This article about Jessica Ericzon was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.
Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease. She is also a member of the Vaccines Working Group on Ethics and Policy.
This post revisits another sad, sad tragedy, the death of Jessica Ericzon, which was blamed on vaccines – this time, Gardasil, the vaccine that prevents infection with high-risk strains of HPV. Once again, the claim has no real evidence behind it. The concern, of course, is that these stories will lead to parents who are not already anti-vaccine refusing to protect their children against an infection that causes cancer.
Not protecting children against HPV infections that kill thousands and cause tens of thousands of cancer each year is putting them at unnecessary risk and setting the stage up for preventable tragedies. Doing it because of a painful death that no good evidence links to the vaccine, is doubly tragic. However painful, we owe it to future victims of preventable HPV cancers to set the facts straight.
The tragedy of Jessica Ericzon
In 2008, young Jessica Ericzon died suddenly and tragically, aged only 17, less than 48 hours after she received her third dose of Gardasil. Her parents blame the vaccine. During the last week of February 2018, for some reason, posts from 2014 about her death were re-shared broadly from a Facebook page with the obvious name “Gardasil Kills2.”
What happened to Jessica?
Apparently, she received the first dose of the HPV vaccine on July 16, 2007, with no noticeable side effects. On September 17, 2007, she received her second dose, and her only complaint was that her arm hurt. However, at some point between that shot and October 23, 2007, she started complaining about headaches, tiredness, dizziness. According to her mother, she claimed that a spot at the back of her head hurt. Note that we don’t know when, exactly that started, and there’s no indication it was immediate.
A month later she was checked by her regular doctor – who was well aware of the vaccine – who found nothing, and concluded it was from stress. Jessica continued an extremely active lifestyle, though she did suffer occasional headaches. On February 20, 2008, she got her third dose of Gardasil. That day there were no noticeable reactions, but the next day, apparently February 21, she complained that the spot at the back of her head that she had complained about before hurt.
The next day, February 22, 2008, her parents left the house in the morning and came back in the afternoon to a nightmare. Their beloved, lovely daughter, healthy just the day before, was lying, dead, on the floor of the bathroom. Their world came crashing down. Who can fail to sympathize?
As all humans do, they looked for something to blame. According to their story, Jessica’s mother mentioned Gardasil to the troopers who came immediately, and the next day, Jessica’s father googled Gardasil – and the results of their internet search led them to blame the vaccine. Basically, this is a case where the parents naturally blamed something close in time to the death, in this case, the vaccine, and their belief was then reaffirmed by an internet search.
The medical examiner did not conclude it was the vaccine. In the day after, all he could tell the family was that she died instantly. According to an article in the New York Post:
“Jefferson County Medical Examiner Samuel Livingstone is stumped.
“She was essentially dead by the time she hit the floor. Whatever it was, it was instantaneous,” Livingstone said. His autopsy found no cause.
He speculates she suffered a cardiac arrhythmia, or irregular heartbeat, extremely rare in young people.”
4. Petitioner alleges that Jessica developed cerebral vasculitis that was caused-in-fact by her HPV vaccinations, and that her death was a sequelae of her alleged injury.
6. Respondent denies that Jessica’s HPV vaccines caused her cerebral vasculitis, any other injury, or her death.
7. Maintaining their above-stated positions, the parties nevertheless now agree that the issues between them shall be settled and that a decision should be entered awarding the compensation described in paragraph 8 of this Stipulation.
Basically, the parents’ theory is vasculitis, the state denies causation – but the parties are settling the claim, each maintaining their position. This settlement provides little additional information, beyond naming the parties and suggesting a theory – vasculitis – and the case itself is sealed, though the docket is available through Pacer.
No real evidence that the HPV vaccine Killed Jessica Ericzon
As tragic as this story is, there is no real evidence in it that the vaccine killed Jessica. The medical examiner that examined her did not conclude that. He suggested a different theory – a heart problem. Pathologist Michael Paolini explained to me that the timing – 48 hours from the vaccine – would lead him to consider a connection and examine whether there was one. The medical examiner finding no cause suggests that he did not find a link to the vaccine, though without seeing the report, we do not know exactly what he looked at.
It’s important to remember the problem with using the timing as an indication. With millions of teens vaccinated each year, and some teens dying unexpectedly (as they do), a death within a day or a few days of HPV vaccines is expected, maybe even inevitable, by coincidence alone. It’s natural to blame vaccines for something that happened near in time, but that alone is not good evidence.
