P. O. Box 5444 heidelberg west, vic, 3081

	Australian Peacekeeper & Peacemaker VETERANS’ Association P.O. Box 5444 heidelberg west, vic, 3081 (INCORPORATED IN VICTORIA) ABN 59 558 194 094
Patron Major General John Pearn AM, KStJ, RFD (Ret’d)	Telephone: (03) 9496 2327 Fax (03) 9496 2285 Mobile: 0409 650016 Email: Graham.Castles@austin.org.au Website: www.peacekeepers.asn.au Listed Ex-Service Organisation with the Department of Veterans’ Affairs ESO Directory

1. 
   This paper is written on behalf of the Australian Peacekeepers and Peacemakers Veterans Association (APPVA).Its intent is to detail potential adverse effects associated with the vaccines administrated by the Australian defence forces (ADF) during both routine vaccination programme and those that are more specific to operational deployments. This paper will also address the potential adverse effects associated with the use of various forms of anti malarial prophylaxis and treatment.
   

2. 
   while it is acknowledged that the vaccination of ADF troops is a necessary requirement to fulfil the ADF’s duty of care responsibility to its personnel, it is also recognised that some individuals with potentially experience short term adverse events, of grater significant, however is that a percentage of this population may experience long sequelae which can impact both their ADF service retention and future and social well being.
   

3. 
   In the context of the potential for long term health impacts resulting from ADF directed vaccinations, it is prudent for the Australian repatriation authorities to include medium to long term adverse outcomes as compensable under the military compensation and rehabilitation Act. Recognition of linkage between number of operationally required vaccinations and the ongoing health and well-being of the veteran community is of major concern to many in veteran community , these concerns have been well documented by the Australian media¹ ,particularly with regard to the vaccination of Australian troops with anthrax, and therefore demand careful consideration regarding there validity in claim.
   

4. 
   In line with , and in many respects exceeding, accepted community vaccination protocols and standards the ADF routinely vaccinated s its personnel with following vaccines:^2,3
   

1. 
   Adult Diphtheria and Tetanus vaccine (ADT)
   
2. 
   Sabin Oral Polio vaccine / Inactivated Poliovirus(IPV)
   
3. 
   Meningococcal vaccine (Meningococcal Quadrivalent vaccine)
   

4. 
   Typhoid vaccine (Thyphim VI)
   
5. 
   Hepatitis A and B vaccines Rubella vaccines (either enegirix B Havrix 1440 or Twinrix combined Vaccine)
   
6. 
   Measles mumps and rubella vaccine (MMR 11)
   
7. 
   Vericella Vaccine (Varilix)
   

5. 
   Additional operational specific vaccination schedules are initiated at the direction of the operational mounting authority for particular ADF operation. This direction is made in response to specific health thread identified as endemic to the area of operations or according to real or potential threat such as biological welfare agents. These additional vaccines are :⁴
   

1. 
   Anthrax Vaccine (UK or US variant)
   
2. 
   Botulism Vaccine (Clostridum Botulinum Toxoid)
   
3. 
   Cholera Vaccine (oral Cholera)
   
4. 
   Japanese Encephalitis vaccine
   
5. 
   Plague Vaccine
   
6. 
   Rabies vaccine
   
7. 
   Smallpox Vaccine
   
8. 
   Yellow Fever Vaccine
   

6. 
   Adverse reaction may occur with the administration of any vaccine and vary in severity localised, to systemic (whole body reaction), or allergic reaction. Allergic reactions are the most severe and are potentially life threatening, Usually occurring rapidly following vaccination. Most reactions are, however of the localised type, causing minor discomfort for a limited period of time.
   

7. 
   The Australian immunisation hand book5 states the following in relation to adverse reactions:
   

Acute flaccid paralysis

Allergic reaction

Anaphylactoid reaction (Acute hypersensitivity reaction)

Anaphylaxis

Arthralgia

Arthritis


⁴ ADFP 1.2.2.1 Immunation Procetures, common wealth of Australia 2003

⁵ The Australian Immunisation Hand Book 8th Edition ,NHRMC 2003

⁶ The Australian Immunisation Hand Book 8^th Edition ,NHRMC 2003

⁷ The Australian Immunisation Hand Book 8^th Edition ,NHRMC 2003

Brachial neuritis

Death

Disseminated BCG

Encephalitis

Fever over40.5C

Guillain – barre Syndrome()GBS

Hypotensive-hypotensive episode (Shock,collaps)

Local reaction (severe

Lymphadenitis(include supporative Lymphadenitis)

Meningitis- diagnosis must be made by a physician

Orchitis

Osteitis

Parotitis

Rash (severe or unusual)

Screaming (persistent)

Seizure

Sepsis

Thrombocytopenia

Toxic – chock syndrome

Vaccine associated paralytic poliomyelitis

Other severe or unusual events(pages22-23)’⁸
9. While every effort made to minimise possible adverse reaction they cannot be entirely eliminated. good screening of individual undergoing vaccination should identify a percentage of ADF personnel who may be susceptible to adverse reactions. Screening will identify previously known reactions, immunosuppression, sickle cell anaemia’s asplenia, concurrent medication or a family history of reaction to a particular vaccine: however it will not eliminate potential adverse events entirely.

