Autism: Why The Debate Rages

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March 6, 2008, 12:39 PM
Autism: Why The Debate Rages
written by Christine Lagorio| 6

EDITOR'S NOTE: this entry by CBS News investigative correspondent Sharyl Attkisson was first posted last June, but as the debate over autism and vaccinations rages on, it seems worthy of repeating.

Just yesterday, U.S. health officials conceded that childhood vaccines interacted with and worsened a rare disorder that ultimately led to autism-like symptoms in a Georgia girl. Her family is set to be paid from a federal fund.

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With the first autism case now being heard in federal vaccine court in Washington D.C., it makes sense to ask: Why is anyone even still debating the possibility of a link between vaccines and autism? After all, for years, many government health officials, advisors and vaccine manufacturers have said there's no association.

Here are a number of reasons why the question remains open:

1. While government scientists, advisors and pharmaceutical companies have been responsible for infinite lifesaving and life improving medical advances, they are not infallible.

• It's the same group that originally thought it was safe to use x-ray machines in shoe stores, gave pregnant women Thalidomide for morning sickness and once allowed mercury in medicines. They assured us Vioxx and Duract were safe painkillers, prescribed Rezulin for diabetics and then denied any of them were responsible for patient deaths. If we never questioned that group, we might not have discovered that Fen-phen and the dietary supplement Ephedra are not safe weight loss products, that antidepressants in kids can lead to suicidality and Viagra can cause blindness. The list goes on.

• When it comes to vaccines, the same group failed to predict that the 1990's rotavirus (diarrhea) vaccine would have to be pulled from the market after infant deaths. They encouraged use of the oral polio vaccine (eventually discontinued after it gave too many children polio). And they allowed the use of a mercury neurotoxin preservative in childhood vaccines, only to admit later that they hadn't thought to calculate the cumulative amount kids were getting as more and more vaccines were added to the childhood immunization schedule.

• Recent history demonstrates that too often, government health officials, mainstream doctors and pharmaceutical companies aren't on the leading edge of alerting us to health risks; they're bringing up the rear. Patients feel left to fend for themselves, seeking independent research and opinions on their own. They and their dogged, relentless determination have often been the catalyst that eventually brings medical dangers to the forefront.

2. Government scientists, advisors and vaccine manufacturers often take an all-or-nothing approach to vaccinations.

• Government officials and infectious disease experts I've spoken with are fearful that if vaccine side effects are better publicized, or if a link between vaccines and autism and ADD were made, the public would overreact and lose faith in the entire vaccination program. The result, they're afraid, would be parents refusing to give their children any vaccines, leading to new, deadly epidemics of preventable diseases. That indeed would be a disaster. However, their fears have resulted in something I call an all-or-nothing approach: they tend to promote nearly all vaccines for nearly all children as equally necessary and equally safe. Yet at the same time, if asked, they agree not all vaccines are equally safe, equally beneficial, equally necessary and equally tolerated by each individual child.

• Through the Internet and other resources, parents are now able to find research on vaccines and read it for themselves. They compare the government's all-or-nothing approach to the research and become skeptical that the government is presenting the whole picture on vaccine safety generally.

3. Government officials and mainstream scientists who dispel any vaccine/autism/ADD link have ties to vaccine makers.

• There's so much overlap among pharmaceutical companies, government scientists and advisors that the information they provide at least has the appearance of a conflict of interest. Government scientists and advisors often do not mention their connections to the vaccine industry when they provide opinions on the vaccine/autism/ADD issue.

• One of the best examples of this is the landmark autism/vaccine study published in Pediatrics. Early in his study, the lead author, CDC's Dr. Thomas Verstraeten, found statistically significant associations between the amount of mercury (thimerosal) exposure kids got from their childhood vaccines, and a wide range of brain disorders. However, the published version of the study (the one the authors say is accurate) found no evidence of a link to autism. Not disclosed was that Dr. Verstraeten had left CDC midstream during the study and had gone to work for Glaxo, a vaccine manufacturer. That failure to disclose was criticized in a later publication of Pediatrics, but it got little mainstream attention. Also getting little attention was a letter from well-respected scientists, also in Pediatrics, who echoed what parents of autistic children had been saying for months: they questioned the use and exclusion of certain data from Dr. Verstraeten's study that eventually reduced the statistical ties between vaccines and neurodisorders.

• University and government researchers and advisors often do research for vaccine companies, help develop vaccines (even profit from them), and/or are paid to consult for them. Often, these researchers do not disclose their industry ties when they publicly dispel the notion of a link between autism or ADD and vaccines.

• Lastly, the CDC is inextricably tied to vaccine makers through contracts and other business and financial relationships that open the door for the possibility of conflicts.

4. Non-profits which dispel any vaccine/autism/ADD link have ties to vaccine makers.

• Non-profits that promote vaccinations have ties to vaccine makers that they often do not disclose when giving their opinions on vaccine safety. One example is "Every Child By Two." This group contacted CBS News several years ago in an unsuccessful attempt to prevent one of our stories about the vaccine safety from airing. In forms filed for the IRS, the non-profit lists an official from vaccine maker Wyeth Pharmaceuticals as its Treasurer. It lists vaccine maker Chiron as a paid client.

• Another example of a non-profit tied to the industry is "The Vaccine Fund." Its President from 2000-2005 was Jacques-Francois Martin, formerly CEO of vaccine maker Sanofi-Pasteur, CEO of vaccine maker Chiron, and President of the International Federation of the Pharmaceutical Manufacturers' Association. While at The Vaccine Fund, his salary was paid by a company that says it "has developed particular strength in the vaccine industry and vaccine development."

