Meningitis Vaccine in Chad: Not the cause of anything except immunity to Meningitis A

The short version:

In December 2012 in the African country of Chad, there was  a mass vaccination clinic against Meningitis A, using the widely-administered and life-saving vaccine, MenAfriVac®.  After the clinic, 36 children experienced symptoms unlike the known, rare adverse effects of MenAfriVac®.   A group of independent experts investigated, and reported that the children fell victim to a well-known syndrome, mass psychogenic illness. MenAfriVac® did not cause the symptoms.  

Ignore what anti-vaccination activists are claiming about MenAfriVac® and this event.

Mass psychogenic illness (MPI) is a "real thing".  It has occured after mass vaccination events. It's insulting to say, "it is all in your head".  MPI is not "an African thing."

Here is the English-language version of the second official government statement on the events following vaccination, from the Chad Ministry of Health, released on January 21 (Download 2nd statement MoH Chad_21Jan2013), or the French version ( Download NoteinfoMinisteredelaSante_21Janvier2013) 

2nd Statement Ministry of Public Health, Chad

21 January 2013
Republic of Chad
The independent international experts in charge of the in-depth investigation into the unusual reactions recorded during the vaccination campaign against meningitis between 11 and 15 December 2012 at Gouro (West-Ennedi), presented their preliminary findings on Friday 18 January 2013 at SEM. Their investigation was based on four (4) axes:

• Analysis of available documents; 
• Analysis of the organization of the vaccination campaign and vaccine quality; 
• Interviews of the different parties involved; 
• Medical examination of the 36 cases in the two hospitals in N’Djamena. 

As a result from the different analyses, discussions among the team, and after meetings or contacting those implicated (or not implicated), in the event, the experts have come to the preliminary conclusions below:

EXPERT FINDINGS

The vaccination campaign organized in Gouro was conducted under normal conditions by staffs who are experienced in implementing mass campaigns and routine vaccination programs.

The conditions of hospitalization, in particular the medical care at the psychological level, the dialogue between the community and the health staff, were insufficient.

The crises are triggered by noise, visits by foreigners, and the occurrence of crises among other patients. Apart from these agitated periods, the children lead normal lives.

The patients are aged between 8 and 25 years, and with 77% of them being girls, i.e. 27 out of a total of 35.

A child that had not been vaccinated complains of similar symptoms.

All the different medical examinations performed on the patients were normal. The neurological examination on patients at the request of the experts also concluded that all was normal.

The same MenAfriVac vaccine lot 127M1033, used in Gouro, was used in the entire Ennedi region.

The expert reports from WHO on the vaccine lot at the level of the manufacturer Serum Institute of India (SII), showed no manufacturing defect.

The MenAfriVac vaccine, prequalified by WHO in 2010, has been subjected to all the required tests before being used. To date, more than 100 million people have been vaccinated in 10 countries (Burkina Faso, Mali, Niger, Cameroon, Nigeria, Ghana, Sudan, Senegal, Chad, and Benin). The vaccine will be further introduced in 16 African countries. Since the introduction of the vaccine, no case of meningitis “A” has been recorded in vaccinated individuals.

EXPERT RECOMMENDATIONS 

• Ensure the progressive but rapid return of the children to their families and a medical follow-up; 
• Maintain a dialogue with the families, and vaccination stakeholders and partners. 
• Reinforce the medical structure at the local level through the addition of a doctor and a qualified nurse for a better health follow up in the populations and routine immunization activities. 
• Reinforce the ability of the health staff in crisis communication and the management of rumors. 

The experts wish to specifically state that analysis of the epidemiological, medical, clinical, and diagnostic tests data, has not been able to establish a causal link between the clinical manifestations observed in the patients and the MenAfriVac vaccine.

The symptoms observed in patients are similar to those described in the literature under several names:

• Collective hysteria 
• Collective obsessive behavior 
• Mass psychogenic phenomenon 

The independent experts thank the population and the authorities in Chad for their confidence. They request that the authorities be diligent in the implementation of the recommendations that will facilitate a return to a peaceful situation that will be to the benefit of the vaccination programs.

The full preliminary report has been submitted to the governmental authorities and will be finalized by the Health Service in Tunisia, where 7 of the 35 patients from N’Djamena were evacuated.

The Ministry of Public Health has worked in collaboration with the experts whilst guaranteeing the complete independence of the investigation. The Ministry welcomes the experts’ conclusions in reassuring the patients, their families, and the general public of the health status of the evacuated patients from Gouro, the quality of the MenAfriVac vaccine and the overall importance of vaccination.
N’Djamena, 21 January 2013
The Minister of Public Health
Dr Mamouth Nahor N’Gawara.

 Stephen Novella, MD, a neurologist wrote about another case of mass psychogenic illness in the US:

.... A conversion disorder occurs when psychological stress manifests as physical symptoms. We take this for granted to some degree – when people feel anxious they may get sweaty, nauseated, short of breath, and have palpitations. People with panic attacks can have these symptoms and also difficulty swallowing, and episodes that may resemble certain types of seizures with feelings of being separate from reality or from themselves. These are physical symptoms resulting from pure emotional stress. But in some cases psychological stress can also lead to neurological symptoms – pretty much any neurological symptoms, such as weakness, difficulty speaking, loss of vision, and involuntary movements.