10. 
    Another potential causative factor in adverse reaction is the administration of multiple vaccines at single vaccination session. While ADF and NHRMC guidelines ^9,10 suggest that the administration of multiple vaccines is not associated with any increase in adverse reaction ,anecdotal evidence from Australia and international gulf war veterans disputes this finding.¹¹ this anecdotal evidence ,however has been called into question by the minister for veterans affair following the release of study of Australian gulf war veteran’s¹² which indicate that the vaccinations of Australian troops and rates of negative health outcomes within this population are not liked. Evidence from UK study published in the lancet ¹³ belies this finding and strongly suggests that a casual link between multiple vaccinations and the ‘so called’ gulf war syndrome does exist(this finding has also been supported
    

________________________________________________

11 Legal breakthrough for gulf war syndrome vet http:www.abc.net.au/news/newsitesitems/s847662.htm

12 Australian gulf war veterans ‘health study, Monash, university 2003

13 Health of UK servicemen who served in the Persian gulf war, the lancet, volume 353, no9148, 16jan 1999

by the British courts).14another study conducted for the Canadian department of national defence 15 also concluded that a casual link may exit with the chronic fatigue syndrome , but included other potential casual factors such as proximity to uranium depleted munitions and the use of prophylactic chemical welfare agents such as pyridostigmine bromide as potential causes of adverse health outcomes in its veteran community.

10. 
    The information detail above, while acknowledging inconsistencies between the Australian and International research literature, strongly suggest that there is a link between vaccination and adverse reaction in susceptible individuals. Further, it support s an increased potential for adverse reaction and long term sequelae in ADF personnel who undergo multiple vaccinations in preparation for operational deployments. Therefore ,as vaccination is a mandatory requirement of ADF service then it is imperative for the Australian community ,through government ,to recognise adverse reactions as compensable where the balance of probabilities ‘ would suggest the long term consequence of these reactions ()whether presenting as “gulf war syndrome” ,”chronic fatigue syndrome” or in another form of disability) are directly or indirectly attributable to service in the ADF.
    

1. 
   Localised reaction that are usually limited to 3 days-indurations erythimia. Oedema, pruritis, and tenderness.
   
2. 
   Larger reaction close to the site of injection that may persist for weeks – oedema extending from the vaccination site to the elbow or forearm and small painless nodules
   
3. 
   Mild systemic reactions lasting around 2 days- myalgia, headache and mild to moderate malaise
   

Note: anthrax in its inhalation form is uniformly fatal with out vaccination and adequate treatment post exposure.

14 Legal Breakthrough for gulf for syndrome vet http;/www.abc.net.au/news/newsitems/s847662.htm

15 Canadian department of national defence hrrp;/www.dnd.gov/reform/na/hearings/testimony

16 health of UK servicemen who served in the Persian gulf war, lancet vol 353 no 9148 16Jan1999

17 Vaccination and auto immune disease;what is the evidence ? the lancet, volume 362 no 9396,15 nov 2003

18 The Australian Immunisation Handbook 8^th Edition .NHRMC 2003

13. Botulinum : this is the most poisonous bio weapon substance known, potential adverse effects are:¹⁹

A localised reaction that are usually limited to 1-2-days –erythema,oedema and /or indurations at the site of injection

B larger localised reactions are rare but the incident of reaction increases with subsequent doses

Systematic reactions- fever, malaise, headache and myalgia

Incapacitating localised and systematic reactions are uncommon

1. 
   commonly mild local and systemic adverse effects- tenderness, redness, swelling, headache, fever, malaise rash, chills, dizziness, myalgia
   
2. 
   , nausea vomiting and abdominal pain.
   

3. 
   severe long term reaction (rare )- guillian-barriesyndrome,hepatitisand respiratory failure,respiratory and renal failure sudeen death,neaurologic events(enchephalits etc) –causation unclear
   

Reaction may be delayed by as much as 17days following immunisation

16. 
    . Plague : Local and general adverse effects are noted as both mild and infrequent but may cause neurological disturbances, speech disorders.^22,23
    

16. 
    . Rabies : Administrated as both pre exposure prophylaxix and as a post-exposure treatments following potential exposure to rabies.
    

1. 
   minor localised and systematic reaction-sore arm, headache, malaise, nausea
   
2. 
   anaphylactoid reaction are noted as rare
   
3. 
   number of cases of central nervous system disease similar to guillain-barre syndrome have been noted²⁴
   

18. Smallpox

This vaccine is not TGA approved in Australia. Reactions include but are not limited to the following;

1. 
   mild reaction – sore arm, erythema, enlarge and painful axillary glands, headache, fever, mild rash, myalgia, pains and chills
   
2. 
   moderate reactions-high faver, behavioural changes, systematic rash
   
3. 
   severe reactions – anaphylatoid reactions ²⁵
   

19. Yellow fever: Adverse reaction are generally mild with headaches, myalgia, low grade fever and other minor symptoms with hypersensitivity reaction occurring (asthma, uriticaria and rash) infrequently largely due to sensitivity to eggs. Some cases of encephalitis have been noted. ²⁶

20. 
    The mains point in to note in the adverse reaction information detailed above are that many vaccination used by the ADF have very similar reaction profiles, which while generally minor in manifestation are likely to be amplified in the use of multiple vaccination agents, further ,a number of vaccination are not TGA approved for use in Australia calling into direct question the ADF’s duty of the care with regard to its personnel and adverse health outcomes resulting from vaccination.
    

20. 
    There is sufficient evidence in the international literature to suggest that while vaccination is a necessary form of preventative treatment for ADF personnel there are inherent risks and long term sequelae that may manifest in many different forms. it is acknowledged that the correlation between vaccination and long term adverse health outcomes is difficult to quantify directly ,however to ignore that a connection exists in short term will leave the government open to the potential for substantial financial loss through class actions initiated by ADF ex- Servicemen in the future.
    

Further ,gastrointerstinal disorders may also be either exacerbated or initiated by the use of these drugs.

33“Rang,Hp Dale,MM(1987) Pharmacology,chapter 33 Antiprozoal drugs, Churchhill Livingstone.