Measles vaccination - An underestimated prevention measure: Analyzing a fatal case in Hildesheim, Germany.

Measles and rubella are targeted for elimination in the WHO region Europe. To reach the elimination goal, vaccination coverage of 95% must be achieved and sustained, the genotype information has to be provided for 80% of all outbreaks and transmission chains of a certain variant must not be detected for >12 months. The latter information is collected at Germany's National Reference Center Measles, Mumps, Rubella (NRC MMR). We describe here an outbreak of measles occurring in Hildesheim. The outbreak comprised 43 cases and lasted 14 weeks. Surprisingly, a high number of vaccination failures was observed since 11 cases had received two doses of the MMR vaccine and 4 additional cases were vaccinated once. A 33-year-old woman passed away during the outbreak. She was the mother of 5 children between 4 and 16 years of age. Two schoolchildren contracted measles and passed it on to the rest of the family. Due to delivery bottlenecks, the vaccination of the mother was delayed. She developed measles-like symptoms 3 days after vaccination and was found dead on the morning of day 8 after vaccination. A post-mortem examination was done to identify the cause of death. Moreover, molecular characterization of the virus was performed to analyze whether she was infected by the wildtype virus circulating at that time in Hildesheim or whether the vaccine may have been a concomitant and aggravating feature of her death. The result showed that the samples taken from her at the time of death and during necropsy contained the wildtype measles virus variant corresponding to MVs/Gir Somnath.IND/42.16 (WHO Seq-ID D8-4683) that fueled the Hildesheim outbreak and circulated in Germany from March 2018 to March 2020. The vaccine virus was not detected. Moreover, two aspects uncovered by the post-mortem examination were remarkable; the woman died from giant cell pneumonia, which is a complication seen in immune-suppressed individuals and she was actively using cannabis. THC is known to influence the immune system, but literature reports describing the effects are limited.

Fatal gas embolism in hospital: accident or suicide?

Fatal gas embolism in hospital is usually an iatrogenic complication of invasive diagnostic and therapeutic procedures. Air or gas enters the venous circulation, leading to cardiovascular failure or migrating to the systemic arterial circulation. A 73-year-old man died suddenly in hospital. An allergic reaction was initially suspected because of the presence of soft tissue swelling, but it was noticed that his oxygen tube was attached to the indwelling catheter inserted in the patient's right median cubital vein. Whole-body post-mortem multi-slice computed tomography (pm-MSCT) revealed abundant gas in the subcutaneous fatty tissue, in the heart chambers, in the mediastinum, pericardium, thoracic wall and peritoneum. The external examination revealed massive subcutaneous emphysema with marked palpable cutaneous tension and crepitation on palpation of the entire body's surface. Autopsy found gas bubbles in the heart and throughout the vascular system. Death was attributed to cardiac gas embolism.