Cabrera v. Secretary of Health and Human Services
13-598
| Fed. Cl. | Feb 7, 2017Background
- Petitioners (Eric and Carol Cabrera) filed under the National Vaccine Injury Compensation Program on behalf of their son L.C., alleging DTaP vaccine (8/30/2010) caused juvenile idiopathic arthritis (JIA).
- L.C. developed abnormal right‑leg crawling in late September 2010; parents and video evidence show asymmetric “crab crawl” and later pain/limited weight bearing noted by October visits.\
- Orthopedics initially suspected fracture; MRI (Jan/Mar 2011) and rheumatology workup led to JIA diagnosis (Mar 2011); labs: transient ANA positive, HLA‑B27 positive; later ophthalmology documented keratic precipitates consistent with uveitis.\
- Petitioners’ expert (Dr. Brawer) argued vaccine triggered JIA in a genetically susceptible child via molecular mimicry and placed onset ~3 weeks post‑vaccination (late Sept 2010).\
- Respondent’s expert (Dr. Rose) disputed causation, favored spontaneous/genetic ERA subtype, argued onset was late October 2010 (after ear infections/flu) and criticized lack of specific homology/animal data for vaccine causation.\
- Special Master found onset in late September 2010 (based on videos and parental history), accepted molecular mimicry as a reasonable theory here, rejected intervening infection as causal, and awarded entitlement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether DTaP can causally trigger JIA (Althen prong I: medical theory) | DTaP can trigger autoimmunity (molecular mimicry) in genetically susceptible patients (HLA‑B27); literature shows cross‑reactivity between toxoids and phospholipids. | No reliable link shown for this case; ERA/ HLA‑B27 pathogenesis is autoinflammatory (misfolded HLA‑B27), and specific protein/peptide homology or animal data are lacking. | Court: Molecular mimicry is a reasonable medical theory here and sufficient under Vaccine Act preponderance standard. |
| Whether vaccination was the cause (Althen prong II: logical sequence) | Vaccine was the plausible environmental trigger; onset pattern and absence of other proximate triggers support causation. | Disease is genetically determined/spontaneous; ear infections/flu around onset are more plausible triggers. | Court: Logical causal sequence satisfied; vaccine credibly served as the trigger given timing and clinical course. |
| Timing between vaccine and onset (Althen prong III: temporal relationship) | Onset ~3 weeks after vaccination (late Sept); timeframe compatible with adaptive immune response → inflammation. | Onset occurred ~7 weeks post‑vaccine (late Oct); that timing is too long for mimicry and infections then are proximate causes. | Court: Onset found in late September based on video and records; timing is acceptable for causation. |
| Burden to show alternative cause (respondent’s rebuttal) | N/A | Respondent pointed to otitis media and influenza in late Oct as alternative causes. | Court: Respondent failed to show those later infections were the principal cause; vaccine more likely triggered the JIA. |
Key Cases Cited
- Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (sets three‑prong test for causation‑in‑fact in Vaccine Program)
- Capizzano v. Sec’y of Health & Human Servs., 440 F.3d 1317 (Fed. Cir. 2006) (distinguishes Table vs. off‑Table claims under Vaccine Act)
- de Bazan v. Sec’y of Health & Human Servs., 539 F.3d 1347 (Fed. Cir. 2008) (requires each Althen factor be shown by preponderant evidence)
- Caves v. Sec’y of Health & Human Servs., 100 Fed. Cl. 119 (Fed. Cl. 2011) (addresses evidentiary approach to expert proof in vaccine cases)
- Moberly v. Sec’y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (defines preponderance standard application)
- Bunting v. Sec’y of Health & Human Servs., 931 F.2d 867 (Fed. Cir. 1991) (proof of medical certainty not required in vaccine claims)
- Knudsen v. Sec’y of Health & Human Servs., 35 F.3d 543 (Fed. Cir. 1994) (burden shifts to respondent to prove an alternative principal cause)
- Deribeaux v. Sec’y of Health & Human Servs., 717 F.3d 1363 (Fed. Cir. 2013) (clarifies respondent’s burden to show an alternative cause was more likely)
- Andreu v. Sec’y of Health & Human Servs., 569 F.3d 1367 (Fed. Cir. 2009) (permissible consideration of medical literature under the Vaccine Act)
- Rooks v. Sec’y of Health & Human Servs., 35 Fed. Cl. 1 (1996) (describes Program’s compensatory purpose and policy context)