Author Affiliations: Center for Family Medicine, Sioux Falls, South Dakota (Drs Akkad and Huntington); and the Departments of Neuroscience (Drs Salem and Freeman), and Family Medicine (Dr Huntington), Sanford School of Medicine and the University of South Dakota, Sioux Falls.
We appreciate Ambrose and colleagues' interest in our article, and their diligence in investigating the safety of the vaccine their employer produces. We are active advocates of appropriate immunization, including H1N1 influenza vaccination. It would be a tragedy if our article was used to discourage immunizations.
They state that the precise cause of our patient's TM is not known, and that recent Mycoplasma infection and seasonal influenza vaccine are possible etiologies. We concur that the precise cause is not known. As mentioned in the original article,1 determining the exact cause of TM is difficult; among vaccine-associated cases, a causal relationship has been established only for the oral polio vaccine.2
Akkad W, Salem B, Freeman JW, Huntington MK. A Case Report of Transverse Myelitis Following Influenza Vaccination—Reply. Arch Neurol. 2011;68(8):1085-1086. doi:10.1001/archneurol.2011.173