Vaccine court's ruling adds to confusion over autism link

Experts caution that the case, involving an underlying mitochondrial disorder, does not have broad application regarding vaccine safety.

By Susan J. Landers — Posted April 7, 2008

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Physicians are being called upon, once again, to address concerns about the safety of childhood vaccines. This time families' queries are driven by a special vaccine court's decision to pay for the care of a young girl injured by vaccines.

The court ruled last fall that 9-year-old Hannah Poling's underlying mitochondrial disorder was aggravated by the shots which she received as a toddler and resulted in brain dysfunction and "features of autism spectrum disorder."

News of the ruling made waves after it was recently leaked to the public.

The case, however, does not have broad application, and families can be reassured that having their children vaccinated is still the safer approach, experts said.

The mention of autism caught the attention of some who have long suspected that vaccines trigger the condition. However, a preponderance of scientific evidence gathered by Centers for Disease Control and Prevention studies and Institute of Medicine reports has cleared vaccines and the mercury-containing vaccine preservative thimerosal of autism involvement. Regardless, many parents and others remain unconvinced.

The advice for physicians in light of the new case is to "know what this set of events says and doesn't say," said Louis Z. Cooper, MD, a member of the National Network for Immunization Information's steering committee. NNii, a group to which the AMA belongs, provides science-based vaccine information.

"The bottom line is that the court decision is not germane to any but a very few American children. The best summary is, there are a few unanswered questions but this doesn't change the need to vaccinate," added Dr. Cooper, also a past present of the American Academy of Pediatrics.

A major reason that question marks regarding the case remain is that the judgment remains sealed, and federal health officials are still not able to explain it fully.

But in a press briefing about the general issues surrounding it, CDC Director Julie L. Gerberding, MD, MPH, said, "Let me be very clear that the government has made absolutely no statement about indicating that vaccines are a cause of autism. That is a complete mischaracterization of the findings of the case and a complete mischaracterization of any of the science we have at our disposal today."

A rare disorder

The ruling also put a spotlight on mitochondrial diseases. About one in 4,000 children in the United States will develop mitochondrial disease by the age of 10, and 1,000 to 4,000 children each year are born with some type of the disease, which can affect cells of the brain, nerves, muscles, kidneys, heart, liver, eyes, ears or pancreas, according to information from the Cleveland Clinic in Ohio.

Although the vaccine court determined that the five vaccines administered when Hannah was 19 months old worsened her underlying mitochondrial disease, Paul Offit, MD, chief of infectious diseases at Children's Hospital of Philadelphia, questioned whether that is even possible. "It doesn't make sense for a number of biological reasons."

"The challenges we face during the day in terms of eating non-sterile food and breathing non-sterile air are much greater than one ever encounters in vaccines," said Dr. Offit. Many studies have concluded vaccines don't weaken the immune system, he said.

Timothy Doran, MD, chairman of the Dept. of Pediatrics at Greater Baltimore Medical Center, noted that the court, established by the National Childhood Vaccine Injury Act, is a no-fault system designed to compensate for any possible relationship between vaccines and ill health. It doesn't look at causality, he said.

The role of the special vaccine court, which was established in 1989 to hear petitions and render compensation under the vaccine injury act, is frequently misunderstood, including by physicians.

Dr. Offit said one of his colleagues had even thought that the U.S. Supreme Court had made the ruling.

Over the years, the special court has awarded compensation in 948 cases and dismissed another 1,165. Claims considered by the court cover virtually all vaccines, with the most frequent involving DTP, diphtheria-tetanus-whole cell pertussis.

Although the Poling case may only tangentially involve autism, the disorder's link to vaccines has been occupying the attention of three "Special Masters," or vaccine court judges, since last year.

They now are gathering evidence in three test cases that represent 4,800 petitions for compensation filed over several years by families of children with autism.

These cases were combined in an omnibus proceeding, which is expected to move forward next month when the federal agency in charge of the vaccine injury act will present its views on the allegation that vaccines cause autism.

Meanwhile, Dr. Doran would like the government to shed more light on the Hannah Poling case.

"The award to her family creates confusion among the families of infants ready to receive vaccines," he wrote in a March 17 op-ed piece for the Baltimore Sun newspaper. "A few days ago, a mother of one of my patients, herself a doctor, asked me why the government had made the award if the vaccines were not the cause of autism."

"I think the award was probably OK," said Dr. Doran. "Maybe the girl's mitochondrial disease got worse after the vaccines. Whether she has autism or a mitochondrial deficiency, we don't know."

Genomic science may one day provide the answer to whether vaccines do pose a risk to certain children, noted Dr. Cooper. But we aren't there yet.

"It would be wonderful if our immunization recommendations were not one-size-fits-all," he said. "But for now, for the greatest good for the greatest number of children, it is the only approach we can take."

Back to top


Important to know

A special vaccine court's award of damages to a family whose child's underlying mitochondrial disease was determined to have been aggravated by common immunizations has stirred fears about vaccine safety. The American Academy of Pediatrics published the following responses to questions that might arise about environmental triggers that could initiate or worsen autism-like symptoms in children with such diseases.

  • Mitochondria produce the energy needed for cells to function normally. There are a number of genetic disorders that cause mitochondria to produce less energy than cells need. Symptoms of these disorders can be very mild or quite severe. In some cases the disorders do not develop for many years. In many cases, an event that requires more energy, such as an infection, fever or other illness, can lead to the development of symptoms.
  • Although details of the case cannot be disclosed by the Dept. of Health and Human Services, a statement was released noting that the federal Health Resources and Services Administration had reviewed the scientific information concerning the allegation that vaccines cause autism and found no credible evidence to support the claim.
  • The Centers for Disease Control and Prevention said the case was unique, representing one special instance, and does not change the immunization recommendations for children for whom vaccines are otherwise recommended.
  • The United Mitochondrial Disease Foundation has said, "There are no scientific studies documenting that childhood vaccinations cause mitochondrial disease or worsen mitochondrial disease symptoms. In the absence of scientific evidence, the UMDF cannot confirm any association between mitochondrial diseases and vaccines."

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn