Sen. José Peralta definitely did not die because of the flu vaccine

We’re getting into grant application season again, which, as regular readers of the blog know, means that blogging tends to slow down. That doesn’t mean, however, that I can resist the bug that’s kept me cranking out Insolence, both Respectful and not-so-Respectful, nearly every day for the last 14+ years. I might not be as prolific as I used to be, but I’m still plenty prolific for a blogger. In any event, because of a recent story I saw, I thought I’d visit a story that, for whatever reason, I didn’t get around to blogging about in November when it first hit the news. At that time, I recall seeing antivaccine websites go wild over this story, thinking that it was slam dunk evidence that vaccines kill. So, before we get to the new story, let’s go back in time a couple of months and revisit the tragic sudden death of New York State Senator José Peralta (D-East Elmhurst).

Sen. Peralta died on November 21 after a brief illness. Here’s where the antivaccine angle comes in. It turns out that Sen. Peralta was a strong advocate of public health, so much so that he had partnered with a local hospital to get offer free flu shots for people in his community:

A flyer for Sen. Peralta’s flu vaccine clinic.

Of course, José Peralta also got a flu shot at the vaccination event that he had helped organize. Four days later, he was dead. If you’re an antivaxer, what else could that mean but that the flu shot killed him? Obviously, there could be no other explanation, right? Of course, it’s not that simple. Here’s the New York Times account of his death:

José R. Peralta, the first Dominican-American elected to the New York State Senate, died on Wednesday night in a hospital in Queens, where he represented a diverse constituency. He was 47.

He was taken to Elmhurst Hospital Center after becoming disoriented following a two-week illness, but the cause of death had not yet been determined, a staff member said. An autopsy was scheduled.

Mr. Peralta, a Democrat, lost his re-election bid in September after serving eight years in the State Senate representing neighborhoods in Jackson Heights, Corona, Elmhurst, East Elmhurst and portions of Woodside and Astoria.

So here we learn that Peralta had been ill for a couple of weeks before his death, a week and a half before he received the flu vaccine:

Though he had been ill for at least two weeks, he had been reluctant to visit a doctor, according to Chris Sosa, his director of communications. After much prodding, he finally went for an exam recently, and he had a follow-up scheduled for December.

“It was like pulling teeth to get him to talk about not feeling well,” Mr. Sosa said. “He just thought he was having symptoms related to getting the flu shot.”

Mr. Peralta was at home with his family on Wednesday night when he became disoriented. He was taken to the Elmhurst hospital and died there at 9:23 p.m., Mr. Sosa said.

So, here we have an admittedly puzzling case. A relatively young man who was previously healthy, became ill and basically dropped dead within a couple of weeks. His death occurred four days after he got the flu shot. Not long after his death, antivaccine websites began speculating that the flu shot had something to do with Sen. Peralta’s death. By that time, it had been reported that Peralta had died of sepsis. Of course, the cause of the sepsis was not as of yet known, but that didn’t stop antivaxers from finding a way to imply that it might have been the flu shot that did it. For instance here’s The Vaccine Reaction (TVR), a house organ of Barbara Loe Fisher‘s antivaccine group the National Vaccine Information Center (NVIC) edited by Marco Cáceres (who, let’s face it, appears to write most of the articles for the website):

Health authorities do not know what caused Peralta to develop sepsis. According to Mrs. Peralta, “The doctor said it’s rare, [given] his age and that it happened so quick… he was healthy. He was a healthy guy.”10

Currently, there is no evidence that Sen. Peralta’s sudden death was caused by the influenza vaccination he had recently received.

But (there’s always a “but”):

According to the Centers for Disease Control and Prevention (CDC), common side effects of the influenza vaccine include soreness, redness, and/or swelling from the shot, headache, fever, nausea and muscle aches. The influenza vaccine can occasionally cause fainting and the vaccine has been associated with Guillain-Barré Syndrome (GBS), which is inflammation of the peripheral nervous system.

