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Case Report Describes Fatal Motor Neuron Disease Following HPV Vaccination: Presented at ANA

By Charlene Laino

BALTIMORE, Md -- October 18, 2009 -- A case report suggests there may be a link between the vaccine against human papillomavirus (HPV) and a rapidly progressive, fatal, motor neuron disease, researchers reported here on October 13 at the American Neurological Association (ANA) 134th Annual Meeting.

At her poster presentation, Catherine Lomen-Hoerth, MD, PhD, Director, ALS Center, University of California, San Francisco, Medical Center, said that a 14-year-old girl developed weakness in her left leg 2 months after her third and final Gardasil dose. The condition progressed rapidly: her muscle weakness relentlessly progressed to all her extremities and her muscles atrophied, she said. Despite treatment with aggressive immunosuppression, the girl died of respiratory failure 21 months after onset of symptoms.

Dr. Lomen-Hoerth said the features suggest a clinical diagnosis of amyotrophic lateral sclerosis (ALS), but the disease progressed more quickly than typical for young ALS patients, she said.

Postmortem examinations revealed widespread infiltration of T lymphocytes and macrophages in the grey and white matter at all levels of the spinal cord, Dr. Lomen-Hoerth continued. Additionally, there was widespread demyelination and severe loss of motor neurons.

"We were surprised that the spinal cord was so inflammatory. That is very different from what we normally see in ALS," she said.

"These pathological features support the temporal association of the clinical presentation and vaccination and provide supporting evidence that immune-mediated reactions in the nervous system are potential risks after Gardasil vaccination," she said.

Still, "we don't know for sure if it's coincidence or if it's connected [to the vaccine]," Dr. Lomen-Hoerth said. "We hope that by raising awareness, we will become aware of any other cases," facilitating further study.

Her team plans further study comparing the symptoms and pathological features of young adults with ALS who received the Gardasil vaccine to those who have not been vaccinated. "If the features are identical, then we'll know [the vaccine] is not the cause," Dr. Lomen-Hoerth says.

Pam Eisele, a spokesperson for Merck & Co., which makes the vaccine, said the company cannot comment specifically on the case as it has not seen the data.

"However, after carefully reviewing all the information available to us about reported adverse events, including reports of deaths, Merck does not believe these events have been caused by Gardasil," she said.

[Presentation title: Demyelination and Severe Loss of Spinal Motor Neurons Following HPV Vaccination. Abstract WIP-19]

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