[Autistic syndrome (Kanner) and vaccination against smallpox (author’s transl)]

Klin Padiatr. 1976 Mar;188(2):172-80. [Article in German] Autistisches Syndrom (Kanner) und Pockenschutzimpfung

[Autistic syndrome (Kanner) and vaccination against smallpox (author’s transl)]
Translated by Birgit Calhoun

Eggers C.

Abstract
Because of the observation of a boy who was 15 months old at the beginning of an illness and 5 ½ years
old at the point in time of the last follow-up investigation, the question of an etiological connection
between smallpox vaccination and early childhood autism is discussed. After 3 to 4 weeks of a usually
uncomplicated course of the first smallpox vaccination a full picture of the Kanner type syndrome
gradually developed. A causal relationship is thought to be extremely unlikely. However a triggering
function for the development of the autistic syndrome is acknowledged.
…
II. Kasuistik
Eggers: Case
In the patient’s family there are no known cases of neuropsychiatric disease. The pregnancy and birth
took place without complications, the birth weight was 3350g and the newborn breathed and screamed
unremarkably and drank well. The psycho-motor development was normal at first and then slowed
down a little: First reactive smile occurred at about 6 to 8 weeks. Head control and lifting of head from
belly position at 6 to 8 weeks, sitting up on his own at 7 to 8 months, crawling at 10 to 12 months,
standing up at 16 months, free walking at 18 to 20 months. At age 1 the boy spoke the following words:
“Lala” (=Laterne), “Mama,” “Papa,” “Autos”.
The boy was friendly, had good contact to the parents was interested in his surroundings and handled
things age-appropriately. At age 13 months he was housed with friends of the family for one week.
According to a report by that family the boy at that time participated actively with his environment and
was very receptive to it.
On 11/11/1969 at the age of 16 months the patient was pre-vaccinated with 1.0ml vaccinia antigen, the
first-time smallpox vaccination was conducted 10 days later. There were neither seizures nor paresis nor
a disturbance of consciousness, dizziness, sleepiness nor stiffness in the neck
3 to 4 weeks after the small pox vaccination the parents noticed that the boy did not show interest in his
surroundings any longer. He kept busy a lot and persevered using his fingers with which he “played” for
hours. As opposed to earlier, he didn’t look into the camera when he was being photographed and
reacted neither to other persons’ glances, talking or tenderness.
The contact was broken, the child retreated completely from his surroundings. He moves as if he was in
his own world without caring anything about it and developed stereotypical behavior: Bending of
fingers, humming to himself, screeching, head wobbling, rhythmical banging of the head against the
walls and hard surfaces, turning in circles. The boy kept busy with things that were of specific interest
only to him: his own fingers, wool threads, paper snips that he tore to pieces. He did not talk at all any
longer and did not seem to understand the meaning of words, commands were no longer followed,
outside of humming- and screeching-noises the boy did not utter any sounds. Even though the motor
development progressed, it was clearly much slower than before. At around age 2 the boy moved only
by walking on his toes. He only looked to the ground; he had panic reactions to a change in his
surroundings (e.g. visiting a department store) and was overly sensitive to noises (e.g. motor noise,
crying of the sibling). He held his ears shut for hours or poked in his eyes with his fingers. He could not
leave things that attracted his attention (puddle, telegraph pole, and bush). The child refused to take in
solid food and had to be fed gruel food for more than a year. At times he occupied himself with himself,
the boy scratched his face, bit his hand again and again or hit himself. This state lasted about two years.
At the age of 2 an1/2 years the child was presented for the first time at the neuro-pediatric services at
the University Clinic Heidelberg. The behavior at the ambulatory visit was described as follows:
The child ran around aimlessly, ran form one object to another, put everything in his mouth, did not at
all react or he panicked when talked to, ran aimlessly at objects in the room that were in the way, licked
the wall and the sink and merely gave off screeching and humming noises. He did not talk, seemed to be
caught completely in his own world and showed multiple stereotypical behaviors of a motor and vocal
variety. From an internal and neurological view point there were no findings. All serological
investigations including a plasma thin-film chromatogram were inconspicuous. The echo-encephalogram
was in the vicinity of normal, the x-ray picture of the cranium showed a macro-cephalic cranium without
pathological findings. The calcium salt content in the wrist was normal, the bone age was delayed by 1
year. The electro-encephalogram was marked by a noticeable theta-rhythm with a focal point of slow
waves left pre-centro-temporo-parietal. An examination to determine hearing ability at the pediatricaudiological
advice clinic in Heidelberg showed that the boy reacted to all noises offered from the free
sound field pressing to 50 db. Even with paper crackling, rattling, bell ringing and similar high frequency
noises clear albeit slower reactions could clearly be observed through head-turning to the origin of the
sound.
At age 3 the boy started to talk, he repeated words and sentences (echolalia) again for the first time
such as “Bürste”, “die Tür ist zu”, “Frank-Olef nicht unken”, “jetzt stehen wir auf”. Besides that the child
learned to name objects in the apartment. The patient was treated with so-called total psychosomatic
therapy (speech therapy, breathing therapy, self-experiencing of the own body, of the body boundaries
and the relationship within the space, perception training). Because of this the language development,
