Michael Pavan v. HHS - Varicella, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (2020)

On January 24, 2014, Michael Pavan, as next friend of J.P., a minor, filed a petition alleging that J.P. suffered a significant aggravation of his pre-existing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) as a result of receiving the varicella vaccination on January 28, 2011. Petitioner argued that the varicella vaccine triggered an immune response, specifically an anti-idiotype response that mimicked molecular structures on the myelin-associated glycoprotein (MAG), leading to damage and exacerbation of J.P.'s CIDP.

Petitioner's experts, Drs. Margulies and Axelrod, supported this theory, emphasizing the temporal proximity between the vaccination and the worsening of J.P.'s symptoms.

Respondent's experts, Drs. Bingham and MacGinnitie, contested this, arguing that CIDP, particularly in children, is primarily T-cell mediated and that anti-idiotype antibodies are generally protective, not pathogenic, in autoimmune diseases.

They also questioned the temporal association, suggesting that a T-cell mediated response would be more rapid. The court reviewed J.P.'s medical history, noting pre-existing conditions such as high bilirubin, GERD, anemia, and vitamin D deficiency.

Symptoms of fatigue were noted in the months leading up to the vaccination. Following the vaccination, J.P. experienced increased fatigue, withdrawal from activities, emotional changes, and physical issues including limb failure, grip issues, fine motor issues, and a left eye droop.

These symptoms led to a diagnosis of CIDP confirmed by EMG/nerve conduction studies in June 2011. J.P. subsequently received IVIG treatments and other therapies.

The Special Master considered the six-part test for off-Table significant aggravations established in Loving. The Special Master found that the petitioner failed to establish a reliable medical theory connecting the varicella vaccine to the aggravation of CIDP, noting that the literature presented suggested anti-idiotypes tend to suppress immune responses rather than cause damage, and that pediatric CIDP is primarily T-cell mediated.

Furthermore, the Special Master found that while there was a temporal association (approximately 21 days between vaccination and symptom worsening), it was not sufficient to establish causation, especially given the lack of a persuasive medical theory and the evidence suggesting J.P.'s symptoms began prior to the vaccination and followed a relapsing-remitting course consistent with the disease's natural progression. Ultimately, the Special Master concluded that the evidence was insufficient to demonstrate a causal role for the varicella vaccination in exacerbating J.P.'s CIDP, and therefore, the petition was denied and dismissed.

Petitioner was represented by Scott W. Rooney, and respondent was represented by Kyle E.

Pozza. Special Master Thomas L.

Gowen issued the decision.