Yes, but wait a minute! There’s no mention of sepsis there!

Nor here:

Additionally, the influenza vaccine can cause severe allergic reactions that may be fatal, including difficulty breathing, hoarseness or wheezing, swelling around the eyes or lips, hives, paleness, weakness and a fast heart beat or dizziness.15 There are ingredients in influenza vaccines that can cause some people to have reactions.16

Sepsis is not an allergic reaction. Of course, what TVR wants to do is to imply that the flu vaccine killed Sen. Peralta without actually saying it (because even Cáceres can’t find any evidence that it did) and then pivot to try to convince readers that the flu vaccine causes all sorts of horrible complications.

Of course, the antivaccine cranks over at Collective Evolution were less…reticient, with someone named Richard Enos going so far as to write a post entitled After Getting Flu Shot, New York State Senator Gets Sick For Two Weeks, Then Dies. Of course, José Peralta didn’t get sick for two weeks after getting a flu shot. He was sick for two weeks (at least) before his death, but he got his flu shot four days before his death. Now, Enos is mildly clever in that he emphasizes at the beginning of his article that Peralta “attributed [his illness] to a flu vaccine he had taken.”

Later, he adds:

That last point is important. Often when a person is sick, they have a pretty good idea what caused it. When we have a hangover, we obviously look to what we drank. When we have food poisoning, we can usually pinpoint what it is that we ate that was the problem. With Peralta thinking that he was suffering from symptoms related to the flu shot, it means that he must have felt fine before the flu shot, and starting feeling symptoms after, perhaps even right after receiving the flu shot.

Ironically, Peralta was a strong advocate for the flu shot, and in fact was coordinating a flu shot clinic in his district only days earlier. Perhaps his advocacy of it contributed to his reluctance to seek medical help for his symptoms.

No, no, no, no! People are terrible at determining the cause of their illness. The reason is that we humans are very susceptible to the post hoc ergo propter hoc fallacy, also known as confusing correlation with causation. Just because something happens before something else does not mean that that something caused the something else. It might have, but very often there is no relation. Yet humans blame things all the time for their illnesses that might or might not have caused them. Also, all reports indicate that Peralta wasn’t feeling well for at least two weeks. It’s also known that his condition didn’t alarm anyone until he developed a fever the day before his death and later became disoriented and short of breath. Particularly despicable is Enos’ victim-blaming, in which he more than implies that the reason Peralta didn’t seek medical care sooner is because he was such a strong advocate of the flu vaccine and didn’t want to reveal an illness that he thought possibly due to the flu vaccine. More likely, he was a typical man who’s been taught all his life not to complain and to “suck it up” when he’s sick.

Next comes the conspiracy mongering:

Of course, there is no way for me to know for sure whether the flu shot was the cause of, or was a contributing factor in Jose Peralta’s death. What I would like to point out, though, is how deathly silent the Mainstream Media is on this possible connection.

The reason that there was no evidence that Peralta’s untimely death was caused by the flu vaccine or that it was a contributing factor to his death. Basically Enos’ message is fear mongering at best. He bases his attack on the flu vaccine on the fact that sepsis (usually from a complicating pneumonia) can be a complication of the flu plus the antivax claim that the flu shot can cause the flu. (It can’t; it’s not a live virus vaccine.)

Elsewhere, other antivaxers were making the same connection, with varying degrees of waffling and uncertainty. For instance, über-quack Joe Mercola didn’t directly blame the vaccine, but tried to imply that it somehow had weakened Peralta’s immune system.

