NYT on Mitochondrial Disorders and Vaccination
In the Health section of the New York Times today, there was an article concerning mitochondiral disorders and vaccination entitled “Experts to Discuss One Puzzling Autism Case, as a Second Case Has Arisen“. As the title notes, a second case has cropped up:
On Jan. 11, a 6-year-old girl from Colorado received FluMist, a flu vaccine, and about a week later “became weak with multiple episodes of falling to ground” and “difficulty walking,” according to a case report filed with federal health officials and obtained by The New York Times.
The girl grew increasingly weak and feverish and “became more limp, appears sleepy, acts as if drunk,” the report said. She was hospitalized and underwent surgery and was finally withdrawn from life support. She died on April 5, according to the report.
What first struck me, though, was that apparently this second girl did not recieve a diagnoses of autism; instead, the turn of events was fatal for her. Even still, I was bracing myself for posts and blog entries on the web branding thimerosal as the boogeyman. Not so fast, the CDC says:
Is influenza vaccine that does not contain thimerosal as a preservative available this flu season (2007-08)?
At the current time, sanofi pasteur is projecting that 10 million to 12 million doses of thimerosal-free vaccine in pre-filled syringes or vials will be produced for the 2007-08 influenza season. The majority of this vaccine will be in 0.25 mL syringes (indicated for ages 6-35 months) with the remainder in 0.5 mL vials or syringes (indicated for ages 36 months and older). MedImmune is projecting up to 7 million doses of thimerosal-free nasal vaccine, FluMist, will be produced for the 2007-08 season. [Emphasis mine] In addition, the single dose syringe preparation of CSL Biotherapies’ product, Afluria, is thimerosal-free and can be used in persons 18 years of age and older. Finally, both Novartis and GlaxoSmithKline are producing preservative-free (trace thimerosal) influenza vaccines this season. Novartis’s Fluvirin (single dose syringe preparations) can be used in persons 4 years of age and older and GSK’s Fluarix can be used in adults 18 years of age and older.
Being that thimerosal was not present in the FluMist vaccination that the second girl received, I’m pretty sure we’re going to see the toxin gambit cropping up again. From my admittedly lay perspective, though, it seems that the bigger issue is that of mitochondrial disorders in general. From the NYT article:
Many experts said infections could be so devastating to those with mitochondrial disorders that the risks associated with vaccines were far outweighed by the benefits. Still, none dismissed the notion that a vaccine could cause a decline in such children.
“Most of these kids get a common cold, and either during the cold or soon after, the parents notice a drastic deterioration,” said Dr. Bruce H. Cohen, a neurologist at the Cleveland Clinic.
It seems to me, then, that pretty much any sort of infection or illness could cause such a drastic decline in children with mitochondrial disorders. I’m not sure if one could rule out vaccines as a potential source of that, but you certainly can’t rule out other factors also. The second case might just be a prime example of the post-hoc ergo propter hoc fallacy; in other words, a temporal connection between the two events (the vaccination and the deterioration) does not rule in a causal connection.
The article also goes on to talk about the difficulties in developing screening technologies for mitochondrial disorders which, by extension, would make studying this particular population extremely difficult (at least as far as I understand it).