FIRST AUTISM-VACCINE LINK: HOW HANNAH MADE HISTORY
Posted Jun 10 2009 12:18am
Hannah Poling and her parents
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.
(Not true! Thimerosal beganbeing taken out in 1999, but is not yet fully removed.) 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.