Intended for healthcare professionals


Conflicts of interest compromise US public health agency’s mission, say scientists

BMJ 2016; 355 doi: (Published 24 October 2016) Cite this as: BMJ 2016;355:i5723

Can we trust the CDC to honestly investigate the current AFM outbreak?

Around 100 cases of acute flaccid myelitis (AFM) have been reported to the CDC so far in 2016. The cause is unknown, but polio-like viruses, such as enterovirus D68, are suspected. Antecedent injections have been suggested as possible co-factors by clinician-scientists who remember "provocation paralysis"; Hill and Knowelden, for example, found a 20-fold risk of paralytic polio in children who received the DTP shot during the 1949 British polio epidemic (BMJ-July 1, 1950). During the 1990s the NEJM published a study in Romania linking vaccine-associated paralytic polio (VAPP) to penicillin injections. Tissue studies have shown how muscle damage by an injection can provide a portal of entry to the CNS for neurotropic viruses.

Right now I am in Seattle and have been reading news reports of 9 suspected cases of AFM in children 3 to 14 years of age in Washington State. I also had occasion to chat with the public health official investigating the outbreak. He is aware of "provocation paralysis" and he is wary of anti-vaccine forces who would misuse data suggesting a serious adverse effect of vaccinations; for this reason he indicated that statistical details of the CDC's investigation would not be released to the news media.

Why did AFM appear in 2014? Why has it been reported only in the U.S.? Why are young schoolchildren (average age 7-8 years) the primary targets? Why have the bulk of cases occurred between August and October, with a September peak? I hope that the CDC's investigative questionnaire asks if victims had received any injections within a month or so of illness onset?...what kind of injections? of injections? I hope also that whoever administers the questionnaire or tallies the data are not biased for or against any theory regarding the causes of AFM.

The CDC, the AAP and many public health officials are afraid that any bad news about vaccines will cause the public to turn away from life-saving vaccines. Along with the manufacturers, they are also afraid of the effect such news might have on incomes and careers. Will the CDC do an unbiased, thorough and transparent investigation of the current AFM outbreak?

Competing interests: No competing interests

05 November 2016
Allan S. Cunningham
Retired pediatrician
Cooperstown NY 13326 USA