunization age to two years compensation for SIDS cases would inevitably cease since all SIDS cases occur at a much younger age.

  Obviously, if vaccines are not being given they cannot be blamed, thus claims would inevitably cease.

  The only thing that disappeared in Japan was -claims- for SIDS vaccine damage. The actual -incidence- of SIDS cases, however, as demonstrated in the data above, not only continued but gradually increased.

  Thus, the Japanese are in agreement with the rest of the world wherein numerous very large scale studies in the 1990s have repeatedly, consistently, and emphatically demonstrated that no pertussis vaccine/SIDS connection exists.

  Whether it was due to personal bias, lack of relevant health science training, or inept research on her part, or a combination, Ms. Scheibner's claims have not withstood the test of time, or critical examination, and should be rejected.

REFERENCES:

1.Noble, G. and R. Bernier, Acellular and Whole-Cell Pertussis Vaccines in Japan Report of a Visit by US Scientists. JAMA, 1987  March 13. 257(10): p. 1351-6.

2.Cherry, J., et al., Report of the Task Force on Pertussis and Pertussis Immunization 1988. Pediatrics (Supplement), 1988: p. 932-984.

3.Nishida, H., Overview of sudden infant death syndrome in Japan. Acta Paediatr Jpn, 1994 Jun. 36(3): p. 301-3.

4.Sivan, Y. and Shen,G., Sudden infant death syndrome in the Tel Aviv and Petah Tikva districts. Isr J Med Sci, 1992 Jul. 28(7): p. 430-5.

5.McLaughlin, S.A. and M.G. Valdes, Incidence of sudden infant death syndrome in Olmsted County, Minnesota: 1945 through 1992. Mayo Clin Proc, 1995 Sep. 70(9): p. 837-43.

6.Funayama, M., Tokudome, S., and Matsuo, Y., Autopsy Cases of Sudden Unexpected Infant Deaths Examined at the Tokyo Medical Examiner's Office, 1964-1993. American Journal of Forensic Medicine and Pathology, 1996. 17(1): p. 32-37.

7.Sato, Y. and Kagahara, B, Diagnosis of asphyxia on the sudden infant death--prone sleeping position and vomit aspiration. Nippon Hoigaku Zasshi, 1992 Dec. 46(6): p. 407-12.

8.Fujita, T., M. Minowa, and Y. Miura, [A record-linkage study on risk factors for cause- specific infant mortality]. Nippon Koshu Eisei Zassh, 1994 Feb. 41(2): p. 114-25.

9.Nishi, M. and Miyake, H., Vaccination of children in Japan. Asia Pac J Public Health, 1990. 4(2-3): p. 128-31.

 

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