A tragic as yet unexplained death, exploited by antivaccinationists

As I noted a few days ago, the antivaccine fringe suffered a major setback in the House of Representatives when Rep. Darrell Issa (R-CA), chair of the House Committee on Oversight and Government Reform, canceled a previously promised hearing about the National Vaccine Injury Compensation Program, even after it had reached the stage of representatives from the antivaccine Canary Party giving a briefing featuring a boatload of misinformation about the NVICP and the Vaccine Court. Never let it be said, however, that the antivaccine movement can’t pivot on a dime to latch onto the latest bit of news as “proof” that vaccines are horrible. This time around, it’s a tragic case that was reported over the weekend.

This is the case of a young man named Chandler Webb, who was only 19 years old when he died earlier this month. While I have incredible sympathy for the parents of such a young man who died of an unexplained illness, I still feel obligated to examine the story in a skeptical fashion because the tragic story of this young man is being used by the antivaccine crank blog as evidence that flu vaccines are deadly. Here’s the basic story:

A Utah woman says a flu shot caused her son’s death.

Lori Webb put her assertion in her son’s obituary and is warning other families about what she believes are potential hidden dangers of vaccinations.

“I could not believe it,” Webb said. “I never in my life would ever think, ‘Your son is in a coma?’ How does it happen?”

Chandler Blake Webb, 19, was the perfect picture of health, his mother said, and was preparing to submit his papers for a mission for The Church of Jesus Christ of Latter-day Saints.

However, the day after a physical, tuberculosis test and flu shot, the Brighton High School graduate turned very ill.

Within a few days, he was in the hospital for the second time. Within 24 hours of his second check-in, Webb said her son was in a coma.

We see the same claim reported in multiple news stories, such as this one from KUTV and this one from Fox and Friends:

These reports are definitely exploitative in that they prominently feature images of Chandler Webb in the intensive care unit, on a ventilator, with a tracheostomy tube, intracranial pressure monitor, and multiple IVs running. In particular, the Fox and Friends report plays this up, lining up Elisabeth Hasselbeck, Lori Webb, and images of Chandler Webb in the ICU in the same frame for nearly the entire interview, including pictures of Lori Webb lying with her son in the hospital bed to hug and console him. Only a heart of stone can resist such imagery. Unfortunately, blatant appeals to emotion do not equal scientific and medical validity. Looking at the various news stories, one thing thing that caught my attention is that apparently Webb went to one emergency room, was discharged because he was getting better, and then returned to another emergency room, after which his condition deteriorated. In every story, she repeats again and again that she thinks it was the flu vaccine, after listing all the things her son’s doctors looked for. In some stories, she points out that “only one doctor” ever suggested a potential connection with the flu vaccine, and then it was only near the end of her son’s hospital course, when it was becoming clear that it was unlikely he would survive. Lori Webb latched onto that comment, which was most likely a stray remark, like a drowning woman would latch onto a piece of flotsam. She hasn’t let go of it yet.

Reading between the lines of the various stories I found, I think it was clear that the doctors thought that Webb probably had some sort of infectious meningitis. They had him on broad spectrum antibiotics and various other medications, and most of his workup was clearly aimed at finding infection. His mother describes the workup on her Facebook page thusly:

Chandler had a brain biopsy, that is why I didn’t allow an autopsy. He was tested and tested by the infectious control, the CDC every test came back negative…negative for meningitis…negative for lymphoma, negative for tics. They even checked him for rabies. He was negative for every fungus, bacteria and virus. He was tested for tics, herpes, anything and everything…Everything NEGATIVE. Encephalitis is a secondary symptom, yes he did have that. People should be informed of the negative side effects that the inserts in each box of vaccine contain. Also, wouldn’t it be nice if when someone enters an ER with these symptoms, that the Dr.’s would ask if they had recently had a vaccine. This should have been the first thing they checked instead of the last. So So Sad.

