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SPECIAL ARTICLES: Paul A. Offit and Charles J. Hackett Addressing Parents’ Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases? Pediatrics 2003; 111: 653-659 [Abstract] [Full text] [PDF]

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Luca Rosti   (20 March 2003)

Vaccine safety: causal or coincidental associations

Paul A Offit   (20 March 2003)

Untitled 20 March 2003
Luca Rosti, pediatrician & neonatologist Pediatric Cardiology, Istituto Policlinico, San Donato Milanese, ITALY Send letter to journal: Re: this article l.rosti{at}grupposandonato.it Luca Rosti	A premise is mandatory: I strongly recommend all available immunizations in all infants and children; and the paper by Offit and Hackett on the concerns of parents about vaccinations is extremely convincing, but… A brief report. AR was a healthy 18-month old girl with a family history completely negative for immunological diseases, except for an allergic rhinitis in the father. Growth and development were normal for age. She underwent all scheduled immunizations, without any side effect (DTaP, OPV, HBV, Hib, MMR) at the scheduled times. At the age of 18 months, she received varicella immunization. Two weeks later, a non-tender swelling of the left knee was noted. Because she was attending day care, an occult trauma while playing was thought to be involved. She did not refer pain, nor functional impairment was present. However, she was evaluated by a pediatric orthopedic and a pediatric radiologist, who made a diagnosis of “intra-articular effusion of unknown etiology”. No therapy was instituted. Eventually, an experienced pediatric rheumatologist saw the little girl and performed a needle aspiration of the joint effusion. A diagnosis of rheumatoid arthritis (pauciarticular, type 1) was made. As frequently seen in this disease, laboratory test resulted normal. The little girl was treated with intra-articular corticosteroids and, by 6 months, the effusion was resolved. She is currently doing well, and ophthalmological and rheumatologic follow-up are negative. Based on clinical and laboratory grounds, the rheumatologist firmly denied the possibility that the condition was a “reactive arthritis”, as those seen following natural varicella infection. Currently, the most important known risk factor for this baby is that she the relative of a doctor: actually, she is my beloved daughter. Despite this, I still strongly recommend the varicella immunization… Luca Rosti
Vaccine safety: causal or coincidental associations 20 March 2003
Paul A Offit, physician The Children's Hospital of Philadelphia Send letter to journal: Re: Vaccine safety: causal or coincidental associations offit{at}email.chop.edu Paul A Offit	The story of a child who developed chronic arthritis following receipt of the varicella vaccine, while compelling, does not offer a formal proof of causality. At best, such an observation raises the hypothesis that vaccines may be a cause of immune-mediated disease. The only way to prove an association between receipt of a vaccine and the development of specific chronic diseases is by comparing the incidence of specific chronic diseases in vaccinated and unvaccinated groups. The hypothesis that vaccines might cause chronic allergic or autoimmune diseases has now been tested in many excellent, well-controlled studies. No evidence has been found to support the hypothesis. These clinical findings are consistent with important differences between immunologic events that occur after natural compared with those that occur after immunization.