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Neurology Today:
doi: 10.1097/01.NT.0000324682.98661.5c
Article

After Vaccine‐Autism Case Settlement, MDs Urged to Continue Recommending Vaccines

FALLIK, DAWN

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Parents are worried about the rising rates of autism, and doctors are unsure of the cause or how to treat it. But a federal court decision has doctors fearing that parents will stop vaccinating their children altogether for fear of inducing autism-like symptoms — which could result in a public health calamity.

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Although several studies have failed to show a link between autism and vaccines, lay concerns about a possible cause and effect continue to arise. In the past year, those concerns have been flamed by celebrities, such as comedian and former Playboy centerfold Jenny McCarthy, whose son is autistic; she has appeared on television to insist that vaccines cause autism.

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ARTICLE IN BRIEF

Experts cautioned physicians to continue recommending vaccines to patients, even in the wake of government settlement of a case involving vaccines and autism.

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THE POLING CASE

The issue flared again when Jon S. Poling, MD, PhD, an Athens, GA, neurologist, filed a lawsuit against the Department of Health and Human Services in 2002 concerning his daughter, Hannah. In 2000, when she was 19 months old, she received five routine shots against nine infectious diseases. Two days later, she had a fever, screamed incessantly, and would not walk.

Hannah was diagnosed with autism at 33 months, but then was later referred for a muscle biopsy, which indicated she had mitochondrial dysfunction. Dr. Poling described the case in a February 2006 paper in the Journal of Child Neurology.

Dr. Poling believes that the stress of those vaccines aggravated his daughter's underlying problems. The HHS Division of Vaccine Injury Compensation reviewed the child's medical records. In November 2007 the Department of Justice issued a concession awarding a yet-to-be determined compensation to the family. There were no courtroom proceedings or public hearings. The documents from that case have not been released, citing privacy issues.

In an April 11 article in The Atlanta Journal Constitution, Dr. Poling wrote that mitochondrial dysfunction might not be rare among children with autism, citing a March 2005 Portuguese study in Developmental Medicine & Child Neurology that found at least 7.2 percent of autistic children have a mitochondrial dysfunction.

He urged more studies to determine the prevalence of mitochondrial abnormality among children with autism and then re-evaluate previous studies about vaccine safety, particularly when several doses are given at once.

“Everyday, more parents and some pediatricians reject the current vaccine schedule,” he said. “In an abundance of caution, meaningful reform must be performed urgently to prevent the re-emergence of serious diseases like polio or measles.”

And, in a blog on the Web site for The New York Times, Dr. Poling wrote in response to an article by Tara Parker Pope, “Will a 9-year-old Change the Vaccine Debate?”: “All three of our children are fully vaccinated, except Hannah didn't receive her second MMR (her antibody titers were still very high). I am pro-vaccine; but we need better government safety mechanisms in place.”

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CASE IS NOT CONCLUSIVE

Many interpreted the court decision as the government's concession that vaccines caused autism. But doctors pointed out that there have been no scientific studies showing such a link, or that patients with mitochondrial disorders were affected by vaccinations. They cautioned parents not to jump to conclusions.

“You can't take what happened to one person and generalize it to 300 million,” said Bruce Cohen, MD, a pediatric neurologist at the Cleveland Clinic. “This is one case, and to draw anything further to patients with mitochondrial disorders or to the rest of society — it could be a public health tragedy if people started changing the way immunizations are given.”

Although mitochondrial diseases take many forms, they are rare, occurring about once in every 5,000 adults, said Michio Hirano, MD, an associate professor of neurology who specializes in mitochondrial diseases at Columbia University Medical Center.

Mitochondria are the powerhouse of the cell, converting fats and glucose to adesonine triphosphate. When there's a problem with the mitochondria, the tissues or organs that require a lot of energy — like the brain or muscles — become dysfunctional.

Many of the mitochondrial diseases do not appear until the child is a toddler, said Dr. Hirano, and infections, whether an ear infection or a flu, can aggravate the symptoms. But patients with mitochondrial diseases generally tolerate vaccinations and should have them, he said, because while a healthy child might be able to recover from an attack of the measles, it could be devastating to someone with a chronic disease.

“The consensus is to recommend vaccines, even to children with mitochondrial disorders,” he said. “An infection could be harmful and it is important to protect them from being devastated by other illnesses.”

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‘ALLAY PATIENT FEARS’

Paul Offit, MD, chief of infectious diseases at the Children's Hospital of Philadelphia, is frustrated because the media gives credence to celebrities without scientific knowledge; he says millions of dollars have been spent studying a possible link between vaccines and autism without finding any connection.

In the Poling case, Dr. Offit said that while natural infections can worsen symptoms of chronic neurological illnesses in children, there has been no scientific evidence that vaccines cause that kind of stress.

“We need to allay parent's fears,” he said. “Say, ‘Look, it's a medical question — do vaccines cause autism — how would you study that?’ And that study has been done redundantly — 16 times.”

Dr. Cohen, of the Cleveland Clinic, said the government should provide the resources to study the current immunization methods. “Maybe the proof we need is a study where a large group of children are vaccinated with the current vaccine schedule and another large group treated with a modified schedule,” he said. “After two or five years you look at how many children were immunized in each group and whether the autism rates have changed.”

If the schedule, which currently calls for as many as 23 vaccines before age 2, does change, there could be drastic consequences, he said.

Splitting the visits means more doctor-visits for busy parents, and he worried that some children might slip through the cracks. Already, federal officials believe that there will be more measles cases in 2008 than in any other since 2001, mostly in people who were never vaccinated.

“It wasn't that long ago that you kept kids inside all summer long for fear of polio,” he said. “It could come back quickly.” •

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REFERENCES

• Poling JS, Frye RE, Zimmerman AW, et al. Developmental regression and mitochondrial dysfunction in a child with autism. J Child Neurol 2006;21(2):170–172.

• Oliveira G, Diogo L, Oliveira CR, et al. Mitochondrial dysfunction in autism spectrum disorders: A population-based study. Dev Med Child Neurol 2005;49(10):726–733.
• Poling JS. Father: Child's case shifts autism debate. The Atlanta Journal-Constitution. April 11, 2008.
www.ajc.com/opinion/content/opinion/stories/2008/04/11/polinged0411.html
• Parker-Pope Tara. Will a 9-year-old change the vaccine debate? April 12, 2008. Dr. Poling's blog entry is #103: http://well.blogs.nytimes.com/2008/04/12/will-a-9-year-old-change-the-vaccine-debate/#more-178.

©2008 American Academy of Neurology

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