Lorrin Danielle Kain: A Reason Not to Vaccinate?

In 1994, a car seat manufacturer produced a small lot of defective car seats. A six-week-old baby was seriously injured as a result and suffered from traumatic brain injury that led to long-term disability, and, fifteen years later, death. The little girl and her family were compensated by the company and the car seat was recalled.

Nothing can change or undo what happened to this little girl. Nothing can take away a parent's grief. No statistics about "one in a million" can temper the anger directed at the car seat manufacturer. It was a tragedy. A horrible, deadly, and possibly preventable tragedy, and fury and despair are understandable reactions.

But should the parents be trying to persuade others to never use any car seats, ever again?

This is exactly what happened in the heartbreaking case of Lorrin Danielle Kain, a beautiful little girl who passed away in 2009-- except that it wasn't a car seat. It was a vaccine.

After reading everything I could find about Lorrin and her condition, I have a few nagging doubts about whether Lorrin's condition was genuinely a vaccine reaction. At least a few people have pointed out that Lorrin's symptoms actually match Dravet syndrome, a serious form of epilepsy that has not been linked to immunization. But let's assume that Lorrin suffered and died because of vaccines.

That still isn't a good reason not to vaccinate your kids. 

Lorrin suffered because of a bad batch, not because vaccines are fundamentally dangerous. According to Lorrin's mother, Lorrin received a dose from a "hot lot"-- a defective batch of vaccines that caused "seizures or worse" in eleven children who received it. As tragic as it is, defective batches happen in absolutely all kinds of products. Consider, for example, that contaminated foods cause 3,000 deaths per year and go nearly unnoticed. Cantaloupe from a farm that had received "superior" health inspection ratings from multiple third parties killed 33 people in 2011, but I didn't hear anyone say that cantaloupe should be banned. We need both food and medicine to survive. Tragedies like this are reason to call for better safety in food and medicine, not to abandon them entirely. |

Not only has the batch been off the market for over two decades, but so has the entire line of inoculations. The DTP vaccine-- the one that caused Lorrin's reaction-- is not available anymore in the United States. Lorrin's mother and her supporters often conflate the DTP vaccine, which Lorrin received, with the Tdap and DTaP vaccines, which are part of the modern immunization schedule. They're not the same thing, and it's dangerous to treat them like they are. Conflating the Lorrin's vaccine with DTaP is like comparing the inactivated polio vaccine-- which can't possibly cause polio infection-- with the live-virus inoculation, which can. It's a completely different shot with completely different risks, and modern medicine has dramatically reduced the risks associated with many immunizations.

So what's different? The D, T, and P stand for diphtheria, tetanus, and pertussis. All variations of this class of vaccine-- and there are many-- protect against these three serious illnesses. DTP, which was given until the mid-nineties. contained whole cells of the diseases it protected against, and that meant a relatively large number of side effects, mostly in the form of fevers and local swelling. But DTP is a thing of the past, a chapter in medical history books not far from the smallpox vaccine.

The "a"s in DTaP and Tdap, which are given today, stand for acellular, meaning that they contain just a few proteins from the pertussis bacterium. The use of acellular vaccines is a victory for modern medicine: the  American Academy of Pediatrics points out that, today, we protect against 11 diseases by exposing kids to just 130 antigens (proteins from germs). Compare that to a hundred years ago, when a single smallpox vaccine contained 200 antigens altogether. As much as parents fear overwhelming the immune system, kids' bodies actually just need to react to a few little pieces of germs in today's schedule.

As a result of these advancements, today's DTaP shots are even less likely than their predecessors to cause serious adverse events. The advent of acellular vaccines means that kids today have about 90% fewer side effects from DTaP than they did from its predecessor twenty years ago.  In other words, the vaccine that your baby would get in 2015 is only one-tenth as dangerous as the vaccine that caused Lorrin's reaction in 1994.

