Incidence of Acute Transverse Myelitis in Rochester, Minnesota, 1970–1980, and Implications with Respect to Influenza Vaccine

Abstract

Acute transverse myelitis is a clinical entity characterized by acute onset of nonrecurrent, bilateral but not necessarily symmetrical, cross-sectional sensorimotor involvement of the spinal cord. Vascular lesions, inflammatory (mainly viral) disorders, and necrotic myelopathy as a remote effect of cancer have been reported as possible etiologic factors. Epidemiologic data on the disease are scarce. From the Mayo Clinic records-linkage system, 5 cases fulfilling the diagnostic criteria of acute transverse myelitis were collected during the study period 1970–1980 among the residents of Rochester, Minn. (USA), providing a mean annual incidence rate of 0.82 per 100,000 person-years, or 1.2 per 100,000 person-years for those 18 years of age and over. None of the cases described were post-vaccinal; an estimate of the number of cases occurring fortuitously following the swine flu vaccination program of 1976 in the USA is provided.

Spontaneous Infection or Vaccination as Cause of Acute Disseminated Encephalomyelitis

“…For example, infection occurring before the acute onset of transverse signs and symptoms limited to the spinal cord were noted in 0% [2], 25% [1] [3] of these larger reported series. Prior vacci nations, however, were much less frequently recorded: none in the reports of Beghi and Mulder [2], Allrocchi [1], or Lipton and Teasdall [11], Two immunization cases were cited in the report of Berman et al [3] in the same context as 19 patients who had prior upper respiratory infections. In the series of Ropper and Poskanzer [17], one case in 53 had an oral polio vac cine 41 days before.…”

Transverse myelitis unlikely to be due to measles, mumps, and rubella vaccine

“…No case of suspected transverse myelitis has become known to us. On the assumption that the yearly incidence of transverse myelitis in Germany is similar to that in Minnesota (approximately 7.4/100000 people),3 postvaccination transverse myelitis after rubella vaccination is unlikely. Furthermore, the three other published cases of myelitis to which Joyce and Rees refer occurred after the administration of vaccines other than those currently used.…”

Reply to Dr. Poser's Letter to the Editor of Neuroepidemiology

“…

It is essential that we provide a response to Dr. Poser' s criticism of our article concerning the epidemiology of acute transverse myelitis [1], since the results of this investigation have important implications, both scientific and legal. Proposed links between swine flu (influenza A/New Jersey/76) immunization and a number of diseases have been the subjects of consid erable litigation in US courts of law.

Poser states that our study is 'misleading' and that we used 'transverse myelitis' and 'transverse myelopathy' interchangeably.

…”

“…A more serious matter is that Poser' s comments on GBS and epidemi ology indicate that he missed the key point of the paper by Beghi et al [1], Since there is no satisfactory animal model or consistent experimental evi dence that influenza vaccine is a risk factor in GBS or transverse myelitis, the logical approach is to determine the relative risk following exposure to the swine flu vaccine. To do so requires a comparison, preferably of the incidence rate in the vaccinated population, with the incidence rate in the unvaccinated population.…”

“…The study by Beghi et al [1] used well-defined criteria for case ascertainment and was done in a delineated population in which virtually all medical problems can be identified.…”