Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

The detailed history of the patient is included in the autopsy form that is submitted to the team (Autopsy Surgeon/Pathologist/Forensic Specialist) conducting autopsy. The additional specific information to the autopsy team will help them look for any underlying disease/pathologies in the deceased which may be cause of death or contributed in the cause of death.

• It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.
• Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories as early as possible to avoid loss of biological samples due to decomposition.
• All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.
• Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.
• All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen viscera in bottle.
• The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further pathological examination.

Emedinews:Insights on Medicolegal Issues:Postmortem examination in death due to Adverse Events Following Immunization (AEFI)

·         It is recommended that an autopsy in a death suspected to be due to an AEFI be performed as soon as possible (within 72 hours) to avoid tissue damage, development of postmortem artifacts and autolysis of the adrenal glands, which can alter diagnosis.

·         Samples for both histopathological and toxicological examination should be sent to approved and accredited government reference laboratories through investigating police agencies. The samples should be collected and transported to forensic laboratories as early as possible to avoid loss of biological samples due to decomposition.

·         All samples should be labeled with the name, number and autopsy report/form number along with the necessary documents requesting the examination and investigation, and the conclusions from the autopsy, which should list the cause of death, utilizing International Classification of Disease (ICD 10) and, if possible, the causative agents/drugs.

·         Sampling for histopathology examination to be sent to pathologist for underlying disease/pathologies in the deceased which may be the cause of death or contributed in the cause of death: The samples should be representative of the suspicious area of disease/pathology; however, in general 80 to 100 gms of liver, 100 gms of brain with meninges, fragments from both adrenal glands, half of transverse section of kidneys, half of Spleen and whole heart should be taken.

·         All the visceral specimens should be collected in separate containers, a wide – mouthed bottle as prescribed and 10% formalin should be added as preservatives. The quantity of the formalin should be sufficient to cover all the pieces of specimen viscera in bottle.

·         The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further pathological examination.

Emedinews:Insights on MEdicolegal Issues:Autopsy in death due to adverse events following immunization (AEFI)

Autopsy in death due to adverse events following immunization (AEFI)

The doctor conducting the autopsy is duty bound to take samples for toxicological screening and send them to Forensic Laboratory for toxicological/chemical examination

• The injection site and the tissues underneath up to 2–3 cms (button size) with dermis and epidermis of the sight of injection prick should be excised out. It should be preserved in a glass jar which should be filled two–thirds with saturated saline water. The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further toxicological/chemical examination.
• Viscera for toxicological/chemical examination: The following viscera specimen/biological samples should be collected for toxicological/chemical examination (80-100 gms of liver, 80-100 gms of brain with meninges, whole of the stomach with gastric contents (If no gastric contents, a section of stomach should be sent), upper part of small intestine about 30cm long with its contents, fragments from both adrenal glands, half of transverse section of kidneys, half of spleen, blood (100 ml ideal/minimum 10 ml) and urine (100 ml/minimum 10 ml).
• All the visceral specimens should be collected in separate container a wide-mouthed bottle as prescribed and saturated saline should be added as preservatives. The quantitative of the saline should be sufficient to cover all the pieces of specimen viscera in bottle.
• The specimens should be sealed, signed, labeled by the doctor/autopsy surgeon and should be handed over to police/investigating officer for further chemical examination in a forensic lab.