Even if we were still using the DTP vaccine that Lorrin received, the risk of a serious adverse reaction would still be infinitesimally small. The World Health Organization reports that serious adverse reactions occurred in only about 1 in 750,000 children who received the vaccine, when it was available. By comparison, diphtheria had a death rate of about 1 in 5. Untreated tetanus kills 1 in 4-- and with excellent treatment might kill as few as 1 in 9 and cause permanent disability in 1 in 3. 

In developing countries where most moms are unvaccinated and can't pass tetanus immunity to their newborns, tetanus still accounts for nearly 1 in 5 newborn deaths. Pertussis (also known as whooping cough) is the most mild of the three infections, but is still pretty serious: it kills 1 in 50 babies who contract it and lands 2 out of 3 in the hospital. Even when we still relied on the modern DTaP vaccine's whole-cell predecessor, it was still very much worth the risk. 

Lorrin's mother found comfort by aligning herself with the anti-vaccine movement and its claims that vaccines cause autism. The anti-vax website Age of Autism regularly features information about Lorrin and her family, and Lorrin's image and story are promoted on autism-related websites and social media pages as evidence of the link between autism and vaccines. This doesn't make much sense to me. Lorrin did not have autism-- it was never, ever part of her diagnosis. She may have developed an adverse reaction to a vaccine, but "I believe the MMR vaccine causes autism because Lorrin Kain developed brain damage from DTP," makes about as much sense as, "I believe that aspirin causes cancer because I heard of someone who died from a penicillin allergy." It is neither the same substance nor the same condition. The people exploiting Lorrin's death to promote their agenda are helping no one.

Statistics don't do much to quell grief. I could never look Lorrin's mother in the eye and tell her, "Your daughter's death was worth it because vaccines save lives."

But I could also never say, "Your child's death was worth it because a defective batch of DTP vaccines hurt someone 21 years ago," to the mothers of Callie Van Tornhout, Brie Romaguera, Brady Alcaide, Landon Dube, or any of the other thousands upon thousands of children who die because of diphtheria, tetanus, and pertussis. I can not justify the abandonment of an entire class of live-saving preventative medications because a tiny number of people have suffered from adverse reactions.

Lorrin's family will always have my deepest sympathies. I believe that no parent should ever lose a child. It is not a pain that I would wish on my worst enemies, and I consider myself lucky every day that my children are healthy and happy. It is because of that-- because of my desire to see children live and thrive-- that I am a vaccine advocate. We can't let extraordinarily rare accidents lead us to abandon a miracle of modern medicine that saves so many new and innocent lives. 

My Great-Aunt Died From Diphtheria. This is Her Legacy.

There are no photos of Wilma Dean, but this photo shows the home where she spent her short life. The young man on the far left is her father. The photo was taken about 15 years before her death.

I never met my Great-Aunt Wilma. She died before I was born—long before I was born, in a time and place when children’s lives were a dime a dozen, when parents had twelve children in hopes that three might survive. The closest that I came to her was when I laid flowers on her grave in May of 2012. She sleeps in a forgotten cemetery among the oaks and hickories of rural Alabama. This is the last of her short and small legacy.

My grandmother invited me to drive her to her family’s graveyard for “Decoration Day.” It’s an old term for Memorial Day, which was, at least to my grandmother, a day for honoring all the dead, not just veterans. She hadn’t been to her family’s cemetery in years, so my toddler and I accompanied her on the long and lonely drive. We disappeared onto dirt roads. Soon, there was no cell phone reception. Later, no power lines. Eventually, unpaved paths with no names.

“Are you sure you know where we’re going?” I asked.

“I’m sure,” she said.

“What’s this place called?”

“There’s not a name for it. I think they get their mail on the Ragland route.”

We arrived to see a bleak cemetery with mostly un-engraved grave markers, crooked boulders sticking out of the Earth like teeth. The few that had words written on them were misspelled. Some had the names of mothers and babies who were buried together. Some had dilapidated confederate flags on tiny wooden poles in front of them. On a hill, half-choked by weeds, was one small, unassuming tombstone.

“That was my sister Wilma Dean,” my grandmother said, tearing a few weeds away with her gnarled fingers.

