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One commonly repeated incident that propagates and recirculates on anti-vaccine websites is that of a nine-year-old Florida girl who developed an extremely rare neurological condition known as acute disseminated encephalomyelitis (ADEM) five days following her immunization for the flu in November 2013. The incident itself, described in local news accounts, is real: The stricken girl was ultimately diagnosed with ADEM, and while most cases of ADEM resolve completely or carry only minor long-term consequences, this case left the patient in a wheelchair and has caused lasting neurological damage. While devastating, the event’s causal relationship to the flu shot is a much more complicated area of science, one that has been misrepresented repeatedly in the anti-vaccine posts that have used this family’s story to advance their fear-driven agenda. A representative example can be found on the conspiracy mill website known as Natural News: A 2016 review of ADEM in the journal Neurology described the disease as belonging to a group of poorly understood conditions known as immune-mediated demyelinating CNS disorders. A demyelinating process is one that damages or removes the protective covering surrounding the nerve fibers of the central nervous system, known as a myelin sheath. An immune-mediated demyelinating process is one caused by the body’s own immune system attacking these surfaces, leading to neurological damage: Because ADEM is an immune-mediated disease, vaccines have long been considered as a plausible trigger for the condition, which is most commonly thought to be caused by the body's inflammatory response to various viral or bacterial infections. Evidence for a possible minor link to the MMR vaccine, mentioned above in the Natural News post, has been published, although those conclusions have been disputed, and no widespread epidemiological study has ever found clear evidence of a causal relationship between ADEM and the influenza vaccine, as alleged in the viral story. This is likely why Natural News and other similar outlets rely upon a vaccine injury lawyer, whose livelihood stems from fees garnered from bringing complaints to the National Vaccine Injury Compensation Program, to assert the connection. A 2015 review of the influenza vaccine’s overall safety concluded that evidence was insufficient to establish a causal relationship between influenza vaccines and acute disseminated encephalomyelitis: In fact, the risk of developing ADEM directly following influenza inoculation may well be lower than the risk of developing ADEM without receiving the influenza vaccine. A 2014 paper that reviewed cases of central nervous system demyelination (like ADEM) following vaccinations of any kind concluded that The risk of onset or relapse of CNS demyelination following infections against which the vaccines are aimed to protect is substantially higher, and the benefits of vaccinations surpass the potential risks of CNS inflammation. Rare neurological disorders which have their onset at around the time a child is of the correct age to receive a vaccine are often asserted to be caused by those vaccines based on temporal proximity, despite a lack of conclusive evidence to draw a mechanistic link. The available evidence does not support a connection between ADEM and the flu vaccine, but the condition is so rare that insufficient data exists to robustly prove a lack of causation at this time. As such, claims that the 9-year-old girl in Tampa developed as a result of the flu shot is unproven.
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