5. The dual role of the CDC undermines the appearance of fairness.

• There is a perceived, if not real, conflict of interest with the government's Centers for Disease Control (CDC) heavily promoting vaccines, but also responsible for monitoring adverse events. At least two respected medical journals, the "American Journal of Public Health" and "Pediatrics" have published letters or articles recommending "greater independence in vaccine safety assessments" apart from "the highly successful program to promote immunizations." In short, the CDC's bread and butter is achieving high vaccination rates. But that role is in conflict with the agency's responsibility to fully research and disclose adverse events that could, in theory, bring down vaccination rates.

6. There is no definitive research proving a link between vaccines and autism or ADD, but there is also no definitive research ruling it out.

• Something rarely reported is that while there's no definitive study linking vaccines to autism or ADD, there is also no study definitively disproving a link. And there's a substantial body of peer-reviewed, published science from places like Columbia, Yale and Northeastern suggesting a link, or pointing to the need for further study.

• Many credible voices deny a link. But many other credible voices support the idea of a link. One example of the latter is George Wayne Lucier, formerly a senior official at the National Institutes of Health in Environmental Toxicology, an NIH advisor, member of the National Academy of Sciences Committee on Toxicity Testing and a scientific advisor for EPA who concludes "...it is highly probably that use of thimerosal as a preservative has caused developmental disorders, including autism, in some children." A lengthy Congressional investigation also concluded that the autism epidemic is likely linked to vaccinations.

7. Those who say autism and ADD are not linked to vaccines do not know what is causing the epidemics.

• The most frightening part of the autism/ADD epidemics is that if, indeed, they're unrelated to vaccinations, that our best, brightest public health experts still have no idea what is causing it. Excluding ADD, one out of every 150 American children are now being diagnosed with autism.

Vaccinations have provided lifesaving miracles in public health. However, it's undisputed that they are also responsible for many serious adverse events including brain disorders and, rarely, deaths. Trying to maximize the potential benefits of vaccines and minimize the harm shouldn't be seen as a threat to the nation's inoculation program, it's merely a logical step forward.

One scientist who testified for the plaintiff this week in The Vaccine Court said there's a way to test children for a hidden hole in their immune make-up that makes them susceptible to bad immune reactions from vaccinations. He said that, ideally, every child should undergo such a test before their first vaccinations. But he also said the test is very expensive and so "not worth it." Many parents might disagree. If they knew such a test was available, they'd find a way to pay for it. But such information has to be disseminated to the public before a first step can even be considered.

Mainstream medicine initially said that autism was caused by mothers who weren't affectionate enough with their children. If that doesn't teach us that we should always seek further knowledge and not necessarily accept what's spoon-fed to us by certain experts…then nothing will.

http://www.cbsnews.com/blogs/2008/03/06 ... 3875.shtml

Last edited by sinsboldly on 07 Mar 2008, 9:52 am, edited 1 time in total.

The vast majority of doctors are honest, caring people who wish to do everything they can to help people. A desire to help people is among the most common reasons for entering the medical profession (if it was just for money, there are easier ways to earn money). Your explanation requires that vast numbers of doctors are willfully lying in such a way that jeopardizes the health of millions of children. Somehow I find this unlikely, as you are ascribing ill intent to far to large a group of people.

I am not ascribing anything to anybody, Orwell, I posted an article I thought the community might like to read.
I posted the author's contact information, (which is not me) I am not even pretending I wrote the article, please direct your comments on what the author is trying to portray to her, not me.

Merle

This article is extremely misleading in a number of ways.

This is extremely misleading because the examples given bear little resemblance to the vaccine-autism issue. Specifically, the cited cases are examples of people being assured of the safety of something where few (if any) studies had been done to evaluate the safety. That is not at all the situation in the case of vaccines and autism (see below).



This one is absolute nonsense. While a few do, the overwhelming majority of scientists are paid by government grants and have no ties whatsoever to any industry. I've been a working scientist for many years and I have never obtained a single penny by any industry. Every last cent I have ever been paid has come entirely from government grants that are not connected to any industry.

Furthermore, given the HUGE body of research (again, see below) that dispels any link between vaccines and autism it is a silly conspiracy theory to imagine that all -- or even most -- are secretly committing scientific fraud to protect some unproven link to big pharma.

Actually, the real conflicts of interest involve some of the scientists that originally promoted the vaccine-autism link idea:

http://csicop.org/si/2007-06/novella.html

4. Non-profits which dispel any vaccine/autism/ADD link have ties to vaccine makers.




Yes, there is (see below).



First of all, how do we know there is an epidemic? Secondly, it should be patently obvious that lack of knowledge regarding the cause of autism is not evidence that vaccines cause autism.



There was never any evidence to support the notion that lack of maternal affection causes autism. In contrast, there is a tremendous amount of relevant evidence regarding vaccines and autism. In the text below, I cite every recent peer-reviewed study I could find that included an abstract. While this omits some that did not have abstracts, I think it's reasonable to say that this gives one a good picture of the scientific evidence.

I can't believe anyone would seriously argue that the vast number of scientists involved in this work are all committing scientific fraud by hiding evidence of a vaccine-autism link. In the citations below, note that most of the studies that did suggest a link came from a single lab. I find that suspicious.



http://www.ncbi.nlm.nih.gov/pubmed/1797 ... d_RVDocSum

Low-Level Neonatal Thimerosal Exposure: Further Evaluation of Altered Neurotoxic Potential in SJL Mice.
Berman RF, Pessah IN, Mouton PR, Mav D, Harry J.

Department of Neurological Surgery and the Center for Children's Environmental Health.

