Title:Vaccines and autism revisited--the Hannah Poling case.
Author's Address:Children's Hospital of Philadelphia and University of
Pennsylvania School of Medicine, Philadelphia, USA.
Source:The New England Journal Of Medicine [N Engl J Med] 2008 May 15; Vol.
358 (20), pp. 2089-91.
Vaccines and Autism Revisited — The Hannah Poling Case
On April 11, 2008, the National Vaccine Advisory Committee took an unusual step:
in the name of transparency, trust, and collaboration, it asked members of the
public to help set its vaccine-safety research agenda for the next 5 years.
Several parents, given this opportunity, expressed concern that vaccines might
cause autism — a fear that had recently been fueled by extensive media coverage
of a press conference involving a 9-year-old girl named Hannah Poling.
When she was 19 months old, Hannah, the daughter of Jon and Terry Poling,
received five vaccines — diphtheria–tetanus–acellular pertussis, Haemophilus
influenzae type b (Hib), measles–mumps–rubella (MMR), varicella, and inactivated
polio. At the time, Hannah was interactive, playful, and communicative. Two days
later, she was lethargic, irritable, and febrile. Ten days after vaccination,
she developed a rash consistent with vaccine-induced varicella.
Months later, with delays in neurologic and psychological development, Hannah
was diagnosed with encephalopathy caused by a mitochondrial enzyme deficit.
Hannah's signs included problems with language, communication, and behavior —
all features of autism spectrum disorder. Although it is not unusual for
children with mitochondrial enzyme deficiencies to develop neurologic signs
between their first and second years of life, Hannah's parents believed that
vaccines had triggered her encephalopathy. They sued the Department of Health
and Human Services (DHHS) for compensation under the Vaccine Injury Compensation
Program (VICP) and won.
On March 6, 2008, the Polings took their case to the public. Standing before a
bank of microphones from several major news organizations, Jon Poling said that
“the results in this case may well signify a landmark decision with children
developing autism following vaccinations.”[ 1] For years, federal health
agencies and professional organizations had reassured the public that vaccines
didn't cause autism. Now, with DHHS making this concession in a federal claims
court, the government appeared to be saying exactly the opposite. Caught in the
middle, clinicians were at a loss to explain the reasoning behind the VICP's
The Poling case is best understood in the context of the decision-making process