Shaken baby syndrome or vaccine-induced encephalitis?

Townsend Letter for Doctors and Patients,  Oct, 2003  by Harold E. Buttram

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Shaken baby syndrome (SBS), as reviewed in the Journal of the Royal Society of Medicine and other journals, (1-3,7) commonly describes a combination of subdural hematoma, retinal hemorrhage, and diffuse axonal injury (DAD as the triad of diagnostic criteria. In some, the presence of rib or other fractures is also taken as a sign of abuse.

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 SBS, the true cause of death was from a catastrophic vaccine reaction. By definition, the word "syndrome" refers to a group of signs and symptoms that occur together. The question in these instances is whether or not the syndrome of SBS may have more than one possible cause.

This article concerns an unpublished series of 25 cases with accusations or convictions of SBS, largely collected by jury counselor, Toni Blake of San Diego, California (personal communication, 2000), as well as some from personal knowledge, which have the following suggestive features:

* All occurred in fragile infants born from complicated pregnancies. Problems included prematurity, low birth weights, drug/alcohol problems, diabetic mothers, or other maternal complications.

* All were 6 months or less of age.

* In each instance there was a pattern of timing at 2, 4, or 6 months, with onset of signs/symptoms of deterioration following within 12 days of vaccines.

* All had subdural hematomas.

* Some had multiple fractures.

If more extensive review of SBS cases reveals a continued consistency of this pattern, it is highly suggestive that we are dealing with a newly recognized syndrome involving the effects of vaccines in mimicking the SBS, or what is thought to represent SBS.

As will be reviewed below, the limited availability of published studies on the effects of vaccines, such as before-and-after studies of immune parameters, or of before-and-after brain function studies such as electro-encephalograms, as well as the dearth of long-term safety studies, may have set the stage for frequent misdiagnosis. It is questionable whether consideration has been given to the additive or synergistic effects of multiple simultaneous vaccines in causing adverse reactions. In the case of toxic chemicals, it has been found that 2 chemicals together may be 10 times more toxic than either chemical separately, or 3 chemicals 100 times more toxic. (4-6) The same may take place with adverse effects from vaccines in what has been represented as SBS.

Medical-Legal Issues

As reviewed in "the amicus brief for SBS," (7) and provided through the courtesy of Toni Blake, who was previously mentioned, the following beliefs have become prevalent in courts dealing with SBS: 1) That shaking alone in an otherwise healthy child can cause a subdural hematoma; 2) that non-traumatic new bleeding in an existing subdural hematoma will always cause only minor symptoms; 3) that a child suffering from an ultimately fatal brain injury will not experience any lucid interval; 4) that short distance falls by children are never fatal; and, 5) that retinal hemorrhage occurs only in shaken babies. As reviewed in the amicus brief, there is a body of literature which casts doubt on the validity of these assumptions:

In the early 1970s Guthkelch (8) and Caffey (9) offered concepts in the etiology of the shaken baby syndrome that have become widely accepted. This syndrome was presented in the context era battered child with multiple, multi-directional-force 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. (10) 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 a team of scientists 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. (11,12) 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 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. (13,14) New bleeding in an established subdural hematoma may occur spontaneously and without new trauma. (15) In the cited example, the child was in a hospital under the care of a physician.