Ethylmercury in thimerosal-preserved childhood vaccines has been suggested to be neurotoxic and to contribute to the etiology of neurodevelopmental disorders, including autism. Immune system function may be an important factor influencing vulnerability of the developing nervous system to thimerosal. This possibility is based in part on a report by Hornig et al. (2004, Mol. Psychiatry 9, 833-845) of neurodevelomental toxicity in SJL/J mice that develop autoantibodies when exposed to organic mercury. The present study reexamined this possibility by injecting neonatal SJL/J mice with thimerosal, with and without combined HiB and DTP vaccines. Injections modeled childhood vaccination schedules, with mice injected on postnatal days 7, 9, 11, and 15 with 14.2, 10.8, 9.2, and 5.6 mug/kg mercury from thimerosal, respectively, or vehicle. Additional groups received vaccine only or a 10 times higher thimerosal + vaccine dose. Low levels of mercury were found in blood, brain, and kidneys 24 h following the last thimerosal injection. Survival, body weight, indices of early development (negative geotaxis, righting) and hippocampal morphology were not affected. Performance was unaffected in behavioral tests selected to assess behavioral domains relevant to core deficits in neurodevelopmental disorders such as autism (i.e., social interaction, sensory gating, anxiety). In an open-field test the majority of behaviors were unaffected by thimerosal injection, although thimerosal-injected female mice showed increased time in the margin of an open field at 4 weeks of age. Considered together the present results do not indicate pervasive developmental neurotoxicity following vaccine-level thimerosal injections in SJL mice, and provide little if any support for the hypothesis that thimerosal exposure contributes to the etiology of neurodevelopmental disorders.



http://www.ncbi.nlm.nih.gov/pubmed/1735 ... d_RVDocSum

Curr Opin Neurol. 2007 Apr;20(2):181-7.Click here to read Links
Vaccination, seizures and 'vaccine damage'.
Brown NJ, Berkovic SF, Scheffer IE.

Epilepsy Research Centre and Department of Medicine, University of Melbourne, Austin Health, Heidelberg West, Victoria, Australia.

PURPOSE OF REVIEW: Concerns about the safety of vaccination have plagued the community, with reduction in vaccine uptake resulting in increased risk of epidemics. Vaccination has been implicated in the cause of febrile seizures, 'vaccine encephalopathy' and autistic spectrum disorders. Evaluation of alleged associations is complicated by evolution in the vaccination field. This review focuses on the risk of seizures following vaccination and the alleged associations of vaccination with vaccine encephalopathy and also with autism spectrum disorders. RECENT FINDINGS: Over the last decade the introduction of new vaccines such as the acellular pertussis vaccine has produced a reduction in seizures following vaccination, the outcome of which was benign even with older vaccines. New evidence emerged in 2006 showing that cases of alleged 'vaccine encephalopathy' are due to mutations within a sodium channel gene. The weight of epidemiological evidence does not support a relationship between vaccination and childhood epileptic encephalopathies or autism spectrum disorders. SUMMARY: Vaccines are safer than ever before, but the challenge remains to convey this message to society in such a way that produces change in attitudes to vaccination and subsequent increase in vaccine coverage.

http://www.ncbi.nlm.nih.gov/pubmed/1716 ... d_RVDocSum

: Can J Neurol Sci. 2006 Nov;33(4):341-6.Links

Comment in:
Can J Neurol Sci. 2006 Nov;33(4):339-40.

Immunizations and autism: a review of the literature.
Doja A, Roberts W.

Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.

Because of a temporal correlation between the first notable signs and symptoms of autism and the routine childhood vaccination schedule, many parents have become increasingly concerned regarding the possible etiologic role vaccines may play in the development of autism. In particular, some have suggested an association between the Measles-Mumps-Rubella vaccine and autism. Our literature review found very few studies supporting this theory, with the overwhelming majority showing no causal association between the Measles-Mumps-Rubella vaccine and autism. The vaccine preservative thimerosal has alternatively been hypothesized to have a possible causal role in autism. Again, no convincing evidence was found to support this claim, nor for the use of chelation therapy in autism. With decreasing uptake of immunizations in children and the inevitable occurrence of measles outbreaks, it is important that clinicians be aware of the literature concerning vaccinations and autism so that they may have informed discussions with parents and caregivers.


http://www.ncbi.nlm.nih.gov/pubmed/1701 ... d_RVDocSum

Pediatrics. 2006 Oct;118(4):1664-75.Click here to read Links

Erratum in:
Pediatrics. 2006 Dec;118(6):2608.
Comment in:
Pediatrics. 2006 Oct;118(4):1744-5.

No evidence of persisting measles virus in peripheral blood mononuclear cells from children with autism spectrum disorder.
D'Souza Y, Fombonne E, Ward BJ.

Division of Infectious Diseases, McGill University Health Center, Montreal, Quebec, Canada.

OBJECTIVES: Despite epidemiologic evidence to the contrary, claims of an association between measles-mumps-rubella vaccination and the development of autism have persisted. Such claims are based primarily on the identification of measles virus nucleic acids in tissues and body fluids by polymerase chain reaction. We sought to determine whether measles virus nucleic acids persist in children with autism spectrum disorder compared with control children. PATIENTS AND METHODS: Peripheral blood mononuclear cells were isolated from 54 children with autism spectrum disorder and 34 developmentally normal children, and up to 4 real-time polymerase chain reaction assays and 2 nested polymerase chain reaction assays were performed. These assays targeted the nucleoprotein, fusion, and hemagglutinin genes of measles virus using previously published primer pairs with detection by SYBR green I. Our own real-time assay targeted the fusion gene using novel primers and an internal fluorescent probe. Positive reactions were evaluated rigorously, and amplicons were sequenced. Finally, anti-measles antibody titers were measured by enzyme immunoassay. RESULTS: The real-time assays based on previously published primers gave rise to a large number of positive reactions in both autism spectrum disorder and control samples. Almost all of the positive reactions in these assays were eliminated by evaluation of melting curves and amplicon band size. The amplicons for the remaining positive reactions were cloned and sequenced. No sample from either autism spectrum disorder or control groups was found to contain nucleic acids from any measles virus gene. In the nested polymerase chain reaction and in-house assays, none of the samples yielded positive results. Furthermore, there was no difference in anti-measles antibody titers between the autism and control groups. INTERPRETATION: There is no evidence of measles virus persistence in the peripheral blood mononuclear cells of children with autism spectrum disorder.


http://www.ncbi.nlm.nih.gov/pubmed/1681 ... d_RVDocSum

Pediatrics. 2006 Jul;118(1):e139-50.Click here to read Links
Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations.
Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D.

