Autism Blog - Action For Autism

Mitochondrial disorder and autism

When Hannah Poling won her claim for an adverse vaccine reaction that triggered a pre-existing mitochondrial disorder and caused her to develop autistic symptoms it created quite a flurry in the autism world.

The strange thing was there were at least 5000 families in the Autism Omnibus Proceedings who believed that vaccines had caused their child’s autism. Their lawyers had spent years collecting medical evidence to support their claims. But when they presented their evidence in test cases before the Office of Special Masters of the U.S. Court of Federal Claims there was no mention of mitochondrial disorder. Hannah Poling was due to be one of those test cases before she withdrew from the Omnibus Proceedings because her mitochondrial disorder set her apart from the other petitioners.

The obvious conclusion remains that hers was a special case and her settlement has no bearing on the general causation theories of the Omnibus Proceedings. However publicists for the petitioners have tried to spin her story as follows.

They say vaccines do not cause autism. Here we have a case where vaccines do cause autism. Therefore why shouldn’t it cause autism in the rest of our cases?

Except that they were arguing for a completely different mechanism that did not involve mitochondrial disorders at all. This point was not lost on some of them. Take vaccine injury lawyer Robert Krakow, himself the parent of an autistic child. He was intimately connected with the Omnibus for many years. In fact his was to be the replacement test case for Hannah Poling until he decided that the evidence for mercury causing autism was so weak that he jumped ship and is now pursuing his own claim for a vaccine induced mitochondrial disorder.

The vaccine-autism email lists were suddenly full of enquiries into “tests for mito.” Previously ignored research that had looked at links between mitochondrial disorder and autism was taken up by anti-vaccine bloggers as proof that these susceptible children were the real driving force behind the vaccine induced autism epidemic.

To do so they had to ignore a couple of inconvenient truths, in addition to the aforementioned failure of the petitioners’ legal teams and medical experts to uncover any link between autism and mitochondrial diseases.

Support groups for mitochondrial disorders and experts in the field were all agreed that vaccination was the best option for these children to protect them from the devastating consequences of exposure to full blown infection with vaccine preventable diseases.
Prior to the Hannah Poling case extensive research into mitochondrial disorders had not identified autism as a significant consequence. That is why the case took everybody by surprise.

Now when an event takes scientists by surprise, rather than rush to judgement they look for data. This is what researchers at Northern California Kaiser Permanente (NCKP) have done. As a major health care organization they are in position to check the medical records of thousands of children to see if vaccines and autism and mitochondrial disorders are related. They presented their findings at the recent annual meeting of the Infectious Diseases Society of America.

According to press reports

The research findings could contradict previous concessions by the US Department of Health and Human Services that suggested a possibility that vaccination might have aggravated a child’s underlying mitochondrial disorder and caused her autism symptoms.

“After that ruling, there was some concern that vaccination may place some children with genetic disorders at increased risk for autism or other adverse effects,” said Nicola Klein, MD, Kaiser Permanente Vaccine Study Center, Oakland, California, on October 30. “But we found no increase in emergency room visits or serious side effects” among children with inborn errors of metabolism.

Dr Larry Pickering was reassured by the results.

“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,” he said. “They are at increased risk for devastating complications, even death, from the diseases that the vaccines prevent.”

Of course it is difficult to judge the importance of a study based on the evidence of a conference presentation. No doubt its strengths and weaknesses will be easier to ascertain after full publication. Sullivan has discussed potential weaknesses on LBRB. The authors have already acknowledged that the sample size was small. But this in itself is significant. If the Kaiser Permanente North California database can turn up so few cases of inborn errors of metabolism, not all of whom went on to develop mitochondrial disorders, this makes it an unlikely candidate for the rise in autism. Despite the small sample size it must be reassuring for parents that, on the evidence so far, there is no significant increase in risk for adverse reactions to vaccines for this group of vulnerable children. Hannah Poling is likely to remain an isolated case that does not set a precedent for a new theory of causation for autism.

Here is the abstract.

