Asia-Pacific, Development & Aid, Headlines, Health

SRI LANKA: Anxiety Persists Over Safety of Rubella Vaccine

Amantha Perera

COLOMBO, Nov 4 2009 (IPS) - Sudarma Senevirathana’s teenage daughter is at an age when she can already be given the ‘rubella’ vaccine, administered free of charge by government health officials at schools.

But Senevirathana refuses to subject her twelve-year-old daughter to the injection. "She can take it when she is nearer to getting married," says the mother from Kurunegala, about 100 kilometres east of the capital Colombo, "I don’t want to risk my daughter’s life."

The rubella vaccine is given to girls between the ages of 12 and 13, the period medical experts say the body’s immune system is at its strongest to fight any rubella infection. It is administered to prevent still births and other birth defects commonly associated with the rubella virus, which triggers a disease known by its name, or commonly called German measles.

According to the World Health Organization (WHO), the congenital rubella syndrome caused by the rubella virus is a major cause of severe birth defects. A woman who has caught the virus early in her pregnancy has a 90 percent chance of passing on the virus to her fetus. As a result, the fetus either dies or acquires CRS. The resulting birth defects could be found in the eyes, heart and brain.

Between March and September, the rubella vaccine, according to reports, has led to the death of two young school girls who were the same age as Senevirathana’s daughter after they took the injection.

One of them passed away in March in the southern town of Matara, and the other in Wariyapola, nearer to Senevirathana’s home, in September. Both girls received the injection during their schools’ vaccination programmes.

Before 2009 the rubella vaccination was a standard public health programme, similar to any one of the shots given through government’s immunisation campaigns, which have been overwhelmingly successful. But the two deaths have undermined public confidence in these otherwise routine undertakings.

The first death resulted in wide-ranging investigations, with WHO officials visiting the school, located 160 kilometres south of Colombo. The WHO later said the vaccine in question was up to its standards.

Public health officials resumed the vaccinations based on the WHO’s clean bill. Six months later, another death was reported, which was similarly blamed on the rubella vaccine. The vaccine has since been put on cold storage indefinitely.

A report filed by the Epidemiology Unit of the Ministry of Health confirmed that the young girl’s death in March was caused by the vaccine.

"The death of a child following [the administration of the] rubella vaccine in Matara district was identified as a vaccine reaction," said the Unit in its Epidemiological Bulletin for April- June 2009.

"When the first girl died, there was an investigation; after that, the same vaccine was given," Senevirathana said. "Now there is a second death. It can be two deaths in 5,000 injections, but they are still two lives."

This chain of events has done nothing to ease the deep concerns of parents like Senevirathana. On the contrary, it has only heightened them.

Senevirathana said that she would only reconsider allowing her daughter to take the vaccine if a new vaccine was imported. "I don’t want to risk my child’s life, knowing that this brand has killed two already," she said.

Many other parents have voiced their strong opposition to getting their children vaccinated against rubella since the two deaths were reported, said school principals.

Soon after the March death became public, the authorities at Vihara Maha Devi Vidayala, a leading girl’s school in the capital, decided to seek the approval of parents before administering the vaccine to its students. But not a single parent agreed to the vaccination. "So we had to turn back the health officials who came to give it," said school principal Irangani Konnara.

All most all schools have adopted the policy of administering the vaccine only on written approval by parents. Some have gone as far as to ask the parents to be present when the injection is given.

Sheshala Hasnini, the 12-year-old from Matara who died on March 19, was given the vaccine despite a letter from her parents objecting to the injection, her relatives told IPS in March.

Five days after Hasnini’s death, a public immunisation programme against tuberculosis at a school in Dickwella, about 10 km from Matara, was abandoned following protests by parents.

This shows that public confidence in the government’s immunisation programmes has been severely compromised by the two tragic incidents spawned by rubella vaccination. School authorities say that public confidence in the rubella immunisation, in particular, is now at a very low ebb.

In interviews with IPS, they decried the lack of information on the vaccine, specifically its benefits as well as its potential dangers. The benefits of the vaccine have been overshadowed by the two deaths, the latest following the reinstatement of the vaccine.

Dr Palitha Mahipala, deputy director for public health at the Ministry of Health, has declined to comment on the latest incident involving the controversial vaccine, pending the outcome of the ongoing investigation.

Dr Mahipala was previously quoted by the media as saying that signs of rubella-related birth defects in the early 1990s had prompted the government’s decision to administer the rubella vaccine in 1996.

The incidence of CRS has since steadily declined, said the health ministry. Since 2007 not a single CRS single has been reported in Sri Lanka, leading the public to regard the rubella injection as a fairly innocuous affair until the two girls’ deaths.

"We should not in any way undermine this successful programme due to the controversy," Dr Mahipala said, adding that Sri Lanka has one of the best public vaccination programmes in Asia.

Tens of thousands of rubella vaccinations are administered each year, according to reports compiled by the Ministry of Health. A total of 300,000 dosages of the rubella vaccine administered in March were imported from an Indian manufacturer and 250,000 doses had been used since October 2008, when the first death occurred.

Senevirathana and many other parents are demanding government’s confirmation of the vaccine’s safety before allowing its use. Only then will their confidence in the vaccine be restored, they said.

"I will only reconsider [subjecting my daughter to the rubella vaccination] when we know for sure that the vaccines that caused the [two girls’] deaths have been suspended permanently and a new [batch of] vaccines is used instead," she said.