JAPAN, SIDS, and PERTUSSIS IMMUNIZATION
Lon Morgan, DC,DABCO
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
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.
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.
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. 
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.
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.
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.'
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.'
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. 
This is comparable to the reported Israeli
incidence of SIDS at0.47-0.90 per 1,000 live births.  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.
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.
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 . . ."
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.
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."
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." 
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." 
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
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
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.
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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.
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Proc, 1995 Sep. 70(9): p. 837-43.
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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.
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on the sudden infant death--prone sleeping position and vomit aspiration. Nippon Hoigaku
Zasshi, 1992 Dec. 46(6): p. 407-12.
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