Department of Psychiatry, McGill University, Montréal Children's Hospital, 4018 Ste-Catherine West, Montreal, Quebec, Canada H3Z 1P2. [email protected]

BACKGROUND: The prevalence of pervasive developmental disorders has increased in recent years. Links with the measles component of the measles-mumps-rubella vaccine and the cumulative exposure to thimerosal through other vaccines have been postulated. OBJECTIVES: The purpose of this work was to estimate the pervasive developmental disorder prevalence in Montreal, Canada, in cohorts born from 1987 to 1998 and evaluate the relationship of trends in pervasive developmental disorder rates with: (1) changes in cumulative exposure to ethylmercury (thimerosal) occurring through modifications in the immunization schedule of young children and (2) trends in measles-mumps-rubella vaccination use rates and the introduction of a 2-measles-mumps-rubella dosing schedule during the study period. METHODS: We surveyed 27749 children born from 1987 to 1998 attending 55 schools from the largest Anglophone school board. Children with pervasive developmental disorders were identified by a special needs team. The cumulative exposure by age 2 years to thimerosal was calculated for 1987-1998 birth cohorts. Ethylmercury exposure ranged from medium (100-125 microg) from 1987 to 1991 to high (200-225 microg) from 1992 to 1995 to nil from 1996 onwards when thimerosal was entirely discontinued. Measles-mumps-rubella coverage for each birth cohort was estimated through surveys of vaccination rates. The immunization schedule included a measles-mumps-rubella single dose at 12 months of age up to 1995, and a second measles-mumps-rubella dose at 18 months of age was added on after 1996. RESULTS: We found 180 children (82.8% males) with a pervasive developmental disorder diagnosis who attended the surveyed schools, yielding a prevalence for pervasive developmental disorder of 64.9 per 10000. The prevalence for specific pervasive developmental disorder subtypes were, for autistic disorder: 21.6 of 10000; for pervasive developmental disorder not otherwise specified: 32.8 of 10000; and for Asperger syndrome: 10.1 of 10000. A statistically significant linear increase in pervasive developmental disorder prevalence was noted during the study period. The prevalence of pervasive developmental disorder in thimerosal-free birth cohorts was significantly higher than that in thimerosal-exposed cohorts (82.7 of 10000 vs 59.5 of 10000). Using logistic regression models of the prevalence data, we found no significant effect of thimerosal exposure used either as a continuous or a categorical variable. Thus, thimerosal exposure was unrelated to the increasing trend in pervasive developmental disorder prevalence. These results were robust when additional analyses were performed to address possible limitations because of the ecological nature of the data and to evaluate potential effects of misclassification on exposure or diagnosis. Measles-mumps-rubella vaccination coverage averaged 93% during the study interval with a statistically significant decreasing trend from 96.1% in the older birth cohorts (1988-89) to approximately 92.4% in younger birth cohorts (1996-1998). Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased. In addition, pervasive developmental disorder prevalence increased at the same rate before and after the introduction in 1996 of the second measles-mumps-rubella dose, suggesting no increased risk of pervasive developmental disorder associated with a 2-measles-mumps-rubella dosing schedule before age 2 years. Results held true when additional analyses were performed to test for the potential effects of misclassification on exposure or diagnostic status. Thus, no relationship was found between pervasive developmental disorder rates and 1- or 2-dose measles-mumps-rubella immunization schedule. CONCLUSIONS: The prevalence of pervasive developmental disorder in Montreal was high, increasing in recent birth cohorts as found in most countries. Factors accounting for the increase include a broadening of diagnostic concepts and criteria, increased awareness and, therefore, better identification of children with pervasive developmental disorders in communities and epidemiologic surveys, and improved access to services. The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.


http://www.ncbi.nlm.nih.gov/pubmed/1680 ... d_RVDocSum

Neuro Endocrinol Lett. 2006 Aug;27(4):401-13.Links
A meta-analysis epidemiological assessment of neurodevelopmental disorders following vaccines administered from 1994 through 2000 in the United States.
Geier DA, Geier MR.

The Institute for Chronic Illnesses, Inc., Silver Spring, MD 20905, USA. [email protected]

BACKGROUND: Thimerosal is an ethylmercury-containing compound (49.6% mercury by weight) used as at the preservative level in vaccines (0.005% to 0.01%). METHODS: Statistical modeling in a meta-analysis epidemiological assessment of the Vaccine Adverse Event Reporting System (VAERS) for neurodevelopment disorders (NDs) reported following Diphtheria-Tetanus-whole-cell-Pertussis (DTP) vaccines in comparison to Diphtheria-Tetanus-whole-cell-Pertussis-Haemophilus Influenzae Type b (DTPH) vaccines (administered: 1994-1997) and following Thimerosal-containing Diphtheria-Tetanus-acellular-Pertussis (DTaP), vaccines in comparison to Thimerosal-free DTaP vaccines (administered: 1997-2000), was undertaken. RESULTS: Significantly increased adjusted (sex, age, vaccine type, vaccine manufacturer) risks of autism, speech disorders, mental retardation, personality disorders, thinking abnormalities, ataxia, and NDs in general, with minimal systematic error or confounding, were associated with TCV exposure. CONCLUSION: It is clear from the results of the present epidemiological study and other recently published data associating mercury exposure with childhood NDs, additional ND research should be undertaken in the context of evaluating mercury-associated exposures, especially from Thimerosal-containing vaccines.

http://www.ncbi.nlm.nih.gov/pubmed/1676 ... d_RVDocSum

J Toxicol Environ Health A. 2006 Aug;69(15):1481-95.Click here to read Links
An evaluation of the effects of thimerosal on neurodevelopmental disorders reported following DTP and Hib vaccines in comparison to DTPH vaccine in the United States.
Geier DA, Geier MR.

