Charlotte Porch v. HHS - MMR, Multiple Sclerosis (MS) (2022)

On June 14, 2017, Charlotte Porch filed a petition seeking compensation under the National Vaccine Injury Compensation Program. Ms.

Porch alleged that an MMR vaccine administered on February 11, 2015, caused her to develop Multiple Sclerosis (MS). Initially, the claim also included transverse myelitis (TM) as a potential injury, but this was later limited to MS.

The respondent, the Secretary of Health and Human Services, contested the claim. The petitioner, born November 9, 1967, received the MMR vaccine as a requirement for employment.

Her medical history included shingles, chest pains, carpal tunnel syndrome, and bilateral hand pain and numbness in 2010. After receiving the vaccine on February 11, 2015, she traveled to Kuwait on March 7, 2015.

Petitioner contended that by the end of March 2015, she began experiencing symptoms consistent with MS onset, specifically TM. Medical records from May 2015 in Kuwait showed findings suggestive of cervical spondylosis and a lesion in the cervical spine, with a subsequent MRI noting suspected MS.

By May 31, 2015, she reported persistent and progressive numbness, tingling, and pain in her hands. An MRI on June 6, 2015, revealed brain and cervical spinal cord lesions indicative of demyelinating disease.

She was diagnosed with myelitis and received steroid treatment. Further evaluations in September 2015, including MRIs of the brain and cervical spine, showed lesions consistent with demyelinating plaques, leading to a suspicion of relapsing multiple sclerosis.

A cerebrospinal fluid study did not reveal oligoclonal bands, but other findings were consistent with mildly increased permeability of the blood-brain barrier. By September 25, 2015, she was diagnosed with relapsing-remitting multiple sclerosis, experiencing symptoms including urinary frequency, urgency, incontinence, and ongoing upper-extremity paresthesia.

Petitioner's expert, Dr. Jeffrey Rumbaugh, a neurologist, testified that the MMR vaccine could cause MS through molecular mimicry, specifically by cross-reacting with vimentin, a protein found in CNS astrocyte cells that support myelin-producing oligodendrocytes.

Dr. Rumbaugh cited several studies, including Srinivasappa, 1983 Fujinami, and 2006 Fujinami, to support this theory.

He also referenced epidemiological studies like Langer-Gould, which suggested a potential temporal association between vaccination and CNS demyelinating diseases in younger individuals. Dr.

Rumbaugh opined that Petitioner's symptoms, beginning in mid-to-late March 2015, were consistent with a vaccine-induced onset, approximately 30 to 45 days post-vaccination. Respondent's expert, Dr.

Jeffrey Gelfand, a neurologist specializing in MS, disputed the link between vaccines and MS. He stated that the weight of scientific evidence does not support MS being caused by vaccines, distinguishing it from acute monophasic conditions like Guillain-Barré syndrome.

Dr. Gelfand cited literature, including Mailand and Hapfelmeier, which he argued showed no increased risk of MS following vaccination.

He also critiqued the molecular mimicry theory, questioning how intracellular antigens like vimentin could be targeted by antibodies and how such a reaction would lead to a chronic condition like MS. Dr.

Gelfand noted that Petitioner's treating physicians did not attribute her MS to the vaccine and that the MRI findings were typical for MS, not specifically indicative of a vaccine-induced condition. He also found the proposed onset timeframe of five to six weeks post-vaccination medically unreasonable based on the literature.

Chief Special Master Brian H. Corcoran denied entitlement.

The Special Master found that Petitioner failed to establish the first prong of the Althen test, which requires a reputable medical theory connecting the vaccine to the injury. The Special Master determined that Dr.

Rumbaugh's theory of molecular mimicry, involving cross-reactivity with vimentin, lacked reliable support. The cited literature was considered old, not specifically linked to the MMR vaccine, and did not conclusively demonstrate a pathogenic mechanism leading to MS.

Furthermore, the Special Master found that the evidence did not preponderantly establish that the vaccine likely caused Petitioner's MS, noting the absence of treating physician opinions attributing the MS to the vaccine and the lack of evidence of any post-vaccination reaction. The Special Master also highlighted that MS is a chronic, relapsing-remitting condition, making it more difficult to establish causation from a single vaccination event compared to acute injuries.

Consequently, Petitioner's claim was denied.