Trey Cobb v. HHS - HPV, narcolepsy and cataplexy (type 1 narcolepsy) (2023)

On August 21, 2017, Jeffrey and Kimberly Cobb filed a petition for compensation on behalf of their minor son, Trey Cobb, alleging that he developed narcolepsy and cataplexy (type 1 narcolepsy) that was caused or significantly aggravated by his human papillomavirus (HPV) vaccinations on August 25, 2014, and August 18, 2015. The petition stated that Trey was 13 and 14 years old at the time of these vaccinations.

The case proceeded as an off-Table claim, requiring proof of causation under the Althen standard. Petitioner presented expert testimony from Dr.

Lawrence Steinman, who theorized that molecular mimicry between components of the HPV vaccine and hypocretin (orexin), a neuropeptide involved in wakefulness, could trigger an autoimmune response leading to the destruction of orexin-producing neurons and thus narcolepsy. This theory was supported by BLAST search results showing sequence homology and the Latorre study, which identified orexin-specific T cells in narcolepsy patients.

Respondent presented expert testimony from Dr. Lawrence Brown and Dr.

Robert Fujinami, who argued that there was no established link between the HPV vaccine and narcolepsy, that the molecular mimicry theory was not supported by the evidence, and that the HPV vaccine might even offer protection against autoimmune disease. The Special Master found Dr.

Steinman's theory persuasive, particularly with the addition of the Latorre paper, and determined that the onset of symptoms between one to three weeks after vaccination was a medically acceptable timeframe. The Special Master concluded that Petitioner had met his burden of proof for entitlement to compensation, and an order regarding damages would follow.

Petitioner counsel was Mark Sadaka of the Law Offices of Sadaka and Associates, LLC. Respondent counsel was Debra Begley of the U.S.

Department of Justice. Special Master Katherine E.

Oler issued the ruling on August 21, 2023.