the movement model became more coordinated, the stereotypes were easier to interrupt, the child did
not put everything into the mouth, did not lick the wall any longer; the relationship to objects improved,
also the boy made fleeting contact to persons within the vicinity.
At the age of 4 his vocabulary had increased further; still there was a pronounced echolalia; the
movement model had become more coordinated, the orientation in space had improved, the boy didn’t
run into objects as he had done earlier or didn’t stumble over them to the same degree as before;
instead he was much more sure in the way he moved in space. In contrast to earlier he reacted to being
addressed and to active attention. At about 4 ½ to 5 years the boy spontaneously formed neologisms;
when watching his open mouth in the mirror: “Mundhöhlenkeller [mouth cavity basement]” or while
looking at a snail shell: “Bogengang” [bow path]. About the act of washing hands he said “Einwassern”
[onwatering]. He called a plastic plate without a (bird)-pattern “ungevögelt” [unbirded]. Meanwhile he
knew all letters of the alphabet. Now at 5 ½ years he can read simple words, can count and in the
number area to 12 can add and subtract. The boy attends a special school for language and hearing
impaired children, the psychosomatic holistic therapy is being continued; the parents work intensively
with the child.
During the ambulatory check-ups 8 weeks apart, the intelligent “prince-like” facial features were noted
in the now 5 ½ year old boy. At both check-ups the boy was restless, nervous, fidgety, and hard to pin
down; the eye-contact with the investigator as well as with the parents was flighty and short-lived, the
movements were wooden, stiff and awkward, the speech manneristic, stretched out, the tone melody
monotonous sing-song; while talking (4-5 words max.) the boy emphasized slowly each syllable, single
words (e.g. the name of the investigator or “Türe zu”) always and again stereotypically repeating it.
During the meeting he preferred to play with the double door of the room and could be kept from doing
so for only a short while. His attention span was short, he was easily distracted, and could only badly
concentrate himself and zero in on a specific task. He counted forward mechanically during additions
and subtraction tasks or as the case might be backward in a number range of 1-10, without being able to
do the task in one step. He counted the days of the week equally mechanistically. A concept of time
spans seemed to be missing in him, even though he could mention a few isolated details of earlier or
later happenings, but he could neither organize them time-wise nor describe the total time frame in
which an event occurred.
The fine motor control was clumsy. The boy handled things with his right hand. After being asked
repeatedly, he finally succeeded to correctly lead the right hand on the left ear; the reverse of the task
(left hand to right ear) was performed correctly immediately. During a neurological check-up nothing
pathological was found. The eye background was unremarkable. Outside of a slight general dysrhythmia
the EEG was not pathological.
…
Because of the clinical symptomatology there is no doubt about the presence of a Kanner Syndrome.
The symptomatic described in Section I was quite pronounced in the patient and was, modified by an
intensive healing pedagocical and behavior therapeutical training, clearly visible, too, at the point in
time of the later check-up at age 5 ½ . The contact and language disturbances with this boy were at age
2 to 3 so pronounced that the parents had assumed that he was deaf. A finding that he was hard of
hearing, however, could be eliminated.
…
It is now to be discussed whether the development of an autistic syndrome can be brought on by a
smallpox vaccination. The question comes up because of the close vicinity in time (3 to 4 weeks) of the
smallpox vaccination and the manifestation of psychopathological symptomatology of the patient
described in Section II. Anamnestically, in the illness history, there are no other indications that could
have explained the existence of the autistic illness expression in this boy. There were neither indications
of prenatal or birth-traumatic damages nor the influence of any post-natal noxious events that could
have been made responsible for the appearance of the autistic syndrome. …
…
The child had never been hospitalized so that for this reason, too, a psychogenic autism can be
considered out of the question.
…
The only possibility of a connection between the at age 15 months performed smallpox vaccination and
the 3 to 4 weeks later developing autistic syndrome is that the smallpox vaccination started a kind of
triggering mechanism for the autistic behavior and character change: the early Kanner childhood autism
has to be counted among the forms in the circle of childhood psychoses that outside of that one
[Kanner’s] encompasses childhood schizophrenia, the manic, depressive, symbiontic, pseudo-defective
and pseudo-neurotic psychoses as well as dementia praecoccisima S. de Sanctis, dementia infantilis
Heller and the Kramer Pollnow syndrome. … According to reports by the parents first personality
changes were noticed in one of the 33 by Bosch publicized children after the first smallpox vaccination at
the age of 13 months (the child had become “more difficult”), and after a pertussis at the age of 1 ½ the
autistic behavior disturbance worsened (only then had “it become really critical”). An initiation of an
autistic personality change in the sense of a trigger through smallpox vaccination and a break after break
worsening of the illness picture through pertussis is to be discussed here, too.
…
…A causal connection, in the sense of being the basis for the autistic syndrome, is by the way because of
the performed smallpox vaccination, and, also because of the numerous and careful studies regarding
reactions to vaccinations and the possible injuries after smallpox vaccination as well as because of the
efforts so far about the etiological explanation of early childhood autism most unlikely.