Not surprisingly, Del Bigtree, producer of the antivaccine propaganda film disguised as a documentary, VAXXED, was not so subtle:

Bigtree, as is his wont, dives particularly deep into the stupid in trying to make connections. Peralta suffered from fever and headache? Bigtree goes on about how the flu vaccine can cause fever and headache! Peralta felt dizzy and disoriented? Bigtree goes on to say that the flu vaccine can cause dizziness and encephalomyelitis. Tachycardia has been observed, too. Of course, Bigtree either doesn’t know or doesn’t care that tachycardia (an elevated heart rate) is part and parcel of a diagnosis of sepsis. It’s part of the diagnostic criteria used to make the clinical diagnosis, and rarely do you see sepsis without tachycardia! Bigtree then cites a Daily Mail article about how Peralta’s wife thought they needed to run more tests because of how unusual it is for a man to drop dead of sepsis the way her husband did. (Word to Mr. Bigtree, the Daily Mail is not a particularly reliable source, as shown by the way it sensationalized the quote in a way that other newspapers reporting it didn’t). Is anyone surprised that Sen. Peralta’s wife might have been puzzled at her husband’s rapid deterioration and demise from a mysterious illness and would be very interested in getting answers?

As if that weren’t enough, Bigtree goes on to cite that highly respected medical journal The New York Post describing how sepsis can result when the immune system “overreacts” to an infection, which is a rather simplistic way of describing the process. (If I tried to explain to him the difference between sepsis and systemic inflammatory response syndrome, or SIRS— which looks a lot like sepsis—Bigtree’s brain would explode.) Bigtree sarcastically characterizes the doctors as describing Peralta as having died of “what we call spontaneously combusting into sepsis.” Yes, because vaccines are designed to provoke an immune reaction and there’s an immune component to sepsis, Bigtree “reasons” that vaccines, not sepsis, must have caused Peralta’s death. Clearly, Bigtree doesn’t understand the immune system or sepsis.

Of course, that does leave the question of why Peralta developed sepsis. It is, again admittedly, relatively unusual for an otherwise healthy man in his forties like him to develop life-threatening sepsis without an underlying immunocompromised condition, although a number of infections can cause sepsis. Now here’s where that story I mentioned at the beginning of the article comes in:

It turns out that Sen. Peralta died of complications of undiagnosed leukemia:

The first Dominican-American elected to the New York State Senate, whose death at 47 was previously attributed to an apparent heart attack, actually died of leukemia, the Medical Examiner ruled Tuesday.

New York State Senator José Peralta, of Queens, passed away from natural causes, complications of acute promyelocytic leukemia.

And there’s the likely explanation. Now, it is true that the acute promyelocytic leukemia variant of AML is unusual in that it is is a disease that can cause a severe coagulopathy and bleeding, so much so that sometimes treatment is initiated before a definitive diagnosis can be made. It does this by triggering disseminated intravascular coagulation (DIC), a condition in which the clotting system is diffusely activated, leading to tiny clots in the small vessels throughout the body and a systemic inflammatory reaction. These clots can clog blood vessels and thereby cause organ failure. DIC, it should be noted, is also a not-infrequent complication of severe sepsis, although it can also be seen after severe trauma and or a placental abruption, as well. DIC can be acute or chronic, too, and acute DIC is associated with rapid activation of the coagulation system, with diffuse bleeding and hemodynamic instability. It’s not clear if Peralta suffered any bleeding, but it’s not unreasonable to postulate that he likely died of DIC associated with his leukemia and that that his overall clinical picture might well have resembled severe sepsis in the emergency room. Or, thanks to his compromised immune system from the leukemia, he might have just developed sepsis.

Does anyone want to make a bet that neither Del Bigtree nor any of the other antivaxers who tried to blame the flu vaccine for Sen. Peralta’s death will make a note of what we know now from the coroner’s report? I will admit that it seems a bit odd that Peralta’s promyelocytic leukemia wasn’t revealed sooner from his blood tests, but it’s quite possible that, if he had DIC, that might have made his blood tests more difficult to interpret, and you do need bone marrow aspirates and other diagnostic criteria to diagnose promyelocytic leukemia. Of course, I don’t expect antivaxers to acknowledge that Sen. Peralta died of complications of leukemia after having gone off the conspiracy deep end trying to blame his death on vaccines, but if they do I expect them to try to find a way to blame his leukemia on the flu vaccine too.

It’s what they do.