It’s important to note that this is a known and well-established syndrome. Neurologists see patients with conversion disorder frequently, and it can be positively demonstrated in many cases that the neurological symptoms are not due to any damage or lesion in the nervous system but to psychological stress. For example, it can be demonstrated in someone with psychogenic blindness that their visual system actually works. Many patients with psychogenic seizures display features that are neuroanatomically impossible to be due to actual seizures.

He went on to write,

....In this case [the Leroy illness] we are probably dealing with not only a psychogenic illness but a case of mass psychogenic illness, which is also a known phenomenon. In these cases the stressful trigger is partly the appearance of symptoms in other people, which causes anxiety about there being a contagious illness or an environmental exposure. In susceptible individuals this can trigger a psychogenic illness mimicking the symptoms of those already affected. There may even be an original case that is due to physical illness that acts as the trigger. We do not know what makes individuals susceptible to this, but epidemiologically women are affected much more than men.

The LeRoy case has all the hallmarks of a mass psychogenic illness. Most of the symptomatic individuals are women, they are all part of the same small and close knit community, and have social contact with each other. The diagnosis, therefore, is not based entirely on the exclusion of other causes. The case also has a natural history and epidemiological features that fit a mass psychogenic illness.

Previously here:

• Is It True that a Meningitis Vaccine Paralyzed Many Children in Chad?
• Claim: "40 Children in Chad Paralyzed by Vaccines" Is Probably False

MenAfriVac Adverse event reporting in the medical literature:

• Chaibou MS, Bako H, Salisou L, Yaméogo TM, Sambo M, Kim SH, Djingarey MH, Zuber PL, Perea WA, Pezzoli L. Monitoring adverse events following immunization with a new conjugate vaccine against group A meningococcus in Niger, September 2010. Vaccine. 2012 Jul 27;30(35):5229-34. doi: 10.1016/j.vaccine.2012.06.006. Epub 2012 Jun 16.
• Ouandaogo CR, Yaméogo TM, Diomandé FV, Sawadogo C, Ouédraogo B, Ouédraogo-Traoré R, Pezzoli L, Djingarey MH, Mbakuliyemo N, Zuber PL. Adverse events following immunization during mass vaccination campaigns at first introduction of a meningococcal A conjugate vaccine in Burkina Faso, 2010. Vaccine. 2012 May 30;30 Suppl 2:B46-51. doi: 10.1016/j.vaccine.2011.12.112. Epub 2012 Jan 9.

Selected readings in mass psychogenic illness research:

• Broderick JE, Kaplan-Liss E, Bass E. Experimental induction of psychogenic illness in the context of a medical event and media exposure. Am J Disaster Med. 2011 May-Jun;6(3):163-72.
• Jones TF, Mass Psychogenic Illness: Role of the Individual Physician Am Fam Physician. 2000 Dec 15;62(12):2649-2653.
• Lorber W, Mazzoni G, Kirsch I. Illness by suggestion: expectancy, modeling, and gender in the production of psychosomatic symptoms.Ann Behav Med. 2007 Feb;33(1):112-6.
• Mazzoni G, Foan L, Hyland ME, Kirsch I. The effects of observation and gender on psychogenic symptoms.Health Psychol. 2010 Mar;29(2):181-5. doi: 10.1037/a0017860.

Selected readings in mass psychogenic illness following vaccination:

• Clements CJ. Mass psychogenic illness after vaccination. Drug Saf. 2003;26(9):599-604.
• Kharabsheh S, Al-Otoum H, Clements J, Abbas A, Khuri-Bulos N, Belbesi A, Gaafar T, Dellepiane N. Mass psychogenic illness following tetanus-diphtheria toxoid vaccination in Jordan.Bull World Health Organ. 2001;79(8):764-70. Epub 2001 Oct 24.
• Huang WT, Hsu CC, Lee PI, Chuang JH. Mass psychogenic illness in nationwide in-school vaccination for pandemic influenza A(H1N1) 2009, Taiwan, November 2009-January 2010. Euro Surveill. 2010 May 27;15(21):19575.
• Khiem HB, Huan le D, Phuong NT, Dang DH, Hoang DH, Phuong le T, Sac PK, Chien TM, Tai LA, Dan NT, Deen JL, Seidlein Lv, Clemens J, Trach DD Mass psychogenic illness following oral cholera immunization in Ca Mau City, Vietnam. Vaccine. 2003 Nov 7;21(31):4527-31.
• Peiró EF, Yáñez JL, Carramiñana I, Rullán JV, Castell J. Med Clin (Barc). 1996 Jun 1;107(1):1-3. [Study of an outbreak of hysteria after hepatitis B vaccination]. [Article in Spanish]
• Yasamy MT, Bahramnezhad A, Ziaaddini H. Postvaccination mass psychogenic illness in an Iranian rural school. East Mediterr Health J. 1999 Jul;5(4):710-6.

Comments

[Todd W.]

I had my suspicions that that was the case, but wanted to wait until more evidence came in. Good reporting, Liz!