The Genetic Centers of America, Silver Spring, Maryland 20905, USA. [email protected]

Thimerosal is an ethylmercury (49.55% mercury by weight) preservative historically added to some vaccines. Toxicokinetic studies showed children in the United States received doses of mercury from Thimerosal-containing vaccines (TCVs) in excess of safety guidelines. In the United States during the 1990s, diphtheria-tetanus-pertussis (DTP) and Haemophilus influenzae type b (Hib) vaccines (maximally, 50 mug mercury per joint administration) and diphtheria-tetanus-pertussis-Haemophilus influenzae type b (DTPH) vaccines (25 mug mercury per administration) were given to children in the same childhood vaccination schedule at 2, 4, 6, and 15-18 mo, so that children receiving DTP and Hib vaccines may have maximally received an additional 100 mug more mercury exposure from TCVs than children administered DTPH vaccines. A case-control epidemiological study of neurodevelopmental disorders (NDs) reported to the Vaccine Adverse Event Reporting System (VAERS) (online public access version; updated 31 August 2004) following administration of DTP vaccines in comparison DTPH vaccines manufactured by Lederle Laboratories (Pearl River, NY) from 1994 through 1998 was undertaken. Significantly increased odds ratios for autism, speech disorders, mental retardation, infantile spasms, and thinking abnormalities reported to VAERS were found following DTP vaccines in comparison to DTPH vaccines with minimal bias or systematic error. Additional ND research should be undertaken in the context of evaluating mercury-associated exposures, especially since in 2005 the Institute of Medicine issued a report calling into question handling of vaccine safety data by the National Immunization Program of the Centers for Disease Control and Prevention.

http://www.ncbi.nlm.nih.gov/pubmed/1672 ... d_RVDocSum

J Autism Dev Disord. 2006 Apr;36(3):299-316.Click here to read Links
Is there a 'regressive phenotype' of Autism Spectrum Disorder associated with the measles-mumps-rubella vaccine? A CPEA Study.
Richler J, Luyster R, Risi S, Hsu WL, Dawson G, Bernier R, Dunn M, Hepburn S, Hyman SL, McMahon WM, Goudie-Nice J, Minshew N, Rogers S, Sigman M, Spence MA, Goldberg WA, Tager-Flusberg H, Volkmar FR, Lord C.

University of Michigan, Ann Arbor, 48109-2054, USA.

A multi-site study of 351 children with Autism Spectrum Disorders (ASD) and 31 typically developing children used caregiver interviews to describe the children's early acquisition and loss of social-communication milestones. For the majority of children with ASD who had experienced a regression, pre-loss development was clearly atypical. Children who had lost skills also showed slightly poorer outcomes in verbal IQ and social reciprocity, a later mean age of onset of autistic symptoms, and more gastrointestinal symptoms than children with ASD and no regression. There was no evidence that onset of autistic symptoms or of regression was related to measles-mumps-rubella vaccination. The implications of these findings for the existence of a 'regressive phenotype' of ASD are discussed.

http://www.ncbi.nlm.nih.gov/pubmed/1668 ... d_RVDocSum

J Dev Behav Pediatr. 2006 Apr;27(2 Suppl):S120-7.Click here to read Links
Early medical history of children with autism spectrum disorders.
Niehus R, Lord C.

University of Michigan Autism and Communication Disorders Center University of Michigan, Ann Arbor, Michigan 48109, USA.

Previous studies have suggested that children with autism spectrum disorders (ASD) may have different medical histories than nonspectrum children in several areas: their reactions to vaccinations, number of ear infections, chronic gastrointestinal problems, and use of antibiotics. Furthermore, some studies have found associations between regressive autism and gastrointestinal (GI) symptoms. The present study analyzes the medical records from birth to the age of 2 years of 99 children (24 typically developing; 75 with ASD, of whom 29 had parent-reported regression). Data were coded in the following areas: frequency and purpose of pediatrician visits, frequency and type of illnesses and medications, type and chronicity of GI complaints, date of vaccinations, growth data, and whether the pediatrician noted behaviors indicative of an ASD before the age of 2 years. Children with ASD were found to have significantly more ear infections than the typically developing children as well as to use significantly more antibiotics. Typically developing children had significantly more illness-related fevers. There was a nonsignificant trend toward the ASD group having more chronic gastrointestinal problems. There were no significant differences between the groups for the age of vaccination or for number of pediatrician visits. Finally, pediatricians noted symptoms of onset of possible autism, including language delay, for 44 of the 75 children with ASD and 2 of the 24 typical children. Results are discussed in terms of needs for future research.

http://www.ncbi.nlm.nih.gov/pubmed/1655 ... d_RVDocSum

J Med Virol. 2006 May;78(5):623-30.Click here to read Links
Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK.
Afzal MA, Ozoemena LC, O'Hare A, Kidger KA, Bentley ML, Minor PD.