What about the theory suggested in the case, the vaccine causing vasculitis? Vasculitis is described by the Mayo Clinic thus:
Vasculitis is inflammation of your blood vessels. It causes changes in the blood vessel walls, including thickening, weakening, narrowing or scarring. These changes can restrict blood flow, resulting in organ and tissue damage.
There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, or several. The condition can be short term (acute) or long lasting (chronic).
Vasculitis can affect anyone, though some types are more common among certain groups. Depending on the type you have, you may improve without treatment. Some types require medications to control the inflammation and prevent flare-ups.
As mentioned, the theory in the case was that HPV vaccines caused vasculitis that then led to her death. However, there are a number of problems with that claim.
First, the evidence is against vaccines causing vasculitis. There are a number of case reports after vaccines – but then, unless vaccines prevent vasculitis, that’s expected. Large-scale studies that looked at the question found no link between vaccines and vasculitis (here, here, and here).
What could support HPV vaccines causing vasculitis that led to death? Well, there is one article in which Shaw and Tomljenovic claimed that HPV vaccines caused vasculitis that led to death in two other girls (none of which matched Jessica’s age) – that article could have supported that claim. But it runs into a number of problems, some with the methodology, as explained by Orac. Basically, their claims, even in those cases which were without a biological basis, and in conflict with the pathological findings, they failed to use controls, and there is a good reason to think their alleged findings were the results of sloppy methods and lack of expertise.
Further, an analysis by the CDC cast substantial doubt on the Shaw paper. The experts pointed out that there was no basis for the vasculitis diagnosis since the findings did not demonstrate inflammation, that the methods used were questionable and the results were badly interpreted, and other problems.
Two other problems arise. Shaw and Tomljenovic suggest autoimmune vasculitis. But an extensive literature looked at whether HPV vaccines cause autoimmune diseases – and they do not. There is also no biological basis to think they do.
The only ones promoting the claim that HPV vaccines are related to autoimmune diseases are a relatively small group of experts, the most prominent of which is Yehuda Shoenfeld from Israel. Their claims rest on very small numbers of case studies and a very ill-defined syndrome which is not accepted in the scientific community.
In fact, looking at the docket in Ericzon’s case, I learned that one of the experts that testified for her was Dr. S. Blitshteyn, who has published a small number of case reports claiming HPV vaccines caused autoimmune diseases and has co-authored an article with Dr. Shoenfeld.
There is good reason to think she either suggested or supported the claim. However, it is still a claim that goes against the evidence – both against the large studies that examined vasculitis and vaccines generally, and against the studies on autoimmune conditions and HPV.
Finally, Dr. Michael Paolini pointed out to me that vasculitis does not usually cause immediate death. In fact, two case reports that described themselves as the first cases of vasculitis after HPV vaccines (remember, case reports cannot show causation) found very limited and localized harms.
You would expect if it was vasculitis, that it would have significant symptoms that worsen over time – but that’s not what the parents described. They did describe headaches, but they did not describe gradual worsening.
Dr. Paolini explained that “Vasculitis is a non-specific term with many etiologies. It can cause sudden death, most commonly when coronary arteries are involved, but it’s rare. Autopsy findings can lead to the diagnosis and should be documented in the report.”
Here, it wasn’t. While we cannot know what was examined without the report, we do know that the contemporary medical examiner did not make findings in line with the parents’ claims. Specifically, there was no report of any inflammation of the brain, necessary for the claim.
The timing also doesn’t work for death from the vaccine – either by an autoimmune (or other immune response) or allergy. The adaptive immune response (antibodies) takes at least 3 days to react to the vaccine. The Ericzon case is not a typical innate immune system (complement, cytokine, etc) event. Anaphylaxis does not usually occur 40 hours after immunization.
In short, there is no direct evidence that HPV vaccines killed Jessica, the medical examiner did not suggest vasculitis and in fact suggested a different theory, though made no certain findings, and the theory proposed for the parents was simply implausible.
Reminder – HPV Infections do kill
Every year, in the United States alone, thousands of people die from HPV-related cancers. Tens of thousands more have cancer but don’t die. The lifetime risk of cervical cancer for women – almost all caused by HPV – is 1:152.
We can all feel for Jessica’s parents and grieve for her loss. But we should not let our sympathy blind us to the weaknesses in the story, and the unlikelihood that her death was caused by the HPV vaccine. We should not let an implausible story lead to children being left unprotected. Because the tragedies of those lost to HPV – proven cases, thousands of them, like Sorcha, Kristen, or Kelly, or those that suffered from it, like Stephanie, Tamika, Susie, Christine, and so many others are just as real, most of them are now preventable, and it’s unconscionable not to prevent them.
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