ALS-Like Disease in 2 Gardasil Recipients

It's crucial to remember that association does not mean causation. In the former case, the media jumped the gun before knowing the autopsy results. The 14-year-old English girl died of a previously undiagnosed, malignant "chest tumour." However, the nature of the link between Gardasil and the 2 ALS-like—or more accurately motor-neuron—cases remains unclear for now.

One of the motor-neuron cases, that of 15-year-old Jenny Tetlock, is commemorated at her parents' blog, Jenny's Journey. Some details of the girl's case history are also provided here.

Jenny developed leg weakness in May 2007, about 2 months after she received her third Gardasil injection. Her clinical course was, to say the least, rapid, despite "aggressive immunosuppression"—which included high-dose corticosteroids, plasmapheresis, intravenous immunoglobulin, and cyclophosphamide. A demyelinating polyneuropathy was initially suggested by nerve-conduction studies. An inflammatory component was suggested by imaging and spinal-fluid studies. Other entertained diagnoses during Jenny's unusual clinical course included spinal muscular atrophy, progressive muscular atrophy, and multifocal motor neuropathy. Suffice it to say, her clinical picture did not fit snugly into any one of these disease categories.

Jenny became quadriplegic within a year. Her clinical picture was also atypical for ALS, a purely motor disease, in that she experienced sensory symptoms. A sural nerve biopsy revealed mild axonal degeneration; demyelinating features were not prominent. Jenny died on March 15, 2009, of respiratory failure. Her autopsy revealed loss of motor neurons and marked inflammation throughout the spinal cord—an additional finding that is uncharacteristic of ALS.*

Clinical features of the other motor-neuron case, that of a 20-year-old woman, were similar. Motor symptoms began within 4 months of the first Gardasil injection; death occurred 28 months later.

A recent review of the Vaccine Adverse Event Reporting System (VAERS) revealed no similar cases linked to Gardasil, according to the reporting physician, Catherine Lomen-Hoerth, Director of the ALS Center at the University of California, San Francisco. She and her colleagues will examine the pathologic features of young adults with motor-neuron disease who did not receive Gardasil and compare these with the recently reported cases. Similar findings would argue against a causal Gardasil connection.

Juvenile ALS, which by definition begins before the age of 25 years, is generally thought to be a disease that is distinct from adult ALS. The juvenile condition is, comparatively, slowly progressive—possibly because younger patients have more neurologic reserve. Juvenile disease is almost always familial and usually autosomal recessive. Gene culprits have been identified in a minority of these rare cases, however. (Hereditary or genetic data from the 2 Gardasil-associated cases were not provided in medical news reports.) Juvenile ALS affects 1 in every 2-3 million young persons.

More than 7 million have received Gardasil, according to news reports.  

ALS = amyotrophic lateral sclerosis.

* Other atypical clinical features include 3 epileptic convulsions during illness and no upper-motor-neuron signs (eg, hyperactive reflexes). Jenny's history is notable for some developmental delay and a rare, autoimmune skin disorder. Family history does not appear to be particularly contributory.

New sources: WebMD; DocGuide.