Division of Virology, National Institute for Biological Standards and Control, South Mimms, Potters Bar, Hertfordshire, United Kingdom. [email protected]

Leukocyte preparations from children with documented evidence of MMR vaccination and confirmed diagnosis of autism were examined by several assays designed to target multiple regions of the measles virus genome sequence. No sample was found positive by any method. The assays applied were highly sensitive, specific and robust in nature, and were based on the amplification of measles virus RNA transcripts by real-time quantitative RT-PCR (QRT-PCR) as well as by conventional RT-PCR-nested PCR. The assays applied were potentially able to detect measles virus RNA down to single figure copy numbers per reaction. The amount of total nucleic acid extract of leukocytes subjected to various measles virus-specific investigations was several fold higher than minimally required of a sample where measles virus persistence is well documented. This study failed to substantiate reports of the persistence of measles virus in autistic children with development regression. Copyright 2006 Wiley-Liss, Inc.

http://www.ncbi.nlm.nih.gov/pubmed/1651 ... d_RVDocSum

Int Rev Neurobiol. 2005;71:317-41.Links
Immunological findings in autism.
Cohly HH, Panja A.

Department of Biology, Jackson State University, Mississippi 39217, USA.

The immunopathogenesis of autism is presented schematically in Fig. 1. Two main immune dysfunctions in autism are immune regulation involving pro-inflammatory cytokines and autoimmunity. Mercury and an infectious agent like the measles virus are currently two main candidate environmental triggers for immune dysfunction in autism. Genetically immune dysfunction in autism involves the MHC region, as this is an immunologic gene cluster whose gene products are Class I, II, and III molecules. Class I and II molecules are associated with antigen presentation. The antigen in virus infection initiated by the virus particle itself while the cytokine production and inflammatory mediators are due to the response to the putative antigen in question. The cell-mediated immunity is impaired as evidenced by low numbers of CD4 cells and a concomitant T-cell polarity with an imbalance of Th1/Th2 subsets toward Th2. Impaired humoral immunity on the other hand is evidenced by decreased IgA causing poor gut protection. Studies showing elevated brain specific antibodies in autism support an autoimmune mechanism. Viruses may initiate the process but the subsequent activation of cytokines is the damaging factor associated with autism. Virus specific antibodies associated with measles virus have been demonstrated in autistic subjects. Environmental exposure to mercury is believed to harm human health possibly through modulation of immune homeostasis. A mercury link with the immune system has been postulated due to the involvement of postnatal exposure to thimerosal, a preservative added in the MMR vaccines. The occupational hazard exposure to mercury causes edema in astrocytes and, at the molecular level, the CD95/Fas apoptotic signaling pathway is disrupted by Hg2+. Inflammatory mediators in autism usually involve activation of astrocytes and microglial cells. Proinflammatory chemokines (MCP-1 and TARC), and an anti-inflammatory and modulatory cytokine, TGF-beta1, are consistently elevated in autistic brains. In measles virus infection, it has been postulated that there is immune suppression by inhibiting T-cell proliferation and maturation and downregulation MHC class II expression. Cytokine alteration of TNF-alpha is increased in autistic populations. Toll-like-receptors are also involved in autistic development. High NO levels are associated with autism. Maternal antibodies may trigger autism as a mechanism of autoimmunity. MMR vaccination may increase risk for autism via an autoimmune mechanism in autism. MMR antibodies are significantly higher in autistic children as compared to normal children, supporting a role of MMR in autism. Autoantibodies (IgG isotype) to neuron-axon filament protein (NAFP) and glial fibrillary acidic protein (GFAP) are significantly increased in autistic patients (Singh et al., 1997). Increase in Th2 may explain the increased autoimmunity, such as the findings of antibodies to MBP and neuronal axonal filaments in the brain. There is further evidence that there are other participants in the autoimmune phenomenon. (Kozlovskaia et al., 2000). The possibility of its involvement in autism cannot be ruled out. Further investigations at immunological, cellular, molecular, and genetic levels will allow researchers to continue to unravel the immunopathogenic mechanisms' associated with autistic processes in the developing brain. This may open up new avenues for prevention and/or cure of this devastating neurodevelopmental disorder.

http://www.ncbi.nlm.nih.gov/pubmed/1626 ... d_RVDocSum

Neuro Endocrinol Lett. 2005 Oct;26(5):439-46.Links
Mercury and autism: accelerating evidence?
Mutter J, Naumann J, Schneider R, Walach H, Haley B.

Institute for Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Germany. [email protected]

The causes of autism and neurodevelopmental disorders are unknown. Genetic and environmental risk factors seem to be involved. Because of an observed increase in autism in the last decades, which parallels cumulative mercury exposure, it was proposed that autism may be in part caused by mercury. We review the evidence for this proposal. Several epidemiological studies failed to find a correlation between mercury exposure through thimerosal, a preservative used in vaccines, and the risk of autism. Recently, it was found that autistic children had a higher mercury exposure during pregnancy due to maternal dental amalgam and thimerosal-containing immunoglobulin shots. It was hypothesized that children with autism have a decreased detoxification capacity due to genetic polymorphism. In vitro, mercury and thimerosal in levels found several days after vaccination inhibit methionine synthetase (MS) by 50%. Normal function of MS is crucial in biochemical steps necessary for brain development, attention and production of glutathione, an important antioxidative and detoxifying agent. Repetitive doses of thimerosal leads to neurobehavioral deteriorations in autoimmune susceptible mice, increased oxidative stress and decreased intracellular levels of glutathione in vitro. Subsequently, autistic children have significantly decreased level of reduced glutathione. Promising treatments of autism involve detoxification of mercury, and supplementation of deficient metabolites.

http://www.ncbi.nlm.nih.gov/pubmed/1623 ... d_RVDocSum

Cochrane Database Syst Rev. 2005 Oct 19;(4):CD004407.Click here to read Links
Vaccines for measles, mumps and rubella in children.
Demicheli V, Jefferson T, Rivetti A, Price D.

