A four-year-old girl has died in Palermo from suspected diphtheria. She had not been vaccinated

A four-year-old girl has died at the Children’s Hospital in Palermo from suspected diphtheria. Medical Director Domenico Cipolla has no doubts as to the cause, but formal confirmation will come on Monday with the results from the National Institute of Health. The public prosecutor’s office has seized the body and ordered a post-mortem examination. The girl had not been vaccinated.

Last week she had a fever, was vomiting and had little appetite. At home, they thought it might be tonsillitis. She arrived at Villa Sofia-Cervello hospital on Saturday, several days later, on the advice of her regular paediatrician, who had not previously been able to examine her: the little girl had hardly ever been taken for a check-up. Her condition deteriorated rapidly within a few hours. She was intubated and transferred urgently to the intensive care unit at Di Cristina. The toxin had already attacked her heart, liver and colon. “We did everything we could,” says Cipolla.

When interviewed by doctors, the parents – a family from Zen – explained that they had not vaccinated their daughter because a young cousin is autistic and they had become convinced that the vaccine was to blame. This is the Wakefield hoax on autism reaching a suburb of Palermo twenty-eight years after the paper was published and sixteen years after the retraction. The girl’s four-year-old cousin, who was admitted to hospital with the same symptoms, had completed his first course of vaccinations: he is not in a serious condition. The girl’s three other siblings were vaccinated by the local health authority in the hours following her death. The paediatrician has written to all her patients’ families asking them to bring their vaccination schedules up to date as a matter of urgency.

The diphtheria vaccine is compulsory and free of charge for children aged between zero and sixteen, and is included in the hexavalent vaccine administered in the first few months of life. However, there is only one practical means of enforcing this requirement: enrolment in nursery and pre-school. Those who remain outside the education system also fall off the health system’s radar, and the penalty is a fine. 

In Italy, diphtheria is a matter for the history of medicine: over the last thirty years, there have been only six confirmed cases, none of which were fatal, and all caused by strains that did not produce toxin. No deaths had been recorded for over ten years. Vaccination coverage, however, has begun to decline. In Sicily, basic vaccination coverage against diphtheria, tetanus, whooping cough and polio stands at 85.13 per cent among those born in 2022, compared with a national average of 94.46 per cent: the island ranks last in Italy. And for booster jabs at the age of five or six, coverage does not even reach 68 per cent, whilst the Italian average exceeds 84 per cent.

Prior to this case, the last death from diphtheria in Italy had been in 1991: that too involved an unvaccinated girl. Since then, there have been only sporadic cases, almost all of which were imported and non-toxigenic. The rest of Europe has already seen what happens when vaccination coverage drops: in 2015, a six-year-old boy died in Olot, Catalonia – the first case in Spain since 1986; the following year, a three-year-old girl died in Antwerp. Neither child had been vaccinated, by their parents’ choice.

In today’s edition of Il Foglio, Matteo Bassetti writes about health illiteracy: the difficulty in distinguishing "scientific evidence from an opinion", a real risk from a myth, a public health recommendation from so-called individual freedom. The bill, he writes, always comes due: in people’s lives, in hospitals, in the state’s budgets. Creating an enemy – the regime’s doctor, the scientist in the pay of Big Pharma, the forced vaccine – remains easier than explaining the data, admitting mistakes, and investing in prevention.

On social media, the infectious diseases specialist is even more forthright. We cannot accept that in the 21st century a child should die from a disease that medicine knows how to prevent. Keeping track of vaccinations cannot be left to chance, he explains on his Facebook profile: it is a collective responsibility. And he points the finger at the anti-vax messages that have been coming for years from a certain political camp, both in Italy and in the United States under Trump and Kennedy Jr.