The Atlanta Journal-Constitution
Published on: 03/06/08 In a move autism family advocates call unprecedented, federal health officials have concluded that childhood vaccines contributed to symptoms of the disorder in a 9-year-old Georgia girl.While government officials continue to maintain that vaccines don't cause autism, advocates say the recent settlement of the girl's injury case in a secretive federal vaccine court shows otherwise.
The U.S. Department of Health and Human Services has concluded the family of Hannah Poling of Athens is entitled to compensation from a federal vaccine injury fund, according to the text of a court document in the case. The amount of the family's award is still being determined.
The language in the document does not establish a clear-cut vaccine-autism link. But it does say the government concluded that vaccines aggravated a rare underlying metabolic condition that resulted in a brain disorder "with features of autism spectrum disorder."
In an interview Wednesday with The Atlanta Journal-Constitution, Hannah's parents, Jon and Terry Poling, said the government's concession in the case will help pay for the numerous therapists and other medical experts their autistic child needs —- now and for the rest of her life.
"At least we have some commitment from the government to take care of Hannah when we're gone," said Dr. Jon Poling, a neurologist.
But the case also thrusts the family into a national spotlight in the controversial public debate over whether vaccines have played some role in the growing number of U.S. children diagnosed with autism. Of particular concern to some families is the mercury-based preservative thimerosal, not used in child vaccines (except for some flu shots) since 2001.
Hannah's case was one of three vaccine-court test cases alleging that thimerosal caused the children's autism. The other cases go to trial in May.
Suspicion of vaccines is fueled in part by vocal advocates —- including radio shock jock Don Imus and actress Jenny McCarthy —- speaking out on radio and TV shows such as "Oprah" and "Larry King Live."
Even Republican presidential candidate Sen. John McCain said on the campaign trail that "there's strong evidence" that a preservative in vaccines is fueling the dramatic rise in autism cases across the country.
As many as 1 in 150 children in some communities have autism disorders, says the Centers for Disease Control and Prevention.
"We need to recognize this is a national crisis," Jon Poling said.
Autism is a lifelong neurological disorder that causes problems with communication and the ability to have normal social interactions. Autism and related autism spectrum disorders cover a range of symptoms that can vary from mild to severe. The cause is unknown, but scientists believe genes may play a role.
Pediatricians and public health officials worry that this case may cause fear among some parents and prompt them to refuse to vaccinate their children, and put them in real danger from measles, whooping cough and other diseases.
"The risks of diseases are real risks," said Dr. Melinda Wharton, deputy director of CDC's National Center for Immunization and Respiratory Diseases. Numerous large studies don't support a relationship between vaccines and autism, according to the CDC and the Institutes of Medicine.
The Georgia girl's case —- and its implications in the vaccine-autism debate —- raise more questions than it answers, experts say.
Some medical experts say it's difficult to fully assess the case because the federal vaccine-court documents are sealed from public view.
"It raised a lot of questions for us," said Dr. David Tayloe Jr., president-elect of the American Academy of Pediatrics. The national medical group's leadership has been seeking more information about Hannah's vaccine-court case since last week when a sealed vaccine-court document detailing the government's settlement was posted on the Internet by an autism book author, then circulated widely among autism groups.
The pediatrics association has been trying to get access to official documents in the case so medical experts can delve into the science, assess whether there are implications for other children and answer questions from doctors and families.
"Our responsibility is to make sure the public is given good information and make sure the hype doesn't distract from public health," Tayloe said. "I still would not think that we're going to have evidence showing a role of vaccines actually causing autism."
According to the leaked document posted online, the government's Division of Vaccine Injury Compensation concluded that five shots Hannah received in July 2000, when she was 19 months old, "significantly aggravated an underlying mitochondrial disorder" and resulted in a brain disorder "with features of autism spectrum disorder."
Sallie Bernard, executive director of the national autism advocacy group SafeMinds, called the case "unprecedented" in that a link between vaccines and autism is being made public. Federal health officials "have insisted there is no link at all between vaccines and vaccine components and autism. And apparently that is not true," she said.
The case also is significant because other autistic children have mitochondrial disorders, Bernard said. "The question is: What is the proportion?"
Robert Krakow, a New York attorney representing other autistic children in vaccine court, said the significance of the case is "potentially explosive." He said he has several clients with similar histories.
Hannah requires one-on-one care at all times, said her mother, Terry Poling, a nurse and lawyer. The Polings described how Hannah was a normal, verbal toddler until she received several vaccines during a well-baby visit. Within 48 hours of the shots, she developed a high fever and inconsolable crying and refused to walk. She stopped sleeping through the night. At 3 months of age, she began showing signs of autism, including spinning and staring at lights and fans. For a while, she lost her ability to speak.
When Hannah was 6 months old, as the family came to grips with the likelihood that she was autistic, they turned to leading experts in neurology. "I had to know. My daughter didn't just suddenly develop autism for no reason," Terry Poling said.
Hannah's father co-authored an article about her case, which was published in the Journal of Child Neurology in 2006.
Hannah, who has two older brothers, continues to have mild to moderate symptoms of autism. The family says early and ongoing intensive therapy has been critical for her.
"The biggest question right now for the public is: How unique is Hannah's case?" said Jon Poling. Poling said he suspects there are other children like Hannah.
Cliff Shoemaker, the Polings' attorney, said the family has filed a petition with the vaccine court to unseal all of Hannah's records and allow both the family and the government to fully discuss the case.
