Wednesday 22 October 2014

Priest died after suffering reaction to yellow fever vaccine - inquest hears

Gareth Naughton

Published 19/08/2014 | 16:49

Fr Gerard Cusack
Fr Gerard Cusack

An elderly priest who died after he was given the yellow fever vaccine was aware of the higher risk it poses to his age group before he consented to it, an inquest heard.

Fr Gerard Cusack (71), prior of the Holy Trinity Abbey, Kilnacrott in Ballyjamesduff, Co Cavan, died at Beaumont Hospital on March 18 last year, as a result of an adverse reaction to the vaccine.

Worldwide, there have been only 60 documented fatalities due to the yellow fever vaccine since its introduction in the 1930s. There is a higher risk of an adverse reaction to the vaccine, which is live, in older people.

Dublin Coroner’s Court had previously heard that Fr Cusack, who was due to travel to Tanzania to inspect works on a church roof paid for through fundraising efforts, was given the vaccine following a consultation with Dr William Yap at the Tropical Medical Bureau on Grafton Street, Dublin 2 on March 7, 2013.

On the final day of the inquest, Dr Yap gave evidence that he discussed with Fr Cusack the risks associated with the vaccine for people of his age group.

“I am certain I cautioned and warned Fr Cusack of the potential side effects and in the rare instance, a serious adverse life threatening reaction, about one in 100,000. Fr Cusack understood and accepted the risk,” he said.

The World Health Organisation lists Tanzania as being “low risk” for yellow fever and the vaccine is generally not recommended, he said, but it “may be considered for a subset of travellers”. Fr Cusack planned to visit some rural parts of the country and stay with members of his community with a higher risk of exposure to, or inability to avoid, mosquitos. “Fr Cusack and I both agreed that his trip was not generally what an average traveller to Tanzania would do,” he said.

Issues around border control were also taken into consideration in the risk benefit analysis of administering the vaccine. There have been cases where travellers have been forced to receive the yellow fever vaccine at entry points to Tanzania with border officials taking differing approaches to travellers arriving without certification for it, Dr Yap said. There was also a risk that Fr Cusack would not be allowed into a neighbouring country if he was in need of emergency medical treatment without the certification, the court heard.

Eight days after receiving the vaccine, Fr Cusack presented at Cavan General Hospital, complaining of feeling ill for one week.

His GP had prescribed an antibiotic but this had no effect. His condition deteriorated rapidly over the following 36 hours and he was transferred to Beaumont Hospital where he died from multi-organ failure on March 18.

Professor Peter Conlon, consultant nephrologist at Beaumont, previously told the court that there is no treatment for yellow fever other than “supportive” measures and the disease is fatal in 20 per cent of cases.

The post-mortem confirmed the presence of yellow fever in the liver and that the strain of the disease was the same as the one administered to Fr Cusack in the vaccine.

The cause of death was acute liver and kidney failure following an adverse reaction to the yellow fever vaccine.

Returning a narrative verdict outlining the facts, coroner Dr Brian Farrell said that he was satisfied that the chain of causation in the death goes back to the vaccine and death was due to an adverse reaction to it.

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