As flu season kicks into gear, parents have to decide what’s best for their children. (Photo by Getty Images)
Marysue Grivna of Town ‘N Country, Fla., used to sing in her church choir and was an enthusiastic elementary-school student. But now the 10-year-old girl is bedridden, and her mother, Carla, blames her daughter’s condition on the flu vaccine, 10 News in Tampa Bay Sarasota reported.
On Nov. 22, 2013, Marysue received her annual flu shot, and the next morning, she was unresponsive, according to her GoFundMe page. “I attempted to wake her and could not at first,” her mother wrote. “Finally, she opened her eyes but she did not speak to me.” Grivna called 911, and a few days later, her daughter was diagnosed with acute disseminated encephalomyelitis (ADEM), a rare condition associated with inflammation throughout the brain and spinal cord. A year later, Marysue is confined to a wheelchair and eats through a feeding tube.
After developing a rare brain disease last year, Marysue Grivna is bedridden. Could the flu vaccine be to blame? (Marysue Lucille Grivna Trust/Facebook)
Her parents are convinced that the vaccination is what triggered Marysue’s condition. “Yes, it is possible,” said Dr. Aaron Boster, an Ohio State University neuroimmunologist who specializes in ADEM and similar conditions. “About 5 percent of all cases of ADEM might be triggered by a recent immunization.”
Overall, the rate of postvaccination ADEM is extremely low: about 10 to 20 people per million individuals who get immunized, according to a 2014 study in Human Vaccines & Immunotherapeutics, which analyzed an ADEM case in a 59-year-old man who’d received the flu vaccine 10 days before showing symptoms. For the flu shot specifically, the rate of ADEM is about one per 10 million doses. (ADEM has been linked, albeit somewhat tenuously, to a number of vaccines, including those for rabies, mumps, and polio.)
More often, though, ADEM is associated with a recent infection, not an immunization. “You could develop ADEM as a consequence of the flu,” said Dr. Emmanuelle Waubant, a professor of neurology at the University of California, San Francisco. “If you look at the incidence of ADEM related to infections versus cases related to vaccines, there are actually much fewer with vaccines than with infections.”
Either way, the condition is extremely rare — Boster sees only two or three cases of ADEM a year, versus about 25 new cases of multiple sclerosis per day — although doctors can’t predict what causes some people’s immune systems to go haywire. (It’s much more common in children, possibly because their immune systems aren’t fully developed.) “In a nutshell, ADEM is an inappropriate immune response,” he said. The result: In a matter of hours or days, patients develop massive amounts of inflammation throughout the entire brain and spinal cord.
“ADEM is in the same vein as multiple sclerosis,” Boster told Yahoo Health. “But with M.S., you’ll have one area of inflammation, affecting one part of the central nervous system. Here, you might have 20 or 30 [areas] all at the same time. When you do an MRI, you’ll see these large, fluffy, white lesions throughout the brain and spinal cord.”
The specific areas of the central nervous system that are affected determine the symptoms, which can range from seizures to nausea to paralysis. “It’s typically a very dramatic presentation — it can be very, very scary,” Boster said. “But it very often completely resolves and never comes back. It’s a one-hit wonder.”
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Generally, ADEM clears up within three months — although, as in Marysue’s extreme case, symptoms may linger if the recovery wasn’t complete. “Let’s say that the circuitry that runs her leg was affected, and it recovers 90 percent,” he said. “She is going to be left with a residual 10 percent problem.” He compares this to using an electrical cord that’s been run over in your driveway — it may effectively power some of your Christmas lights but could short-circuit if overloaded.
So is the threat of ADEM serious enough to warrant forgoing your child’s flu vaccine? Both Boster and Waubant say no. “You have a better chance of winning the lottery than you do of this happening,” Boster said. “If you’re going to play statistical odds, the likelihood of having a very bad outcome from the flu is much, much higher.” CDC data shows that between 3,000 and 49,000 people in the U.S. die each year from the flu.
And the virus is an especially serious threat to young children. Last season, more than 100 U.S. children died from the flu, according to the CDC; during the H1N1 pandemic of 2009-2010, the flu killed 348 children in the United States alone. That’s why, despite rare instances of vaccine-associated illnesses, such as ADEM, the American Academy of Pediatrics and the CDC recommend the flu vaccine for all children ages 6 months and older.