Servizo Sovrazonale di Epidemiologia, ASL 20, Via Venezia 6, Alessandria, Piemonte, Italy 15100. [email protected]

BACKGROUND: Public debate over the safety of the trivalent measles, mumps and rubella (MMR) vaccine, and the resultant drop in vaccination rates in several countries, persists despite its almost universal use and accepted effectiveness. OBJECTIVES: We carried out a systematic review to assess the evidence of effectiveness and unintended effects associated with MMR. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to December 2004), EMBASE (1974 to December 2004), Biological Abstracts (from 1985 to December 2004), and Science Citation Index (from 1980 to December 2004). Results from reviews, handsearching and from the consultation of manufacturers and authors were also used. SELECTION CRITERIA: Eligible studies were comparative prospective or retrospective trials testing the effects of MMR compared to placebo, do-nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. These studies were carried out or published by 2004. DATA COLLECTION AND ANALYSIS: We identified 139 articles possibly satisfying our inclusion criteria and included 31 in the review. MAIN RESULTS: MMR was associated with a lower incidence of upper respiratory tract infections, a higher incidence of irritability, and similar incidence of other adverse effects compared to placebo. The vaccine was likely to be associated with benign thrombocytopenic purpura, parotitis, joint and limb complaints, febrile convulsions within two weeks of vaccination and aseptic meningitis (mumps) (Urabe strain-containing MMR). Exposure to MMR was unlikely to be associated with Crohn's disease, ulcerative colitis, autism or aseptic meningitis (mumps) (Jeryl-Lynn strain-containing MMR). We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated. AUTHORS' CONCLUSIONS: The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with MMR cannot be separated from its role in preventing the target diseases.

http://www.ncbi.nlm.nih.gov/pubmed/1587 ... d_RVDocSum

J Child Psychol Psychiatry. 2005 Jun;46(6):572-9.Click here to read Links
No effect of MMR withdrawal on the incidence of autism: a total population study.
Honda H, Shimizu Y, Rutter M.

Yokohama Rehabilitation Center, Yokohama, Japan. [email protected]

BACKGROUND: A causal relationship between the measles, mumps, and rubella (MMR) vaccine and occurrence of autism spectrum disorders (ASD) has been claimed, based on an increase in ASD in the USA and the UK after introduction of the MMR vaccine. However, the possibility that this increase is coincidental has not been eliminated. The unique circumstances of a Japanese MMR vaccination program provide an opportunity for comparison of ASD incidence before and after termination of the program. METHODS: This study examined cumulative incidence of ASD up to age seven for children born from 1988 to 1996 in Kohoku Ward (population approximately 300,000), Yokohama, Japan. ASD cases included all cases of pervasive developmental disorders according to ICD-10 guidelines. RESULTS: The MMR vaccination rate in the city of Yokohama declined significantly in the birth cohorts of years 1988 through 1992, and not a single vaccination was administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age seven increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993. CONCLUSIONS: The significance of this finding is that MMR vaccination is most unlikely to be a main cause of ASD, that it cannot explain the rise over time in the incidence of ASD, and that withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD.

http://www.ncbi.nlm.nih.gov/pubmed/1572 ... d_RVDocSum
Arch Dis Child. 2005 Mar;90(3):292-6.Click here to read Links
No evidence of an association between MMR vaccine and gait disturbance.
Miller E, Andrews N, Grant A, Stowe J, Taylor B.

Immunisation Division, Public Health Laboratory Service, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK. [email protected]

BACKGROUND: MMR vaccine has been reported to cause gait disturbance, and this possible association has been claimed to support the MMR-causes-autism theory. AIMS: To determine whether any association between gait disturbance and MMR vaccination exceeds the age related background rate of gait disturbance, using record linkage and self control case series analyses. METHODS: MMR vaccination records were linked to hospital admission and general practitioner attendance data. An increased rate of gait problems with onset in various intervals in the 60 day period after MMR vaccination was looked for in children aged 12 to <24 months. RESULTS: No evidence of an increased rate of hospital admission or general practice consultations for gait disturbance was found in the putative post-vaccination risk periods. CONCLUSIONS: This study provides no evidence for a causal association between MMR and gait disturbance.

http://www.ncbi.nlm.nih.gov/pubmed/1538 ... d_RVDocSum

Acta Paediatr. 2004 Sep;93(9):1140-3.Click here to read Links
Flawed reports of immunization complications: consequences for child health.
Zetterström R.

Flawed studies about complications in vaccination programmes may have serious consequences for community health, as illustrated by a previous report on the adverse effect of pertussis vaccination and a more recent report about a suspected link between MMR vaccination and autistic spectrum disorders. Conclusion: The Editorial Board of The Lancet has apologized for having published a paper which has misled its readers about the risk of MMR vaccination. Due to the important role of TV and newspapers in giving information about health promotion, these media should also be willing to correct false information.

http://www.ncbi.nlm.nih.gov/pubmed/1536 ... d_RVDocSum
Drug Saf. 2004;27(12):831-40.Links
MMR vaccination and autism : what is the evidence for a causal association?
Madsen KM, Vestergaard M.

