http://pediatrics.aappublications.org/cgi/content/abstract/101/3/383

PEDIATRICS Vol. 101 No. 3 March 1998, pp. 383-387 [pdf copy]

Acute Encephalopathy Followed by Permanent Brain Injury or Death Associated With Further Attenuated Measles Vaccines: A Review of Claims Submitted to the National Vaccine Injury Compensation Program

Received Jul 30, 1997; accepted Sep 23, 1997.
 
Robert E. Weibel*, Vito Caserta*, David E. Benor Dagger , and Geoffrey Evans*

From the * Division of Vaccine Injury Compensation, National Vaccine Injury Compensation Program, Health Resources and Services Administration, Public Health Service, Rockville, Maryland; and the Dagger Office of the General Counsel, United States Department of Health and Human Services, Rockville, Maryland.

Objective.  To determine if there is evidence for a causal relationship between acute encephalopathy followed by permanent brain injury or death associated with the administration of further attenuated measles vaccines (Attenuvax or Lirugen, Hoechst Marion Roussel, Kansas City, MO), mumps vaccine (Mumpsvax, Merck and Co, Inc, West Point, PA), or rubella vaccines (Meruvax or Meruvax II, Merck and Co, Inc, West Point, PA), combined measles and rubella vaccine (M-R-Vax or M-R-Vax II, Merck and Co, Inc, West Point, PA), or combined measles, mumps, and rubella vaccine (M-M-R or M-M-R II, Merck and Co, Inc, West Point, PA), the lead author reviewed claims submitted to the National Vaccine Injury Compensation Program.

Methods.  The medical records of children who met the inclusion criteria of receiving the first dose of these vaccines between 1970 and 1993 and who developed such an encephalopathy with no determined cause within 15 days were identified and analyzed.

Results.  A total of 48 children, ages 10 to 49 months, met the inclusion criteria after receiving measles vaccine, alone or in combination. Eight children died, and the remainder had mental regression and retardation, chronic seizures, motor and sensory deficits, and movement disorders. The onset of neurologic signs or symptoms occurred with a nonrandom, statistically significant distribution of cases on days 8 and 9. No cases were identified after the administration of monovalent mumps or rubella vaccine.

Conclusions.  This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles immunization.
Key words: measles vaccine, encephalopathy, encephalitis.

From: Teresa Binstock <binstock@peakpeak.com>

QUESTIONS?  COINCIDENCE??:
Ironic that the Weibel et al Feb-1998 paper's final stages and its peer-review process were occurring at the same time as Wakefield et al Mar-1998 was being finalized for publication in Lancet.

Perusing the paper suggests MMR's role in everything from tics to PDD to autism. Might Tylenol etc have diminished adverse effects (eg, prevented death and most comas) while allowing MMR-induced encephalopathies to manifest differently - eg, as autism?

Exclusion: In 1995, policy regarding dates for onset of vaccine-related encephalopathy changed from <15 days to between 5 and 15 days, yet Weibel et al found that ~16% of the cases had onset on day 4 or less. Also, rhetoric in Weibel et al may be somewhat ambiguous in regard to counting occurrences in days 1 thru 4 or in days 1 thru 5. Regardless, official policy to exclude MMR-related encephalopathies in days 1-4 augments under-reporting Weibel et al presume to have occurred given requirements of the compensation program.

Question after perusing the paper, the researchers excluded postictal phenomena, but I can't help but wonder: in how many kids who received the MMR and developed high fever with non-mild seizures, how many such kids had measurable deteriorations that occurred postictally?


I had  hoped to ask Dr. Weibel the question about the possibility of postictal deteriorations having been excluded.

Pubmed indicated that Weibel RE's last published study was the 1998 gem that reported MMR damage. A google search showed that he still participated as part of an HHS department at least as recently as 2006.

Teresa