Transcript IMFAR Meeting – London – May, 2008

THE VACCINE-AUTISM
DEBATE:
NEW DEVELOPMENTS
FROM SCIENCE AND POLICY
Presentation by David Kirby
Capitol Hill - Washington, DC
September 24th, 2008
1
“Talking Points”
Debate not over – Many unresolved questions.
Look at kids who got sick, work backward from there: What might cause
these physical symptoms?
Look at genetic susceptibilities: immune, metabolic, mitochondrial,
metal metabolism. What percentage of the population is born “at risk?”
No single type of autism and no single cause – Look at many different
combinations of genes and environmental “triggers.”
Possible triggers include mercury & other heavy metals in food, air and
water, thimerosal, multiple vaccines, pesticides, viruses, etc.
Mercury/vaccine research on at CDC, NIH, Universities, Autism Speaks
Vaxed v Unvaxed study needed – Maloney Bill.
2
A NEW AUTISM VOCABULARY
Cause, Effect & Connections of:
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Immune Activation/Suppression/Autoimmunity
Oxidative Stress
Neuro-inflammation / Rapid Brain Growth
Glutathione Depletion
Mitochondrial Dysfunction
Metal Metabolism/Efflux Disorder
Activation of Astroglia & Microglia/“Gliosis”
Demyelination
3
“Autism and the Environment”
Institute of Medicine Neuroscience.
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“The environment may play a significant role in
triggering autism.”
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“Evidence points to a large genetic component,
but genes alone cannot account for its cause.”
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Parents played a major role in this report.
4
Link between mercury and autism?
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Thimerosal not out of vaccines until 2003; still in flu
shot. CA: Too soon to tell? (CDC studies 8 year olds).
Reports of drop in severe autism cases among
youngest children.
Today, autism rates are higher among immigrants –
Thimerosal is still in full use in 3rd World.
Many top university studies show an association
between background mercury/thimerosal and autism.
CDC continues to study mercury and autism today.
5
NIH: “We identified several areas of weakness that were judged
to reduce the usefulness of the VSD for addressing the potential
association between exposure to thimerosal and risk of ASD.”
The weaknesses of primary importance: Case ascertainment;
Heterogeneity in business practices; Systematic changes over
time; Estimation of total mercury burden.
Gerberding General Response: CDC CONCURS
6
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Thomas Burbacher at Univ. of Wash. Primate Center compared
ethylmercury from thimerosal and methylmercury from fish.
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Methyl stayed in blood longer, crossed blood-brain barrier more.
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BUT - Ethyl in brain converts to inorganic Hg faster than methyl.
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2-4 times more inorganic Hg found in brains of ethyl vs methyl
group.
7
“Changes in astrocytes and microglia in primate
brains after long-term methylmercury exposure.”
Neurotoxicology. 1996;17:127-138.
Burbacher: Inorganic Hg, presumably from methyl Hg,
continued to increase throughout all exposure durations.
Both astrocyte and microglial cells had “substantially
elevated” inorganic mercury deposits.
“Inorganic mercury may be a toxic form responsible for
activation of astrocyte and microglia.”
Activation of astrocyte and microglial cells was not noted
for six months or more, in some cases.
8
JOHNS HOPKINS:
‘Neurological Activation &NeuroInflammation in Brain of Autism Patients
Annals of Neurology - Vol 57 No 1 January 2005
Inflammation found in autopsied autistic brains,
produced by ”activation of astroglia and microglia.”
Inflammation apparently associated with
activation of the brain’s immune system.
Compared with controls, autistic tissue showed
ongoing inflammation in various sections of brain.
9
HARVARD:
“Large Brains in Autism: The Challenge of
Pervasive Abnormality”
The Neuroscientist, Volume 11, Number 5, 2000
Neuro-inflammation, oxidative stress &
microglia damage found in autistic brain tissue.
“Chronic disease or external environmental
sources” (ie, heavy metals) may be the cause.