Despite this, a spokesman for the U.S. Department of Justice, which reprersents the government in court cases, would not grant interviews or explain to the AJC why it isn't releasing the records. HHS officials, who administer the vaccine compensation fund, also declined to be interviewed, citing the court's confidentiality requirements.
Shoemaker said the government's November concession in the case is public, but the government's reasons aren't. "I'm not aware of any other conceded autism cases," he said.
Congress created the National Vaccine Injury Compensation Program in 1988 after widespread lawsuits against manufacturers and health-care providers stemming from reports of side-effects of a version of the diphtheria-tetanus-pertussis vaccine used in the 1980s.
With companies getting out of the vaccine business for liability reasons, Congress established the program and a trust fund to serve as a no-fault alternative for resolving certain vaccine injury claims.
The average injury compensation to an individual in vaccine court has been about $1 million. In fiscal year 2007, more than $91 million was awarded to people harmed by vaccines.
Q&A
What does the case mean for the safety of vaccines? Medical experts said parents should continue vaccinating their children because it protects them from diseases known to be deadly. If they're concerned, they should talk with their pediatrician.
Q: What is autism?
A: Autism spectrum disorders are a range of developmental disabilities —- from mild to severe —- characterized by communication problems, an inability to have normal social interactions and unusual behaviors.
Q: What causes autism?
A: Scientists don't know but are exploring what role genetics may play, as well as possible environmental factors.
Q: Why is this Georgia child's case drawing so much attention?
A: A leaked federal vaccine court document, posted on the Internet and widely circulated among advocates, shows the government has agreed to compensate her. Federal health officials have conceded that the five shots she received in July 2000 "significantly aggravated an underlying mitochondrial disorder," which manifested as a brain disease with features of autism. Autism family advocates say this shows the government is conceding —- after years of blanket denials —- that vaccines play a role in at least some autism cases.
Q: What do federal health officials say about the case?
A: The U.S. Department of Health and Human Services branch that administers the vaccine injury program says the government "continues to maintain the position that vaccines do not cause autism and has never concluded in any case that autism was caused by vaccination."
Q: What are mitochondrial disorders?
A: Mitochondria are tiny rod-like structures that serve as the energy-making machines inside cells. When mitochondria don't work properly, they produce less energy and can cause various body systems to fail.
Q: What causes the disorders?
A: For the most part, genes. Sometimes a person's mitochondria —- if their genes make them susceptible —- can be affected by environmental factors such as medications. The Georgia girl's family suspects her mitochondria were damaged by a mercury-based preservative in the vaccines she received. Tests didn't find a genetical link in her case, the family said.
Q: What's the relationship between mitochondrial disorders and autism?
A: While some children with mitochondrial disorders have autistic symptoms, the vast majority do not, said Dr. Bruce Cohen, a pediatric neurologist at the Cleveland Clinic and past-president of the Mitochondrial Medicine Society. Most autistic children do not have mitochondrial disease, he said.
Q: How can a mitochondrial disorder be aggravated by vaccinations?
A: Vaccination —- like illnesses, starvation, extreme heat or any other stress on the body —- may unmask a mitochondrial disorder, experts said. When a vaccine is injected, it causes the body to mount an immune response. This requires increased energy the body may not have if there is an underlying mitochondrial disorder. Still, Cohen said he recommends vaccination, even for most patients with diagnosed mitochondrial disorders. That's because of the greater danger posed by vaccine-preventable diseases.
Q: How common is this?
A: According to the United Mitochondrial Disease Foundation, at least one in every 4,000 children born in the U.S. each year will develop a mitochondrial disease by age 10. Many children are misdiagnosed with such things as atypical cerebral palsy, seizure disorders and other diseases. Adults also can be diagnosed with adult-onset mitochondrial disease.
ELIZABETH LANDT / Staff MITOCHONDRIAL DISORDERS Energy for our bodies is created within our cells. This massive job is handled by the mitochondria. When these tiny guys can't do their job, our whole body suffers. Normal mitochondrion 1. Mitochondria are tiny power plants inside human cells that convert food into energy. 2. If the mitochondria are not working properly, the cell does not get the energy it needs to do its work within the body. Diagram includes a cell containing normal and dysfunctional mitochondrion; the inside of a normal mitochondrian; its Energy-producing particles; DNA. Organ systems: 3. The brain, heart and lungs require the most energy to function properly. If they don't have adequate energy, these organs begin to fail. Symptoms vary depending on the part of the body involved. —- Possible symptoms Mitochondrial disorders are rare. Not everyone who has these symptoms has dysfunctional mitochondria. Brain: Developmental delays, seizures, autistic features, migraines, atypical cerebral palsy Eyes and ears: Visual or hearing loss, degeneration of retina cells Heart: Heart blocks, Cardiomyopathy Muscles: Weakness, cramping, gastrointestinal problems, muscle pain Liver: Low blood sugar, liver failure Kidneys: Failure to excrete acid or wasting Pancreas and other glands: Diabetes and inability to make digestive enzymes, low calcium Nerves: Weakness (may be intermittent), fainting, Chronic nerve pain Systemic: Failure to gain weight, fatigue, unexplained vomiting, short stature, respiratory problems Mitochondrian disorders generally involve three or more organ systems and in some cases produces symptoms similar to autism. Sources: United Mitochondrial Disease Foundation
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