Court: Autism-Like Symptoms Linked to Vaccines
Federal Officials Say Vaccines Worsened Condition That Led to Autism Spectrum Disorder in Georgia Girl
By
Kathleen Doheny
WebMD Health News
Reviewed By
Brunilda Nazario, MD
Federal officials say a Georgia girl is entitled to compensation from a federal vaccine injury fund because she developed autism-like symptoms after receiving childhood vaccines in 2000.
Hannah's father, Jon, tells WebMD he was not surprised by the compensation decision.
"When you are talking about the courtroom versus science, the burden of proof
is different," Poling says. "(But) we showed there was a plausible mechanism. We
showed that an injury occurred shortly after her vaccination. Her growth curve
went flat for months."
The government has not said that
childhood vaccines cause
autism; rather,
officials conclude that the vaccines given to the girl in 2000 aggravated a
pre-existing condition -- a mitochondrial disorder -- that then manifested as a
regressive neurological disease with some symptoms of autism spectrum disorder.
Those who believe there is a vaccine-autism link call the decision a victory,
but those who see no link worry that parents will once again shy away from
childhood vaccines.
"Nothing of this situation should be generalized to the risk of vaccines for
normal children," CDC Director Julie Gerberding, MD, said at a news conference.
"None of this is going to change any of our recommendations stating the
importance of vaccination for every child."
The Back Story
Autism and autism spectrum disorders begin before the age of
3, according to the CDC, and include a group of developmental disabilities
marked by great difficulty in social interaction and communication. Difficulties
on the spectrum range from mild to severe.
The disorder is on the rise, with one in 150 children now diagnosed with
autism spectrum disorders, according to the CDC.
Suspicion of a vaccine link with autism has been ongoing at numerous advocacy
groups, who believe that thimerosal, a mercury-containing preservative used in
some vaccines, is to blame. There is increasing concern and an increasing
awareness of the theoretical potential for neurotoxicity. The preservative, used
in vaccines since the 1930s, has been removed or reduced to trace amounts in all
vaccines recommended for children 6 years of age or younger, with the exception
of inactivated flu vaccine. A preservative-free version of the inactivated flu
vaccine is available.
Advocacy groups against childhood vaccines take issue with other vaccine
components as well.
Autism Groups: Decision a Victory
Sallie Bernard, co-founder of SafeMinds (Sensible Action for Ending
Mercury-Induced Neurological Disorders), is ecstatic about the decision. "We're
finally seeing the truth come out," she tells WebMD. "We've gotten such
incredible pushback, yet here is a case showing this connection quite clearly.
"Here is a case that really looked into the science, and behind this child's
case of autism, they have found a link between the child's autism and the
vaccines that she was given," she says.
Bernard says she hopes the decision will spur re-investigation of the issue.
"I think this will push more scientists and hopefully the NIH [National
Institutes of Health] to really investigate the role of vaccines, the role of
mercury, in autism, because this case is so compelling."
Autism Expert: Case Is "Rare"
A pediatrician who serves on a childhood vaccine advisory committee for the
U.S. Department of Health and Human Services sees the case differently. "To say
mercury causes autism is a giant leap," says Jaime Deville, MD, a pediatrician
at Mattel Children's Hospital at the University of California Los Angeles.
"Epidemiological studies do not support the hypothesis that mercury in
vaccines causes autism in the general population,'' he tells WebMD. "However,
there might be individual sporadic, or rare cases in which patients have an
adverse reaction after a dose of a vaccine that might exacerbate a pre-existing
condition."
That was the contention in Hannah's case -- that Hannah developed a disorder
of the mitochondria, the cells' "power sources," before developing autism-like
symptoms.
In a statement, Chuck Mohan, executive director and CEO of the United
Mitochondrial Disease Foundation, says science has not linked vaccines to
mitochondrial disorders.
"There are no scientific studies documenting that childhood vaccinations
cause or worsen mitochondrial diseases, but there is very little scientific
research in this area," the statement reads. "Mitochondrial diseases are as
prevalent as childhood leukemia, however the National Institutes of Health
devotes only $11 million a year to research into mitochondrial disorders and
only about one-third of that is earmarked for primary mitochondrial disease
research. Many scientists believe unmasking the causes of mitochondrial disease
may lead to possible cures for Parkinson's,
Alzheimer's,
heart disease and
cancer."
Deville worries that parents will again shy away from vaccines. "I would
expect parents to start calling pediatricians," he tells WebMD. But he adds that
Hannah's situation "seems to be an isolated case."
He also points out: "Once mercury was removed [from most childhood vaccines]
in 2001, autism cases did not decline."
He doubts that the decision will spur further research into the proposed
vaccine-autism link, partly because of a lack of research funding.
Autism-Vaccine Link: Hannah's Story
According to the government concession in the Poling case, Hannah had met her
"developmental milestones" such as crawling and walking on schedule during her
first 18 months. But two days after receiving five childhood vaccinations in
July 2000, she developed a 102.3-degree fever and became irritable and
lethargic. The symptoms continued and worsened over the next few months.
By the fall of 2000, the parents became worried about her language
development and had her assessed. The health care professional examining her
concluded there were deficits in communication and social development.
Complicating the picture was a history of
middle ear infections which began
at age 7 months, and the need to prescribe multiple rounds of antibiotics and to
insert pressure-equalization tubes.
By February, 2001, doctors examining Hannah found that she had a persistent
loss of previously acquired language, lacked eye contact, and did not relate
well to others. She persistently screamed and arched her back. Doctors concluded
that she was developmentally delayed and had features of autism spectrum
disorder.