Presentation Abstract

Session: 049-Pediatric and Adult Vaccines
Friday, Oct 30, 2009, 10:30 AM -12:00 PM
Presentation: 187 - Evaluation of Immunization Rates and Safety Among Children with Inborn Errors of Metabolism
Location: 109-AB
Pres. Time: Friday, Oct 30, 2009, 10:45 AM -11:00 AM
Category: P. Pediatric and perinatal infections. Studies of pediatric and adult vaccines
Keywords: VACCINATION; SAFETY; IMMUNOCOMPROMISED PATIENTS
Author(s): NICOLA P. KLEIN, MD, PhD1, LAURIE AUKES, RN1, JANELLE LEE, PhD1, BRUCE FIREMAN, MS1, ROGER BAXTER, MD1, STUART K. SHAPIRA, MD, PhD2, MARHALL L. SUMMAR, MD3;
1Kaiser Permanente Vaccine Study Center, Oakland, CA,2Center for Disease Control and Prevention, Atlanta, GA,3Vanderbilt University Medical Center, Nashville, TN.
Abstract: Background: Children with metabolic disorders are a potential high-risk group for vaccine-preventable diseases. Despite recommendations that they receive all routine immunizations, information regarding both immunization rates and safety data within this population is lacking.

Methods:

Using Northern California Kaiser Permanente’s (NCKP) integrated electronic medical record, we identified children up to age 18 years who had an inborn error of metabolism (IEM) from 1990 to 2007. We assessed immunization rates among a subset of infants with IEM born at NCKP who were members until age 3 years matched to healthy infants (1:20), comparing both immunizations received by age 2 years and timing for receipt of vaccines. We next separately assessed for adverse events after immunization by using self-controlled analyses among all children up to age 18 years with an IEM who received at least 1 vaccine at any time, comparing emergency room visits and hospitalizations during post-vaccine days 0-30 to post-vaccine days 31-60.

Results:

We identified 79 infants with IEM who were born and remained a member of NCKP at age 3 years. Compared to 1580 matched controls, there was no difference in the proportion of children with IEM up to date for vaccines at 2 years, nor was there any delayed receipt of recommended vaccines during the first year. We also preliminarily identified 322 children with IEM who received any vaccine. Preliminary analysis in this group did not detect an increase in emergency room visits [rate ratio (RR) 0.83, 95% confidence interval (CI) 0.60, 1.14] or hospitalizations (RR 1.1, 95% CI 0.9, 1.4) during the 30 days after vaccination compared to post-vaccine days 31-60.

Conclusion:

Children with metabolic diseases in this cohort were vaccinated at rates comparable to healthy children. Although sample size is a limitation, preliminary evidence does not suggest an association between vaccination and an increased risk for serious adverse events.

Disclosures: N. P. Klein,
GlaxoSmithKline Role(s): Research Relationship, Received: Research Support.
Sanofi Pasteur Role(s): Research Relationship, Received: Research Support.
Merck & Co Role(s): Research Relationship, Received: Research Support.
Novartis Role(s): Research Relationship, Received: Research Support.
L. Aukes, None..
J. Lee, None..
B. Fireman, None.
R. Baxter,
GlaxoSmithKline Role(s): Research Relationship, Received: Research Support.
Merck & Co Role(s): Research Relationship, Received: Research Support.
Novartis Role(s): Research Relationship, Received: Research Support.
MedImmune Role(s): Research Relationship, Received: Research Support.
Sanofi Pasteur Role(s): Research Relationship, Received: Research Support.
S. K. Shapira, None..
M. L. Summar, None.

November 2nd, 2009 Posted by Mike | research, vaccines | 14 comments

My Background

I am Mike Stanton. I live and work in the UK where I teach children with severe learning difficulties, many of whom are autistic. My adult son is diagnosed with Asperger Syndrome. I am a member of the National Autistic Society. I speak and write on autism.

My book, “Learning to Live with High Functioning Autism” is available in a Spanish translation, Convivir con el Autismo. I have also contributed a chapter to Asperger Syndrome in Adolescence edited by Liane Holliday Willey.

ACTION FOR AUTISM is a reaction against names like Action Against Autism and Defeat Autism Now! Names like these suggest to autistic people that we are against them as people. You may not mean that. But if you care about autism you ought to care about the feelings of autistic people and not use language that makes them angry or upset. If you disregard the feelings of autistic people do not be surprised if you are disregarded.