“Oxidative stress, brain inflammation, and
microgliosis has been much documented in
association with heavy metal exposures.”
10
Hannah Poling - Concession
November 9, 2007
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Hannah met all milestones in first 18 months. At 9
months: Mimicking sounds, crawling, and sitting.
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At 12-month pediatric visit: Saying “Mom” &
“Dad,” pulling self up, cruising.
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July 19, 2000 visit - Hannah “spoke well” was “alert
and active,” with regular bowel movements and
good sleeping habits.
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July 19, 2000 visit – Hannah received 9 vaccines:
D-T-aP, M-M-R, Hib, Varivax, and Polio
11
Poling Concession
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July 21, 2000 – Two days later: 102.3 degree fever, “lethargic,
irritable, and cried for long periods, with intermittent, highpitched screaming and a decreased response to stimuli.”
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July 22–31, 2000 - Behavior continued over next ten days.
Hannah also began to arch back when crying.
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July 31, 2000 – Hannah had 102 degree fever, diminished
appetite, red dots on chest and “extremely irritable and
inconsolable.”
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September 26, 2000 - Hannah returned with 102 fever, diarrhea,
nasal discharge, reduced appetite, and pulling at her left ear.
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November 13, 2000 – Hannah presented with more diarrhea,
vomiting, diminished energy, fever, and rash on her cheek.
12
Poling Concession
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December 14, 2000 - Doctor noted Hannah had possible
speech delay, was less responsive to verbal direction since
July, and lost some language.
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February 8, 2001 – “Encephalopathy progressed to
persistent loss of previously acquired language, eye contact,
and relatedness, following vaccinations of July, 2000.
Hannah watched the fluorescent lights repeatedly during
the examination and would not make eye contact.”
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February 8, 2001 - Hannah diagnosed with “regressive
encephalopathy with features consistent with an autistic
spectrum disorder, following normal development.”
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May 17, 2001 – Lab results “strongly indicated an
underlying mitochondrial disorder.”
13
Poling Concession #2
February 21, 2008
“The cause for autistic encephalopathy was
underlying mitochondrial dysfunction, exacerbated by
vaccine-induced fever and immune stimulation that
exceeded metabolic reserves.”
OR:
Hannah’s autism was caused by a vaccine-induced
trigger of her underlying mitochondrial dysfunction.
14
Dr. Gerberding on CNN
March 29, 2008
“If a child was immunized, got a fever, had other
complications from the vaccines, and (is) predisposed with the mitochondrial disorder, it can
certainly set off some damage.”
“Some of these symptoms can be symptoms that
have characteristics of autism."
“I think we have to have an open mind about this.”
15
Three Sources of Mito Disorders
Sources: Cleveland Clinic and UMDF
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1) Inherited from mother (in Mito DNA)
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2) Inherited from both parents (in nuclear DNA)
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3) “Sporadic” (acquired via medicines and toxins).
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“Sporadic” type estimated for 75% of all cases.
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Mitochondria can be damaged by mercury, aluminum,
pesticides, formaldehyde, alcohol, even HIV meds like
AZT (which delete large segments of MtDNA).
16
Estimates of Mito Dysfunction
1) Oliveiro et al: Markers for Mito dysfunction found in 20% of ASD
patients, and muscle biopsy confirmed in 7.2%.
2) Kelley, Zimmerman, Natowicz: Mitochondrial dysfunction may
account for 20% of ASD, especially PDD-NOS with language and
cognitive regression in 2nd year. Markers on paternal lines; early testing,
“may rescue some from more severe brain injury and lifelong disability.”
3) David Holtzman, Massachusetts General Hospital, AS Grant:
“Oxidative Phosphorylation in Cells from Autistic Individuals.” Mito
dysfunction might be found in up to 30% of ASD cases.
4) Petitioners Steering Committee – VICP – Up to 50% of 5,000 cases
filed in Vaccine Court show markers for mild dysfunction.
