A six-week-old baby in Nepal died after receiving six vaccines. The child, Bunu Dewan, reportedly received the BCG, DPT, fIPV and PCV vaccines at a community health center in the town of Simaltar. Bunu’s condition is reported to have deteriorated following the vaccination and the child was subsequently taken to Neuro Hospital in Biratnagar.1 2
The BCG (Bacillus Calmette–Guérin) vaccine is given to newborns at birth to protect them from contracting tuberculosis (TB). The DPT vaccine for diphtheria, pertussis and tetanus is scheduled to be given at six weeks, although it is now supposed to be given as part of a pentavalent vaccine that includes a dose of hepatitis B vaccine and Haemophilus influenza B vaccine.3 4
The fIPV, which stands for fractional inactivated polio vaccine, is also scheduled at six weeks, as are the PCV (pneumococcal conjugatve vaccine), OPV (oral polio vaccine) and rotarivus vaccine.4
Countries Are Switching from OPV to IPV
After wild poliovirus type 2 was declared eradicated in September 2015, countries like Nepal and India still using live oral polio vaccine (OPV) that contains type 1,2 and 3 polioviruses began switching from trivalent OPV to a bivalent OPV only containing types 1 and 3 as part of a global initiative to prevent type 2 vaccine strain poliovirus from circulating and causing vaccine strain polio. At the same time, there was a move toward encouraging use of injectable inactivated polio vaccine (IPV) that cannot cause vaccine strain polio (the U.S. switched from OPV to IPV in 1999).
Due to limited supplies of IPV worldwide, a fractionated version of IPV was developed that is given intradermally instead of intramuscularly and uses one-fifth the amount of antigen in a regular dose.5 According to the World Health Organization (WHO), the fIPV can be used as an “alternative to the intramuscular injection of a full dose of IPV” and that, in the context of an IPV shortage, countries should consider instituting a 2-dose fractional dose schedule, where feasible.”6
DPT Still Being Given to Infants in Many Countries
On Feb. 3, 2019, six-month-old Binod Ale Magar died in Kailali district of Nepal within hours of getting the DPT vaccine. Two other children, three-year-old Mihika Chaudhary and two-month-old Dipika Chaudhary, also received the DPT vaccine that day and became ill and developed rashes throughout their bodies.7
In 1996, the U.S. licensed an acellular pertussis vaccine (DTaP) for infants after global clinical trials demonstrated that DTaP causes far fewer serious reactions than DPT.8 9 10 According to the National Vaccine Information Center (NVIC), reactions to pertussis containing vaccines, both DPT and DTaP, usually occur within 72 hours or a week of vaccination and can include high fever, severe swelling and pain at the injection site, convulsions, high pitched screaming, collapse/shock (hypotonic/hyporesponsive episodes), encephalitis and encephalopathy.11
1 Child dies after being administered 4 vaccines at a time. Khabarhub Dec. 21, 2019.
2 Gaur S. Child Dies After 4 Vaccines Given At A Time. The Digital Wise Dec. 22, 2019.
3 Bacillus Calmette-Guerin (BCG) Vaccine. MedlinePlus.
4 National Immunization Schedule of Nepal (2019). Epomedicine May 26, 2019.
5 Centers for Disease Control and Prevention. Fractional-Dose Inactivated Poliovirus Vaccine Immunization Campaign – Telangana State, India, June 2016. MMWR Aug. 26, 2016; 65(33): 859-863.
6 Fractional dose IPV. World Health Organization.
7 TVR Staff. Infant in Nepal Dies Hours After Getting DPT Vaccine. The Vaccine Reaction Feb. 20, 2019.
8 Bernstein DI, Smith VE et al. Comparison of acellular pertussis vaccine with whole cell vaccine as a booster in children 15 to 18 months and 4 to 6 years of age. Pediatr Infect Dis J 1993; 12(2): 131-135.
9 Greco D, Salmao S et al. A Controlled Trial of Two Acellular Vaccines and One Whole Cell Vaccine against Pertussis. N Eng J Med 1996; 334: 341-349.
10 Gustafasson L, Hallander HO et al. A Controlled Trial of a Two-Component Acellular, a Five-Component Acellular, and a Whole Cell Pertussis Vaccine. N Eng J Med 1996; 334: 349-356.
11 National Vaccine Information Center. Can Pertussis Vaccine Cause Injury and Death?