This article was first published in 2008.
Last fall, the federal government (which defends vaccines in cases before the federal vaccine court) conceded the case of Hannah Poling: one of nine autism "test cases" before the special court. The implications have been the subject of much debate. Government officials and some scientists portray the case as an exception without much meaning in the global picture. That's because Hannah has something called "mitochondrial disorder" that the government believes made her uniquely susceptible to vaccine side effects. On the other hand, other scientists believe the case could begin to explain why some children suffer vaccine side effects when others don't - some have inherent weaknesses that make them susceptible. Here's how the government worded its concession in Hannah's case:
"After a thorough review, DVIC (the Division of Vaccine Injury Compensation, Department of Health and Human Services) has concluded that compensation is appropriate in this case. In sum, DVIC has concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations CHILD received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder."
It's the first time we know of that the government has "conceded" an autism case in vaccine court. But CBS News has learned the government has previously been court-ordered to pay on other vaccine injury cases in which a child ended up with damage including autism or autistic symptoms. In one case from 1986, the child had a pre-existing condition that the court decided was aggravated by his vaccinations. Here, the pre-existing condition was "tuberous sclerosis" or TS. According to court testimony, many children with TS will suffer seizures and brain damage. However, the longer they can go before having their first seizures, the better off they are. In this case, the court listened to scientific evidence on both sides and determined that the child's DPT shot* probably triggered his seizures, perhaps earlier than they would've otherwise occurred. At first, the government agreed to pay for the child's seizure medication but refused to compensate for his autism and mental retardation saying they were caused by the TS rather than vaccines. However, not unlike the government's concession in Hannah Poling's case, the court found that vaccines aggravated the child's pre-existing condition, and were therefore responsible for his mental retardation and autism. Here is the court's conclusion in that case:
"Dr. Gomez testified that the longer a TS child remains seizure-free, the better his prognosis for mental development. That is a pivotal issue in tuberous sclerosis cases. The earlier the onset of seizures in childhood, the greater the severity of mental retardation. The avoidance of potential seizure activity is the very reason behind the accepted medical policy of advising parents of children with known TS (or other neurological problems) to avoid the pertussis vaccine. Because of the number of brain lesions, it is unlikely that CHILD would have developed normally. The clinical manifestations of his TS, which had been latent until his first DPT shot, would probably have manifested themselves at some point in his development. None of the medical experts could predict how long CHILD would have remained seizure-free without the DPT shot and it is, therefore, impossible to predict the level of CHILD'S mental condition absent the October 24, 1986 DPT vaccination. However, the fact remains that he was asymptomatic and seizure-free until two days after his first DPT shot. It was from that date and in the following weeks that CHILD started to exhibit the clinical manifestations of his tuberous sclerosis. That CHILD could have had a seizure at any time does not mean that he would have had a seizure on October 26, 1986, and the longer he remained seizure-free, the better his prognosis for normal mental development. The onset of seizures in a tuberous sclerosis case is, in and of itself, significant because of the correlation between age of seizure onset and level of mental retardation. CHILD'S level of mental retardation is a result of the onset of seizures that occurred after his first DPT shot. In triggering the seizure which unleashed the tuberous sclerosis, the October 24, 1986 DPT vaccination significantly aggravated CHILD'S latent preexisting tuberous sclerosis."
Both sides in the debate over vaccines and autism/ADD may assign different significance and meaning to the Poling case and the much older TS case. But it's likely that they might agree on one thing: vaccines may aggravate pre-existing conditions in some babies and children. (In fact, some vaccines already come with recommendations not to vaccinate children with certain issues and conditions). One public health official recently told me that common ground on both sides might be a goal of finding out if there's a way to identify the conditions at play, screen children to identify those apt to suffer, and figure out how to continue a robust vaccination program that protects the nation but is also safe for potentially susceptible children.
*After a rash of DPT-related injuries, a new formulation that is believed to be safer was introduced and is currently in use: DTaP.