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.
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.
“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.”
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.
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Comment by Harold L Doherty | November 2nd, 2009
Mike, you are determined to ensure that no environmental causes, and particularly, no vaccine ingredients triggers or causes, be associated with autism onset. Put aside your fixed ideology fro awhile. Simon Baron Cohen has stated at least 3 times that environmental factors are involved in causing autism. The emerging paradigm is that autism probably results form the interaction of genetic and environmental factors. The “it’s gotta be genetic” paradigm is losing ground. Re-open your mind to the issues.
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Comment by Socrates | November 2nd, 2009
Harold,
Given that there are well-known, and documented direct ‘environmental’ causes of some cases of Autism - your statement is a typical cheap shot at someone who is far better informed than you.
You insult him by claiming that “you are determined to ensure that no environmental causes… be associated with autism onset” - he says in this post no such thing - and I cannot recall him ever saying such a thing.
Neither do I see or have seen any evidence that Mike has a mind that needs “Re-opening”.
Cheap, cheap, cheap and petty. Propaganda to go in the bin with your repeated claims that ASAN does not advocate for, nor care about “low functioning autistics.
Comment by Laurentius Rex | November 2nd, 2009
Life itself requires environmental factors as well as genetics in order to exist.
At this moment millions of mutation inducing cosmic rays will be coursing through the atmosphere. If one of these should perchance cause autism, who you gonna sue Harold? God?
Comment by David N. Andrews M. Ed., C. P.S. E. | November 2nd, 2009
“If one of these should perchance cause autism, who you gonna sue Harold? God?”
LoL… The OTHER Man Who Sued God!
Doubt that Doherty would do as well as Steve Myers (Billy’s character in the film to which I refer)!
Comment by Joseph | November 2nd, 2009
If anyone needs to re-open their mind to the current state of knowledge, that would be Harold “I’m neutral - I swear!” Doherty.
Comment by Socrates (deceased) | November 2nd, 2009
F’in excellent!
Action For Autism reduced to a Kick-Harold’s-Butt festival.
Comment by Mike | November 2nd, 2009
Socrates,
I am more amused than insulted. The most likely environmental factors identified by Professor Simon Baron-Cohen are hormonal e.g. exposure to maternal testosterone in utero.
I am also amused by the automatic presumption that environmental factors have to be triggers for genetic predisposition. In the interests of opening my mind I am quite willing to entertain the idea that we can have environmental brakes on genetic tendencies to autism, including even vaccine ingredients.
Routine vaccination against smallpox in the USA stopped in 1972. Smallpox was officially eradicated in 1980. And autism has been going up ever since. Coincidence? Probably. But we need to keep an open mind. Then we had the change from whole cell DTwP to acellular DTaP in 1991 just before the surge in autism rates. Coincidence? Probably. But we need to keep an open mind. Perhaps one day we will have a vaccine against autism. Probably not. But I am willing to keep an open mind on this and any other question where we lack definitive data.
Meanwhile, going with the available data it looks increasingly unlikely that present day vaccines are contributing to autism in all but a handful of cases and these are open to doubt.
But I digress. This post was as much about research into mitochondrial disorders as it was about vaccines and nobody has commented on the research yet. Would it be too ideologically fixed of me to try and steer the discussion back on topic?
Comment by Prometheus | November 3rd, 2009
Mr. Doherty states:
Great! Now, where are Dr. Baron-Cohen’s data showing these environmental factors? I realize that his work has implicated maternal testosterone, but that isn’t the sort of “environmental” factor that can lead to a therapeutic or preventative intervention (especially since it has yet to explain the numbers of women with elevated testosterone who have children without autism).
As a molecular biologist, I tend to see all biology as the effect of genes interacting with the environment. If autism is caused by an uncommon genotype that interacts with a common environmental exposure to produce autism, is that a genetic or an environmental cause?
My point is that there are few disorders that are completely genetic or completely environmental - even influenza has a genetic component (in both the virus and the host).
More to the topic, this study shows that - at least with this small group - serious adverse events attributable to vaccinations are no more common in children with IEM (some of which are mitochondrial disorders) than “normal” children. This is an important point.
It is one thing to say that it is better to vaccinate children with IEM with a “killed” or attenuated vaccine than it is for them to risk contracting the “wild type” disease - that only makes sense. However, it seems - from this small study - that vaccinating children with IEM doesn’t cause any more serious adverse events that are seen in “normal” children.
That is a significant finding.
It is important to note that “inborn errors of metabolism” is a pretty broad brush. These can be both mitochondrial disorders and non-mitochondrial disorders. I suspect the reason they used such a broad brush was that these disorders are uncommon and concentrating on one disorder (or even one class of disorder, like glycogen storage diseases) would reduce the number of subjects too much.
Still, it is a piece of the puzzle.
Prometheus
Comment by Mike | November 3rd, 2009
Hi Prometheus,
at present Baron-Cohen does not have any published data on hormonal exposure in utero and autism. But as early as 1992 he was arguing that autism could not be 100 percent genetic because there was not 100 percent concordance in identical twins. I thought this was fairly commonplace amongst all autism researchers. Only anti vaccine activists pretend that they are battling against the established view that autism is totally genetic.
Comment by Joseph | November 4th, 2009
Of course, Harold bringing up Baron Cohen is simply part of his MO. Harold probably thinks this is court or something, so he brings in the expert testimony. Any big name would do. If not Baron-Cohen, it might be Dr. Healy. On other occasions, it might be the AAP or the Surgeon General. But that depends on what he’s trying to argue. At other times, questioning authority is the thing to do.
I think a lot of us here can discuss data, so I don’t think it’s necessary for Harold to try to impress with names.
Comment by Laurentius Rex | November 4th, 2009
Well there are subtle differences between twins, the whole principle of electronics is predicated on the notion that a subtle change can cause a larger one so who knows, if the light is switched on when you walk in the room it could trigger a migraine, or that packet of crisps you ate in 1973 might cause an ulcer in 2020.
I am willing to stake my reputation on a significant correlation between astrology and autism, well if someone is willing to do the research of course
Let’s see if you are scorpio, your mother was frightened by a bear, and your dad ate that fatal packet of cheese and onion crisps the night before you were concieved, then the outlook is not good, not good at all, particularly if it rained the day after and it happened to be a Wednesday.
Harold your mother was not frightened by a bear was she? I hear there are a few of them about in Canada particularly if you step on the cracks in the pavement, that is of course only so for pavements on the left hand side of a south facing street.
Now I would like to see some rigourous scientific, empirical proof that those last two paragraphs were nonsence. Come on, put up, where are the studies? give me the citations? what there are none, oh well we must spend more on researching these connections mustn’t we. If it all seems absurd, that is because it is.