Shaken baby syndrome (SBS) commonly describes a combination of subdural hematoma, retinal hemorrhage, and diffuse axonal injury (DAI) as the triad of diagnostic criteria. In some, the presence of rib or other fractures is also taken as a sign of abuse.(1-3)
The basic issue to be reviewed here is whether or not in some instances in which a father, family member, or caretaker has been accused of causing the death of an infant or child from the SBS, the true cause of death was a catastrophic vaccine reaction.
This article concerns an unpublished series of 25 cases involving accusations or convictions for the SBS, largely collected by attorney and jury counselor Toni Blake of San Diego, California (personal communication, 2000), as well as some from personal knowledge, which have the following features: 1) All occurred in fragile infants born from complicated pregnancies. Problems included prematurity, low birth weights, drug/alcohol problems, diabetic mothers, or other maternal complications. 2) All infants were 6 months or less of age. 3) Onset of signs and symptoms occurred at about 2, 4, or 6 months of age, within 12 days of vaccines. 4) All infants had subdural hematomas. 5) Some had multiple fractures.
Few published studies on vaccine effects include before-and-after studies of immune parameters or brain function studies such as electroencephalograms, or long-term safety monitoring. Inadequate consideration has been given to the additive or synergistic adverse effects of multiple simultaneous vaccines, although in the case of toxic chemicals, two compounds together may be 10 times more toxic than either separately, or 3 compounds 100 times more toxic.(4,5)
As reviewed in an the amicus brief prepared for SBS cases by Toni Blake (personal communication, 2000), the following beliefs have become prevalent in courts dealing with the SBS: 1) Shaking alone in an otherwise healthy child can cause a subdural hematoma; 2) non-traumatic new bleeding in an existing subdural hematoma will always cause only minor symptoms; 3) a child suffering from an ultimately fatal brain injury will not experience any lucid interval; 4) short-distance falls by children are never fatal; and, 5) retinal hemorrhage occurs only in shaken babies. There is, however, a body of literature that casts doubt on the validity of these assumptions:
In the early 1970s, Guthkelch(6) and Caffey(3) offered concepts in the etiology of the shaken baby syndrome that have become widely accepted. This syndrome was presented in the context of a battered child with multiple injuries resulting from multi-directional forces. It was postulated that the weak neck muscles and the relatively large head size of an infant made him particularly susceptible to subdural injuries caused by shaking.(7) It should be noted that there was no experimental model to prove or disprove their theory, and no disinterested witness in their reports to confirm the shaking. In spite of this, the theory gradually became accepted as fact. However, several years later Duhaime et al developed a model in an attempt to demonstrate infant susceptibility to shaking. This team of scientists was unable to generate the force required to cause death or serious brain injury unless the head was impacted against a solid surface.(8,9) The authors of those studies concluded that severe head injuries commonly diagnosed as shaking injuries require impact to occur and that shaking alone in an otherwise normal baby is unlikely to cause the SBS.
The statement that rebleeding from a subdural hematoma requires new trauma is of doubtful validity. It has been demonstrated that the neomembrane surrounding an organizing subdural hematoma may itself bleed, and that expansion of a subacute/chronic subdural hemorrhage may cause new bridging veins to rupture, and that an acute clot may predispose to new bleeding.(10,11) New bleeding in an established subdural hematoma may occur spontaneously and without new trauma.(12) In the cited example, the child was in a hospital under the care of a physician.
Regarding belief #3, at least some children have lucid intervals prior to the development of symptoms, including those who die.(13,14) Ribas and Jane state that it is particularly important to emphasize that both contusions and intracerebral hematomas can cause neurologic deterioration after a lucid interval.(15)
Regarding belief #4, isolated reports of fatal falls and biomechanical analysis using experimental animals and adult human volunteers indicate the potential for serious head injury or death from as little as a two-foot fall.(7,16-19)
Finally, as to the assumption that retinal hemorrhages are always caused by nonaccidental head trauma, there is a report of 20 children resuscitated following events other than trauma, such as near-drowning, asthma, sudden infant death syndrome, and other causes, in which two children were found to have retinal hemorrhages.(20) In addition to this, retinal hemorrhages have been attributed to a vast array of causes, including MMR and DTP vaccines.(21)
It is noteworthy that vaccines such as pertussis are used to induce allergic encephalomyelitis in laboratory animals.(22) This is characterized by brain swelling and hemorrhaging similar to that caused by mechanical injuries.(23)
Misdiagnosing a vaccine injury as the SBS has resulted in imprisonments. Testifying in a case in which a father was accused of causing brain injury to his child, San Diego pediatric neurologist Thomas Schweller stated: “There is a tendency in some medical arenas to discount completely the history provided by the family if you find a subdural hematoma.” He cautioned against assertions of 100 percent certainty, and stated that even a three-foot fall could cause a fracture.(24)
Issues of Medical Diagnosis
“Immune Paralysis,” a Possible Role in Spread of Infections: There is a small body of medical literature suggesting that vaccines can bring about an immune paralysis, opening the way for spread of relatively minor infections, such as those of a viral nature, to other parts of the body. One such complication might be viral meningitis. In a small German study, a significant though temporary drop of T-helper lymphocytes was found in 11 healthy adults following routine tetanus booster vaccinations; in four subjects, the levels were as low as those seen in active AIDS patients.(25)
Parenthetically, if this was the result of a single vaccine in healthy adults, it is sobering to think of the possible consequences of the series of multiple vaccines given to infants. Unfortunately, other than clinical observations, we can only speculate as to these consequences. This simple before-and-after testing of immune parameters has never been repeated, as far as I am aware. A few studies are to be found that show depressed function of lymphocytes and segmented neutrophils following vaccines.(26-28) Unfortunately, these are of limited scope.
Historically, one of the earliest reports of disease spread following vaccines is found in the 1967 book, The Hazards of Immunization by Sir Graham Wilson.(29) Although not opposed to vaccines, the author did give an extensive review of their potential side effects. In a chapter entitled, “Provocation Disease,” he described complications such as paralysis from poliomyelitis in an arm that had received a diphtheria/pertussis/tetanus (DPT) vaccine. In more recent times, a similar phenomenon was observed in Oman during a polio epidemic, in which it was found that a significantly greater proportion of polio cases had received the DPT vaccine within 30 days before paralysis than had controls.(30)
As to the possibility that vaccines may result in spread and escalation of minor viral infections into fulminant meningitis with resultant mimicking of the SBS, this area appears to remain unexplored.
Brain Edema and Perivascular Lymphocytosis: Other than occasional anecdotal reports, there is little to be found in the medical literature implicating vaccines in causing brain edema and perivascular/meningeal lymphocytic infiltrations in humans, probably because the phenomenon has never been systematically studied. There are several reports of infants who developed increased intracranial pressure with bulging fontanelles following DPT immunization.(31-33) but for the most part we must look to animal experiments for information in this area.
Perhaps one of the most revealing studies about the nature of vaccine reactions was that conducted by Munoz and co-workers,(34) in which an experimental encephalo-myelitis was elicited in mice by the injection of pertussigen, a derivative of Bordetella pertussis, along with mice spinal cord extract. Histologic findings of perivascular infiltrates, consisting largely of lymphocytes in the brain and spinal cord developed as a result. These findings suggest that histological appearances of vaccine-induced encephalitis may be similar to those seen in viral meningitis.