5) UMDF – Mitochondrial DNA mutations in population: up to 1-in-200
6) Johns Hopkins – Nuclear DNA mutations in population: up to 1-in-50
17
March 11, 2008 CDC Conference Call on
Mito Dysfunction, Vaccines and Autism
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CISA - CDC, vaccine experts and insurance
companies – discussed 5-year study of 30 ASD kids
w/low cellular energy.
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All 30 had the same abnormalities as Hannah
Poling, (who was one of them). All regressed after
normal development.
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Big surprise: “Inheritance pattern" found – When 2
two cousins had autism, genetic link was always
through father – clear nuclear DNA inheritance.
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DNA mutation from 1-in-400 to 1-in-50, or 2%.
18
April 11, 2008 – Meeting to Discuss
Top Vaccine Safety Issues in DC
HHS convened first meeting of the national Vaccine Safety
Working Group to review CDC's recommended safety research
agenda. SOME Specific Questions:
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“Is thimerosal associated with risk for tics and/or Tourettes?
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“Is pertussis vaccine associated with risk for acute
neurological events?”
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“Is combo MMRV vaccine associated with increased febrile
seizure risk?”
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“Are varicella and MMRV vaccines associated with increased
risk for clinically important events?” (2x risk of seizures)
19
April 11, 2008
CDC: Clinical Outcomes To Study
Can vaccines cause:
Neurodevelopmental disorders, including autism?
Autoimmune diseases?
Nervous system demyelinating disorders?
Encephalitis/encephalopathy?
Outcomes associated with post- immunization fever?20
April 11, 2008
CDC Also Proposes Mito Research:
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Q: “Is immunization associated with
increased risk for neurological deterioration
in children with mitochondrial
dysfunction?”
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“CISA has formed a working group to study
methods related to mitochondrial disorders
and immunization, in collaboration with
partners.”
21
“Bridging from Cells to Cognition in Autism: Pathways
to Defective Brain Function and Plasticity”
Dr. Martha Herbert, Harvard – Am. Journ. Biochem. & Biotech 4 (2): 167-176, 2008
Autism may begin when early environmental, infectious, seizure,
or autoimmune insult triggers an immune response that increases
oxidative stress in the brain.
Oxidative stress leads to DNA damage (nuclear and
mitochondrial) and metabolic (glutathione) enzyme blockage.
Inflammatory and oxidative stressors persist beyond early
development, producing ongoing functional consequences.
Continued use of damaged mitochondria and impaired metabolic
function generates additional oxidative stress.
22
Mito dysfunction in autism would activate astroglia and microglia.
Barack Obama: April, 2008
“We've seen just a skyrocketing autism rate.
Some people are suspicious that it's connected
to the vaccines. The science right now is
inconclusive, but we have to research it.”
John McCain: March, 2008
“It's indisputable that autism is on the rise
amongst children, the question is what's
causing it. And we go back and forth, and
there's strong evidence that indicates that it's
got to do with a preservative in vaccines.”
23
Dr. Bernadine Healy on CBS News
May, 2008
“Officials have been too quick to dismiss the
hypothesis as 'irrational,' without sufficient
studies of causation, without studying the
population that got sick.”
“Never turn your back on any scientific
hypothesis because you are afraid of what it
might show."
24
Since the beginning of 2008, we have heard from:
1) Both Presidential Candidates
2) Director of the CDC (and her "open mind")
3) Former head of the NIH and American Red Cross
4) Chair of the House Science Subcommittee on Investigations
5) Dr. Jon Poling, respected Pediatric Neurologist
6) HHS Vaccine Safety Working Group
7) CDC Vaccine Safety Research Agenda
8) Medical personnel at HHS Vaccine Injury Compensation Program
9) Strategic Planning Workgroup of the IAC Committee
10) Clinical Immunization Safety Assessment Network - CISA
11) Autism researchers at Johns Hopkins University Medical School
12) America's health insurance companies
13) Autism Speaks
They have all advocated, or at least considered, exploring the possible
links between vaccines and autism.
25