“What happened to her?” I asked.

“Diphtheria. She was three.”

I clutched my own daughter’s tiny hand. I was barely, at that point, beginning to realize the error I’d made by eschewing immunizations.  I had wanted so desperately to believe that “childhood illnesses” were no big deal and that the world had never been as dark and scary as the history books say. I had wanted to believe that she didn’t need vaccines and that children were safe without them.

“I can’t imagine how upset your parents must have been,” I sighed.

“They weren’t,” my grandmother said with a shrug, “Kids died so often back then, I really think, it was almost like we were just all used to it. They’d buried another baby right before that, and had nearly lost your Aunt Charlsie, too. You know, I can still remember the day she died, better than I can remember last week.”

“What was it like?”

My grandmother looked like she was staring into some place very far away, some place sepia-toned and earthy. A little wooden cabin in the forest. Little girls in cotton sundresses. Mules.

“She got… a real high fever. And swelled up real bad, in the face. Mother and Daddy had a doctor come and see her but I don’t reckon there was anything he could do. Mother was holding her when she died. She was the awfulest color. Daddy thought that she’d caught it from a cat—people was so ignorant back then—and so he shot every single one of our barn cats.”

“Why did he think she got it from a cat?”

“People was ignorant,” she repeated, “And I remember thinking that maybe I was fixin’ to get sick with it, too, and what would happen if Mother and Daddy buried both of us together.”

“How awful.”

“I reckon. But you don’t hear much about diphtheria no more, do you? I think there’s a shot for it now.”

“They say it causes autism,” I said, flinching while I said it. I had to somehow defend my choice not to immunize my daughter. It was too complex of an issue to even begin to explain to someone who knew next to nothing about vaccines, but I still felt a defensive need to say it.

“Autism? What Kelly’s boy across the street has?”

“Yeah. People didn’t have that when you were little, did you?”

“There's always been goofy people," she said plainly, "That ain't nothin' new."

“But autism is different. It’s a vaccine reaction. A lot of people think it is.”

She shrugged, “I’ve seen people get real sick from shots. One time I got a flu shot, and boy did I get sick. But all I know is, I haven’t heard of no one dying from diphtheria in a long time.”

I tried to think of something to say. I was still struggling. I was increasingly aware that my daughter was autistic and increasingly aware that I had made a mistake. Standing in front of the grave of a little girl who died in her mother’s arms of a disease my child would never get, my mistake was that much more painfully apparent. And, as much as I didn't want to know them, I knew the statistics: the DTaP vaccine is highly effective in preventing diphtheria, and without it, diphtheria claims as many as one in five lives.

I lay a flower on her grave and pushed aside the clumps of clay that had mostly buried  the marker.

My grandmother rarely criticized me, especially on topics that she thought I knew more about than she did. She only had a seventh-grade education and she regarded most of her knowledge as passé and unimportant. But, as she got into my car, she wasn’t too shy to tell me what she was thinking.

“People… You’re confused, sweetheart. Everybody spends their whole life trying to make the world better for their kids and their grandkids. But not you. You’re trying to go backwards. I’ll never understand it. Things wasn’t good back then. You want to think that they was, but they wasn’t. You’re going to figure that out one day.”

My car got stuck in the mud as we were leaving, and my grandmother commented that it would be hard to come back without four-wheel drive.

“Do you want to be buried there?” I asked when we finally saw pavement and power lines again.

“Lord, no,” she coughed, “I want people to come and visit me. It’s just a matter of time before that place is forgot altogether.”

My aunt, forever three years old, lies in the earth in some graveyard I will probably never see again. When my grandmother passes away, so will the last remaining memory of what Wilma Dean’s face looked like. That will be the very, very end of a life that was too short, in a time and place when life was cheap.

Wilma was given far too little time in life, but her small legacy is that her tragic and untimely death was one of the factors that made me realize how lucky I am to live in a world where deaths like hers are rare. She helped me realize how fortunate I am that modern medicine, including immunization, can give my kids much longer and happier lives than she had.

Rest in peace, sweetheart.