Editor's Note: Margaret Dunkle is Hannah Poling’s great aunt and an early intervention specialist. She wrote the following memo to her colleagues at the “Early Identification and Intervention Collaborative for Los Angeles County” and has given her permission to Age of Autism to reprint it in full.
To: Early Identification and Intervention Collaborative for Los Angeles County
From: Margaret Dunkle
Date: March 17, 2008
What Are the Policy Implications of the Hannah Poling Decision
for Screening, Intervention and Treatment?
Most of you have heard that the federal government has conceded that:
“…the vaccinations Hannah [Poling, an Athens, GA, girl who is now nine years old] 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.” *
“Having reviewed this additional evidence, [medical personnel at the Division of Vaccine Injury Compensation, Department of Health and Human Services (DVIC)] now recommends compensation for Hannah’s seizure disorder as sequela of her vaccine-injury….” **
What are the policy implications of this decision? What questions need to be asked – and answered – by people who care about both:
• Public health and a safe and effective immunization program for major diseases, and
• The health and future of individual children like Hannah Poling?
This discussion is especially appropriate since, as most of you know, Hannah Poling is the reason I began to work on issues concerning early identification and intervention issues in the first place. Without Hannah Poling, there would be no EII Collaborative!
The policy questions we will discuss at Thursday’s meeting will focus on early screening and intervention:
1. How can we quickly find ways to screen for and identify the subset of children like Hannah for whom vaccines can cause or exacerbate mitochondrial damage and lead to symptoms of autism?
2. In the meantime, how can children such as Hannah*– be they few or many – be identified at the earliest possible moment and sped into intense intervention (i.e., the Part C, Early Start IDEA program for children ages 0-36 months or the Preschool Special Education IDEA program for children ages 3-5)?
3. What would it take to start screening siblings of children with autism to see if they have biomedical markers that could lead to screening tests or treatment for children who, like Hannah Poling, have a mitochondrial dysfunction?
Thinking about national policy, other important questions the Hannah Poling Decision raises are:
1. Should the number, ages administered, and frequency of childhood vaccinations be reviewed – and perhaps changed – to minimize damage to susceptible children, such as Hannah Poling?
Interestingly, just last Friday, March 14, the federal Advisory Committee on Immunization Practices (ACIP) updated it’s recommendations regarding a combo vaccine (for measles, mumps, rubella and varicella – MMRV). Specifically, ACIP changed its recommendation from “preferring” this combo vaccine to having “no preference” for the combo over separate injections of equivalent component vaccines.
ACIP did this because the Vaccine Safety Datalink monitoring system found that children receiving the new combo (4-vaccine) shots had a statistically significant greater risk of seizures than children who received the MMR and varicella vaccine administered separately at the same visit.
For details, see: MMWR, March 14, 2008
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5710a3.htm ) and MedPage Today, March 14, 2008 (http://www.medpagetoday.com/InfectiousDisease/Vaccines/dh/8755)
2. How do we find out how many Hannah Polings there are? Right now, no one knows, since mitochondrial dysfunction in children is almost never measured and, as yet, there is no screening available to detect these problems.
3. Should the federal government revamp the way it approves vaccines and monitors their safety, or even set up an independent agency (separate from the Centers for Disease Control, which also runs the National Immunization Program) to research, approve, and monitor the safety and effectiveness of vaccines?
4. Should the vaccine compensation act be tweaked to give parents longer than three years to file, especially given the newly identified “mitochondrial dysfunction” implications of the Hannah Poling decision and because we want parents and families to devote 100% of their energy to early intervention as soon as they learn their child has a problem?
5. What will it take to quickly and effectively research these mitochondrial issues to get to the bottom of what is going on with children such as Hannah, and to come up with effective screening and treatment?
• Was Hannah Poling born with a mitochondrial dysfunction or did she somehow acquire it after birth?
• What exactly was it about the vaccines Hannah Poling received that triggered her regression – something about the vaccines themselves? the number of vaccines? the timing of the vaccines? preservatives in the vaccines? the combination of vaccines she received on the same day? or something else?
If you are interested in these issues, please be sure to read the two items I sent out last week – a piece I wrote on Autism, Vaccines and Early Intervention (The Hannah Poling Case), and the Letter from Jon Poling, MD, PhD, to Steven Novella, MD.
My best wishes to you,
Director, Early Identification & Intervention Collaborative for Los Angeles County, and
Senior Fellow, Center for Health Services Research & Policy, George Washington University