Leading cancer expert, 67, who treated Jade Goody and was praised by Prince William died after a one in 100,000 reaction to a yellow fever jab, inquest hears
A leading cancer expert who treated Jade Goody and had been praised by , died after having a yellow fever jab at a travel clinic.
Professor Martin Gore CBE died from a one in 100,000 reaction to the inoculation, which caused his organs to fail from a ‘very rare complication‘.
The 67-year-old had treated reality star Jade Goody as she battled cervical cancer and after her death and called for the screening age to be lowered from 25 to 20.
The top oncologist had also previously been presented with a lifetime achievement award by the Duke of Cambridge in 2015.
At the time Prince William said he was a ‘source of inspiration‘ and that he ‘is one of the pioneers of 20th-century cancer care, and a friend, colleague and trusted doctor to many‘.
Professor Gore had planned to travel to Tanzania for a week and booked a vaccination appointment at a chemist in Chelsea, west London, on January 2.
He died a day after being admitted to hospital on January 10.
An inquest at St Pancras Coroner‘s Court was told that the risk of an adverse reaction for a 67-year-old was just one in 100,000.
He had been a leading specialist in melanoma, ovarian and renal cancers, was medical director for ten years at The Royal Marsden Hospital in Chelsea and a Trustee of The Royal Marsden Cancer Charity.
Yellow fever is transmitted by infected mosquitoes and does not yet have a cure – although several treatments are currently at the experimental stage.
Giving evidence at the inquest, infectious disease consultant Dr Sanjay Bhagani from the Royal Free Hospital said antibodies in the vaccination could start to mimic the virus in less than one per cent in 100,000 people.
He highlighted that this risk increases to one in 100,000 for people aged 60 to 69 and 2.2 in 100,000 people over the age of 69.
He said there isn‘t any treatment at the moment to treat yellow fever.
‘In a small percentage of people especially people with immune deficiencies the virus can replicate and cause a disease that mimics the yellow fever disease that you see naturally.
‘As far as we were aware Professor Gore did not have any immune deficiency. It‘s a very rare complication of yellow fever vaccination.‘
‘The whole family are and always have been pro-vaccination. The last thing he wants is for people to not get vaccinations.‘
Senior Coroner Mary Hassell heard Professor Gore arrived at A&E at the Chelsea and Westminster Hospital on January 9 – just seven days after the vaccination – complaining of feeling unwell.
He was lethargic and felt cold, the inquest was told.
Dr Michelle Hayes, a consultant in the intensive care department, in a statement said that the Professor had a previous diagnoses of Hepatitis B in the 70s and that apart from that, he was fit and well.
‘He was not on any medication and had no known drug allergies and no previous surgery.
‘He appeared critically unwell with evidence of multiple organ failure. He was becoming increasingly unwell after his vaccination.
‘Our working diagnosis was that of acute multiple organ failure due to yellow fever vaccination.‘
Professor Gore was transferred to the Royal Free Hospital that evening via an ambulance and was cared for by both intensive care and the infectious disease teams.
Dr Sanjay Bhagani said a decision was made when the Professor arrived that he would be assessed by his team, and then by the liver team in order to determine the possibility of a liver transplant.
‘The liver unit felt given his state this would probably not be a stable admission at this stage.
‘Later that evening we got confirmation that he did have yellow fever vaccination associated virus in his blood at a very high level.
What is Yellow Fever?
Yellow fever is a tropical viral disease usually spread by mosquito bites.
The virus is most commonly found in sub-Saharan Africa, South and Central America, and the Caribbean.
It is believed to infect around 200,000 people each year and to kill 30,000 of them. Most of these cases – around 90 per cent – happen in Africa.
As many as 50 per cent of people who develop severe symptoms, which include fever, muscle pain and soreness, bleeding and vomiting, end up dying of the disease.
People die as a result of the disease causing multiple organ failure and potentially triggering shock.
There is no medicine which can cure yellow fever after someone is infected, but there is a very effective vaccine – which travellers to at risk areas can buy – which gives most people lifelong immunity from a single dose.
‘Clearly it was a very high concentration of the virus which led to other complications.
‘Unfortunately despite maximum support, steroids and antibiotics, his condition continued to deteriorate overnight and then he died the following morning.‘
Asked by the coroner why Professor Gore reacted so severely to the vaccination despite having no history of immune deficiency and being a ‘very fit chap‘, the consultant said: ‘I can‘t find any other explanation apparent from that he was over the age of 60.
‘Once the virus starts to replace at this rate and you‘re starting to get manifestations of early infection the risk is always very high. At this stage mortality is almost 50 to 60 per cent.