Later in 2001, doctors found a defect in "cellular energetics" and diagnosed
a disorder of the mitochrondria.
Her father, Jon, then a neurologist at Johns Hopkins Hospital in Baltimore,
co-authored a paper describing how autistic spectrum disorders can be associated
with mitochondrial dysfunction. It was published in 2006 in the Journal of
Child Neurology.
Accepting his daughter's diagnosis was difficult, Poling tells WebMD. He says
the family was in denial initially that anything was seriously wrong. "After six
months of essentially our daughter being a zombie and gone, we knew this wasn't
going away," he says. "This was chronic. And we had to come to grips with that."
Still, Poling says his daughter's experience has not turned him against
vaccines; he just wants any vaccination risks to be acknowledged and addressed.
"I want to make it clear I am not anti-vaccine," he says. "Vaccines are one
of the most important, if not the most important advance, in medicine in at
least the past 100 years. But I don't think that vaccines should enjoy a sacred
cow status, where if you attack them you are out of mainline medicine.
"Every treatment has a risk and a benefit," he says. "To say there are no
risks to any treatment is not true.
"I don't think the case should scare people," Poling adds. "Sometimes people
are injured by a vaccine, but they are safe for the majority of people. I could
say that with a clean conscience. But I couldn't say that vaccines are
absolutely safe, that they are not linked to brain injury and they are not
linked to autism."
Poling hopes the fed's decision will trigger government action. "I hope it
will force government agencies to look further into what susceptibility factors
are out there for children to develop brain injury after vaccination, to look
into the susceptibility factors of people at risk."
His advice for parents? They should demand to know a vaccine's safety record
before agreeing to give it to their child, including any known links with
metabolic disorders and susceptibility to injury, he says.
Mitochondial Disease
Hannah Poling suffered from a form of
mitochondrial disease caused by a
genetic defect in her mitochondrial DNA.
Mitochondria are organelles -- tiny bodies within our cells -- that carry
their own DNA, which we inherit from our mothers. Mitochondria provide the
energy cells need to function.
Edwin Trevathan, MD, MPH, director of the CDC's National Center on Birth
Defects and Developmental Disabilities, said at the news conference that when
children with mitochondrial disorders are placed under severe stress, such as a
high fever, their bodies don't make enough energy. This often damages the brain,
the body organ that needs the most energy.
The type of problem such children develop depends on the part of the brain
that is affected. Some may become spastic and have trouble walking. Others may
have seizures, problems with language, and sometimes problems with social
behavior, Trevathan said.
Children who have mitochondrial disorders, even though they seem normal, are
predestined to have a problem when they have stress," he said at the CDC news
conference. "This is distressing for parents who watch their children suddenly
deteriorate. Most are normal appearing until they exhibit signs of disease when
placed under severe stress. Most do not have problems with autism."
Some researchers have suggested that mitochondrial diseases or disorders are
more common in children with autism than in other children.
"If anyone said mitochondrial disease prevalence is higher among children
with autism, that is a hypothesis and there is remarkably little data to support
it," Trevathan said. "The truth is we don't know the prevalence of mitochondrial
disease in the general population."
Mohan of the United Mitochondrial Disease Foundation tells WebMD that
mitochondrial disease affects one in 4,000 children -- and maybe more. But he
rejects the link to autism.
"Persons with mitochondrial disease don't necessarily have autism, and
persons with autism don't necessarily have mitochondrial disease," Mohan says.
"Just as with vaccines, there is no scientific proof vaccinations cause
mitochondrial deficiencies or autism."
Trevathan notes that though doctors are urged to consider each child's
individual risk, vaccinations are generally recommended for children with
mitochondrial disorders.
"We do recommend immunizations, because many of the diseases we immunize
against are associated with regression in children with mitochondrial
disorders," he said.
Vaccine-Autism Link: More Info
The court has not yet decided on the amount of damages. That decision, those
close to the case say, could take a few months or more.
The federal Vaccine Injury Compensation Program was set up to ensure an adequate supply of vaccines, stabilize costs, and to provide an avenue for individuals injured by certain vaccines. The CDC web site says the program was triggered by reports in the early 1980s of harmful side effects following vaccination with the diphtheria, tetanus, and pertussis vaccine. As the number of lawsuits filed against vaccine makers increased, vaccination rates among children fell. Vaccine companies wary of liability began to drop out of the market. To help solve the situation, the National Childhood Vaccine Injury Act of 1986 established the compensation program.
The American Academy of Pediatrics in a statement, says the case "raised many
questions."
"The AAP leadership is seeking access to official documents in the case so
medical experts can examine the science and consider whether it raises
implications for other children. The AAP wants to ensure the public is provided
accurate information about the safety and importance of vaccines. Our members
are dedicated to the health of all children and urge parents to fully immunize
their children," the statement says.
SOURCES:
U.S. Court of Federal Claims response to Poling petition for compensation.
Sallie Bernard, co-founder, SafeMinds.
John Gilmore, executive director, Autism United.
Jaime Deville, MD, pediatrician, Mattel Children's Hospital, University of
California Los Angeles and member, Advisory Commission on Childhood Vaccines,
U.S. Department of Health and Human Services. CDC.
United Mitochondrial Disease Foundation.
Statement from Chuck Mohan, executive director and CEO, United Mitochondrial
Disease Foundation.
Chuck Mohan, executive director and CEO, United Mitochondrial Disease
Foundation.
Jon Poling, MD, PhD, neurologist.
Statement, American Academy of Pediatrics.
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