A previously healthy 19-month-old child received five vaccines (MMR, varicella, IPV, DTaP, and Haemophilus influenzae) in 2000 because she was behind in the recommended childhood immunization schedule. She subsequently developed neurodegeneration including some signs of mild autism spectrum disorder. A muscle biopsy and genetic testing revealed that she had a preexisting mitochondrial dysfunction disorder. The US Court of Federal Claims has agreed to pay the family from a federal fund that compensates people injured by vaccines.

The decision to compensate the family is summarized in the following quote from the Division of Vaccine Injury Compensation (DVIC), "[We have] concluded that the facts of this case meet the statutory criteria for demonstrating that the vaccinations child received on July 19, 2000, significantly aggravated an underlying mitochondrial disorder, which predisposed her to deficits in cellular energy metabolism, and manifested as a regressive encephalopathy with features of autism spectrum disorder."

The full text of the decision by the US Court of Federal Claims has been posted (link) although the formal decision has not yet been announced by the Vaccine Injury Compensation Program. More information will be made available in May when this report is scheduled to be made public. In the meantime, federal officials are prohibited from making public statements about a specific case in order to protect the confidentiality of medical records.

Encephalopathy has been shown to occur at an increased rate following whole cell DTP vaccine. That vaccine has been replaced by the acellular pertussis vaccine (DTaP), but rare cases of encephalopathy still occur. The detailed investigation of this child that identifyed the underlying mitochondrial dysfunction disorder may provide an important clue to understanding why these rare complications occur. Moreover, future investigations might help identify a means to screen for such disorders, although because there are many different mitochondrial dysfunction disorders and testing is invasive and expensive, screening is difficult.

Other children with encephalopathy following vaccines have been compensated through the Vaccine Injury Compensation Program. What attracted public attention to this case was that it had been submitted as a test case by petitioners seeking compensation for children with autism following exposure to thimerosal containing vaccines. The decision to award compensation in this case has nothing to do with the thimerosal that may have been present in one or two of the vaccines that the child received (in 2000, only two of the five vaccines this child received would have contained thimerosal; the others were already thimerosal free). The underlying mitochondrial dysfunction disorder in this case predisposes to neurodegeneration following significant stresses associated with infections, and possibly the multiple vaccines that this girl received. After the decision was made to award compensation, the case was withdrawn as a test case.

Additional research is needed to determine if other children with autism, especially those with “the regressive form” of autism have the same or similar underlying mitochondrial dysfunction disorders.

The advisory groups who make recommendations regarding vaccines will undoubtedly examine this case carefully and make decisions regarding the potential need for changes in recommendations for administering multiple vaccines to children who have fallen behind in the recommended childhood immunization schedule.

For more information:

• transcript from a March 6 2008 CDC conference call on this issue

• United Mitochondrial Disease Foundation information and links