But would it? I would argue that it probably would not have saved his life.

Throughout the stories, Lori Webb assumes that if someone had asked about whether her son had received any vaccines recently he would be alive today because the doctors would have known what to do. That is wishful thinking, to say the least, and the reason is that encephalitis due to flu vaccine, particularly so soon after vaccination, is what we in the medical field call a “zebra”; i.e., a very uncommon or rare diagnosis. There’s a saying that covers this: When you hear the hoofbeats, look for horses first, not zebras. Only look for zebras after you’ve ruled out horses. What this means is that, even if doctors knew that Webb had received the flu vaccine the day before, the differential diagnosis of encephalitis and the likelihood of each cause of encephalitis would mandate ruling out far more common causes with a workup that looks like this. These include diagnoses like bacterial meningitis due to bacterial, Rickettsial, fungal, parasitic, and viral causes, as well as non-infectious causes like lupus, lymphoma, leukemia, and several others, including, yes, vaccine-induced encephalitis. Note, however, that vaccine-induced encephalitis remains way down the list because of how rare it is.

Just out of curiosity, I went to the VAERS Database because I wanted to see how common reports of serious encephalitis after the influenza vaccine are. It turns out that they aren’t that common. In fact, they’re quite rare, even in the VAERS database, which is custom-designed for over-reporting regardless of whether a condition reported was related to the vaccine administered in the first place. Looking for all cases of encephalitis in adults receiving the the seasonal influenza vaccine, I was only able to find 115 cases over 23 years. If I narrowed the search criteria to include only life-threatening cases of encephalitis in adults age 18 or older that manifested themselves within one day after vaccination (remember, Webb’s reaction was reported to be less than a day after he received the flu vaccine), I found only ten cases; broadening the criteria to all life-threatening encephalitis reactions, regardless of time after vaccination, increased the number to 38 cases. When I narrowed it again only to include deaths, I found four cases, all in elderly people, the youngest of whom was 70 years old. None of the reports has enough detail to infer or reject the likelihood of causation. However, they do suggest how safe the flu vaccine is, as do other reports. For example, one of the stories about Webb’s death reports that 130 million Americans a year receive the flu vaccine, with only 140 people (0.0001%) report serious adverse events.

There are other reasons to think that it wasn’t the vaccine, as enumerated by Liz Ditz, not the least of which is that if there were a bad lot of vaccines responsible for Webb’s encephalitis then one would expect more cases than just one.

It’s understandable that when something like this happens, we as human beings want an explanation. Unfortunately, in the absence of evidence, Lori Webb has latched onto the flu vaccine as the One True Cause of her son’s death. It’s possible that it was, but, given how rare serious adverse events are from the influenza vaccine, it is unlikely that the flu vaccine was the cause of Chandler Webb’s death. It is not, however, impossible. There’s the difference between skeptics who apply science and reason to the claims of pseudoscience promoters like antivaccinationists and the pseudoscience promoters like antivaccinationists. I will concede that it is possible, however unlikely, that the flu vaccine killed Chandler Webb. I hope that Utah health authorities can figure it with a high level of probability out one way or the other. The antivaccine movement, however, will never concede the possibility that the flu vaccine didn’t kill Chandler Webb. Worse, confusing the issue Lori Webb refused to allow an autopsy of her son. I can understand somewhat why she might have made that choice. She knows what killed her son. Not needing any further confirmation (and subconsciously, likely doesn’t want to risk any disconfirming evidence coming to light), she doesn’t want her son’s body violated anymore, even after death.

Unfortunately, because there was no autopsy, we’re far less likely ever to know for sure what killed Chandler Webb, brain biopsy or no brain biopsy. Worse, without an autopsy, the merry gang of antivaccine cranks at Age of Autism will continue to have an easier time than they might otherwise have had having a field day exploiting the death of her son and her blaming the flu vaccine for her son’s death for their own purposes. Those purpose include the undermining of confidence in the US vaccine program.