‘Once the virus starts to replicate it starts doing this huge inflammatory response. We were hoping to try to switch that off if we possibly could, but we couldn‘t.‘
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He said they understood very little about why people with apparently normal immune systems can succumb to complications such as this.
‘As far as I know it there‘s not been any genetic deformity identified that could put people at high risk.‘
The doctor was also asked by Professor Gore‘s son Alex whether a possible experimental treatment could have been used to help treat his father.
But it was said that the cancer doctor‘s condition had deteriorated too quickly to be considered stable enough to try the new drug – which has currently not even been tested on humans.
It is currently undergoing human safety tests in Brazil, the inquest heard, but can be requested for us in special circumstances – what is ‘compassionate grounds‘ – in the UK.
The coroner heard a vaccination against yellow fever is not required for travellers to Tanzania, but is recommended for anyone who may be passing through an at-risk country for more than twelve hours.
In a statement, a solicitor instructed on behalf of Boots UK Limited said pharmacists at the chain‘s travel clinics use a software that help them to assess a travellers risk during an appointment.
Ms Hassell said: ‘He chose to receive the vaccination for Hepatitis A, and typhoid as well as yellow fever which was administered by injection by the pharmacist during the consultation.
‘Before the injection she advised of the potential side effects as well as the increased risk of side effects for people over 60 which included the risk of a rare but serious risk of adverse reaction.
‘Professor Gore left without any apparent issues.‘
Boots later provided another statement to the coroner defending the software – which the inquest heard had ‘recommended‘ Professor Gore have the yellow fever vaccination despite it not being a requirement of entering the country.
According to the statement, the software is informed by current World Health Organisation guidance which recommends inoculation against yellow fever if a traveller is likely to be exposed to mosquitoes.
Ms Hassell said: ‘A yellow fever vaccination certificate is generally not required for people travelling to Tanzania.
‘It might be recommended for a small sub-set of travellers who are at an increased risk because of prolonged travel or who may have extensive exposure to mosquitoes and are unable to avoid mosquito bites.
‘The software does not recommend yellow fever vaccination by default but it does take into account considerations of other risk factors to determine whether or not a traveller may be within the small sub set.
‘In the consultation report it‘s recorded that Professor Gore confirmed that he may visit areas where there is still water and mosquitoes breed in still water. He also said he was likely to visit rural areas.‘
Boots said it has now updated its software to change the wording from ‘recommended‘ to ‘to be considered‘ if a traveller falls into this small sub-set.
The coroner recorded a narrative verdict, commenting: ‘His medical cause of death was multiple organ failure caused by yellow fever vaccination associated disease.
CAN VACCINES MAKE YOU ILL?
Live vaccines, such as the one given to protect against yellow fever, work by injecting a weakened but still living form of the virus into the body.
The purpose of this is to train the body how to make the right antibodies to fight off the virus, so it can remember how to do so in future.
However, if someone‘s immune system is weakened – by cancer, pregnancy, HIV or age, for example – it may be unable to destroy even the weakened form of the virus.
If this happens, it‘s possible the injected virus can survive, take hold and cause the infection it was intended to prevent.
If this happens the symptoms are usually milder than the real disease.
People who have had live vaccines may also be able to transmit an illness to someone with a weakened immune system, so should stay away from them after the jab.
Live vaccines given in the UK include those for: rotavirus, MMR, flu (nasal only), shingles, chickenpox, tuberculosis, yellow fever and typhoid (oral only). They are all proven to be effective and side effects are rare.
‘I make a determination that Professor Gore died of a rare but recognised complication of yellow fever vaccination administered on the 2 January 2019.‘
Paying tribute to his father outside the inquest, Alex Gore said his father was much loved by patients and family alike.
Alex said that sis death was very sudden and upsetting and that his father had been revered in the medical world and his field of cancer medicine.
‘He was a world renowned doctor who worked at the The Royal Marsden Hospital for 35 years.
‘He was popular and fantastic with all people in all walks of life – not just people who worked with him. He made people smile and life. He was so fun.
‘That‘s why people liked him so much as a doctor beyond the medical side.‘
He highlighted it had been comforting to read what people said about his father after his death, including patients and their relatives.
‘He also had a growing family with four children, three sons and a daughter, and is a grandfather to seven.
‘He was aware of the risks and he was a trained medic.They are baffled by his death and they still don‘t know why it happened.
‘We don‘t blame anyone, it‘s just an unfortunate thing to happen.
‘However it‘s good to see that Boots have updated their guidance about getting the vaccination.
‘We witnessed how hard the Royal Free and Chelsea and Westminster Hospital staff tried to save him, they were amazing and tried everything.‘