Originally published in MedPage Today
by Michael Smith, MedPage Today North American Correspondent
Vaccination does not appear to cause autism or other health problems in children with inborn errors of metabolism, a researcher said here.
In a retrospective analysis, children with such conditions were not more likely than normal children to visit emergency rooms or need hospital care after vaccination, according to Nicola Klein, MD, PhD, of the Kaiser Permanente Vaccine Study Center in Oakland, Calif.
While the data are preliminary and the sample size is small, Klein said at the annual meeting of the Infectious Diseases Society of America, there doesn’t seem to be an association between vaccination and adverse events in children with inborn errors of metabolism.
The issue is important because of a 2007 ruling under the Vaccine Injury Compensation Program that the family of Georgia girl was entitled to compensation.
Hannah Poling was diagnosed with encephalopathy caused by a mitochondrial enzyme deficit and her family successfully argued that a series of vaccinations had led to the condition. (See Despite ‘Sad’ Case of Georgia Girl, CDC Reiterates ‘Life-Saving’ Value of Vaccines)
The girl’s disorder is one of about 90 inherited diseases collectively known as inborn errors of metabolism.
After the ruling, “there was some concern that vaccination may place some children with genetic disorders at increased risk for autism or other adverse effects,” Klein told reporters.
To investigate the issue, she and colleagues combed Northern California Kaiser Permanente’s electronic medical records, looking for children who were diagnosed with an inborn error of metabolism from 1990 to 2007 and remained in the company’s system until they were at least 3 years old.
All told, they found 79 children with such defects and compared their immunization and health records to those of 1,580 matched controls, Klein said.
During the first three years of life, she said, there was no difference in the proportion of children whose vaccinations were up to date at age two. Also, they were not more likely than the healthy children to have any recommended vaccine delays.
The researchers also analyzed emergency room visits and inpatient stays among all children up to age 18 with an inborn error of metabolism who received at least one vaccine at any time.
For each of the 322 children they identified, Klein said, she and colleagues compared events during the first 30 days after a vaccination with the following 30 days.
“If the vaccine was causing any problems, we would expect to see them emerge right around the time of vaccination, not a month later,” she said.
But, for the 30 days immediately after vaccination, compared to postvaccine days 31 to 60, they found:
* For emergency room visits, the rate ratio was 0.83, which was not significant with a 95% confidence interval from 0.60 to 1.14.
* For inpatient stays, the rate ratio was 1.1, also not significant with a 95% confidence interval from 0.9 to 1.4.
“We found no increase in emergency room visits or serious side effects,” Klein said. Interestingly, seven of the larger group of children had a mitochondrial disorder.
The findings are preliminary but “very reassuring,” according to Larry Pickering, MD, of Emory University in Atlanta, who was not part of the study but moderated the session at which it was presented.
“Most of us who take care of kids with inborn errors of metabolism think vaccination is one of the best interventions we can offer them,” Pickering told reporters.
“They are at increased risk for devastating complications, even death, from the diseases that the vaccines prevent,” he said after the session.
Interestingly, the so-called “vaccine court” has sharply rejected recent claims that the MMR vaccine – against measles, mumps, and rubella — led to autism in thee children.
Visit MedPageToday.com for more vaccine news.
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{ 5 comments… read them below or add one }
Thanks for covering this, Kevin. It’s so important that news like this reach the masses.
Won’t slow down the tort bar.
I have some questions about the findings reported in the article:
1. The article assumes that Hannah Poling had an “inborn error of metabolism”. This is not at all clear. She may well have had a mitochondrial dysfunction as confirmed by enzyme deficit, as the article reports, but not necessarily a genetic defect or other “inborn error of metabolism.”
2.The concern about an association between vaccinations and children with mitochondrial disorders does not necessarily mean that the association is between vaccination and a “genetic” disorder, as reported.
3. Following from items 1 and 2, the study subject selection criteria may have looked at the wrong children, as the class of children with mitochondrial disorder who may be adversely affected by vaccines may not be the same as children who have “inborn errors of metabolism” as usually defined. Research has shown that a significant number of children with “autism” also have mitochondrial dysfunction, and no mitochondrial DNA mutation has been found in many such children. It is reported that regression in many of these children was temporally proximate to the administration of a vaccine. It should also be noted that the literature regarding mitochondrial disorders is clear that exposure to toxins can trigger mitochondrial regression.
4. Children with vaccine injury that affects development may not have “emergency room visits and inpatient stays” even if they have vaccine injuries, as it is very common that children with non-catastrophic injuries will not be taken to the emergency room or admitted to a hospital, based on the advice of their pediatrician. Thus, the major assumption contained in this study’s design may be false, rendering the study’s findings suspect and the study’s purported conclusions meaningless.
5. Even if a vaccine caused a problem, therefore, emergency room visits or hospital admissions may not be an accurate measure of a vaccine adverse event.
6. The foregoing is true even if symptoms became obvious as much, or even more than, one month after vaccination. It is well understood that exposure to certain toxins can manifest in symptoms long after the exposure. While temporal proximity is a factor that evidences vaccine injury, there exist vaccine injuries that might not appear until one month after vaccine administration, or will not rise to the level of serious concern until one month after or later. Earlier signs may be more subtle, especially if a metabolic process has been disrupted (due to some form of metabolic susceptibility that is unrelated to a genetic mutation) that, in turn, disrupts the developmental process.
7. The foregoing points, coupled with the small study size raise the issue of whether or not this study is at all helpful. That some medical personnel find it “reassuring” is itself troubling in light of other research that raises serious questions about susceptibility of children to vaccine injury who are also found to have mitochondrial dysfunction.
Disclosure: I am an attorney who handles vaccine injury cases. That is not the issue, but the answer to the substantive points raised above is the issue. I do not suggest I have the answers, but it would be helpful for those schooled in medicine to honestly and forthrightly answer the questions I have raised.
I rarely submit comments but this little study is laughable.
The “study” was clearly intended to “reassure” the masses. The only children who would be involved in this study would have been children so obviously ill (such as failure to thrive), near birth that they were tested and found to have “inborn errors of metabolism.”
None of the children who claim to have been otherwise healthy and developing normally would have been included in such a study as there would have been no reason to have tested and found “inborn errors of metabolism.” This is particularly true for Hannah Poling. To wit, Hannah Poling would Not have been or even qualified to have been one of the children in this study had she been a Kaiser Patient. You are talking apples and oranges here and your are treading on territory that you clearly do not understand.
In addition, having been a Kaiser patient my entire childhood and young adult life, I can say with certainty that getting past the “gatekeepers” (pediatricians) to a specialist would be nearly impossible. Meaning, that most Kaiser children who later developed developmental problems (manifesting as behavioral problems) were likely being treated first in the public school system and not Kaiser. In fact, I think this is something that clearly needs some investigation. Question: Just how many Kaiser patients manifesting symptoms of developmental delay or regression are actually initially diagnosed in the Kaiser system?
Folks need to stop getting their health advice from Don Imus and Jenny McCarthy.