Department of Epidemiology and Social Medicine, The Danish Epidemiology Science Centre, Aarhus, Denmark. [email protected]

It has been suggested that vaccination with the measles-mumps-rubella (MMR) vaccine causes autism. The wide-scale use of the MMR vaccine has been reported to coincide with the apparent increase in the incidence of autism. Case reports have described children who developed signs of both developmental regression and gastrointestinal symptoms shortly after MMR vaccination.A review of the literature revealed no convincing scientific evidence to support a causal relationship between the use of MMR vaccines and autism. No primate models exist to support the hypothesis. The biological plausibility remains questionable and there is a sound body of epidemiological evidence to refute the hypothesis. The hypothesis has been subjected to critical evaluation in many different ways, using techniques from molecular biology to population-based epidemiology, and with a vast number of independent researchers involved, none of which has been able to corroborate the hypothesis.

http://www.ncbi.nlm.nih.gov/pubmed/1536 ... d_RVDocSum

Lancet. 2004 Sep 11-17;364(9438):963-9.Click here to read Links
MMR vaccination and pervasive developmental disorders: a case-control study.
Smeeth L, Cook C, Fombonne E, Heavey L, Rodrigues LC, Smith PG, Hall AJ.

Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. [email protected]

BACKGROUND: Concern that measles-mumps-rubella (MMR) vaccination might cause autism has led to a fall in vaccine coverage. We investigated whether MMR vaccination is associated with an increased risk of autism or other pervasive developmental disorders. METHODS: We did a matched case-control study using the UK General Practice Research Database. Cases were people born in 1973 or later who had first recorded diagnosis of pervasive developmental disorder while registered with a contributing general practice between 1987 and 2001. Controls were matched on age, sex, and general practice. FINDINGS: 1294 cases and 4469 controls were included. 1010 cases (78.1%) had MMR vaccination recorded before diagnosis, compared with 3671 controls (82.1%) before the age at which their matched case was diagnosed. After adjustment for age at joining the database, the odds ratio for association between MMR and pervasive developmental disorder was 0.86 (95% CI 0.68-1.09). Findings were similar when restricted to children with a diagnosis of autism, to those vaccinated with MMR before the third birthday, or to the period before media coverage of the hypothesis linking MMR with autism. INTERPRETATION: Our findings suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.

http://www.ncbi.nlm.nih.gov/pubmed/1534 ... d_RVDocSum
Pediatrics. 2004 Sep;114(3):584-91.Click here to read Links
Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association.
Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B.

Statistics Unit, Health Protection Agency, Communicable Disease Surveillance Centre, London, United Kingdom.

OBJECTIVE: After concerns about the possible toxicity of thimerosal-containing vaccines in the United States, this study was designed to investigate whether there is a relationship between the amount of thimerosal that an infant receives via diphtheria-tetanus-whole-cell pertussis (DTP) or diphtheria-tetanus (DT) vaccination at a young age and subsequent neurodevelopmental disorders. METHODS: A retrospective cohort study was performed using 109 863 children who were born from 1988 to 1997 and were registered in general practices in the United Kingdom that contributed to a research database. The disorders investigated were general developmental disorders, language or speech delay, tics, attention-deficit disorder, autism, unspecified developmental delays, behavior problems, encopresis, and enuresis. Exposure was defined according to the number of DTP/DT doses received by 3 and 4 months of age and also the cumulative age-specific DTP/DT exposure by 6 months. Each DTP/DT dose of vaccine contains 50 microg of thimerosal (25 microg of ethyl mercury). Hazard ratios (HRs) for the disorders were calculated per dose of DTP/DT vaccine or per unit of cumulative DTP/DT exposure. RESULTS: Only in 1 analysis for tics was there some evidence of a higher risk with increasing doses (Cox's HR: 1.50 per dose at 4 months; 95% confidence interval [CI]: 1.02-2.20). Statistically significant negative associations with increasing doses at 4 months were found for general developmental disorders (HR: 0.87; 95% CI: 0.81-0.93), unspecified developmental delay (HR: 0.80; 95% CI: 0.69-0.92), and attention-deficit disorder (HR: 0.79; 95% CI: 0.64-0.98). For the other disorders, there was no evidence of an association with thimerosal exposure. CONCLUSIONS: With the possible exception of tics, there was no evidence that thimerosal exposure via DTP/DT vaccines causes neurodevelopmental disorders.

http://www.ncbi.nlm.nih.gov/pubmed/1528 ... d_RVDocSum
Br J Nurs. 2004 Jul 22-Aug 11;13(14):834-8.Links

Comment in:
Br J Nurs. 2004 Sep 9-22;13(16):955; author reply 955.

Exploring the evidence surrounding the debate on MMR and autism.
Purssell E.

Florence Nightingale School of Nursing and Midwifery, King's College London, London.

Autism is a poorly understood condition that would appear to be on the increase. There is currently much concern about a possible link between the measles, mumps and rubella (MMR) vaccination and autism which has resulted in a substantial reduction in the uptake of MMR, putting children at risk of three significant childhood diseases. This article looks at the evidence for a link between MMR and autism, finding that while a plausible hypothesis has been constructed, there is not substantive evidence for such a link and that the quality of this evidence is, in many cases, poor. This is due, in part, to the difficulties inherent in pre- and post-licensure vaccination research. These difficulties and the importance of vaccination and parental understanding of risk are discussed.

http://www.ncbi.nlm.nih.gov/pubmed/1517 ... d_RVDocSum
Ann Pharmacother. 2004 Jul-Aug;38(7-8):1297-300. Epub 2004 Jun 1.Click here to read Links
Relationship between MMR vaccine and autism.
Klein KC, Diehl EB.

Clinical Sciences Department, College of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI 48109-0221, USA. [email protected]

OBJECTIVE: To evaluate the proposed link between the administration of the measles, mumps, and rubella (MMR) vaccine and the development of autism. DATA SOURCES: A literature search utilizing MEDLINE (1966-November 2003), with the key terms measles, mumps, rubella, and autism, was conducted. Review of the references listed in the articles identified was also performed. DATA SYNTHESIS: Ten articles that specifically evaluated the possible relationship between the MMR vaccine and autism were identified. Review articles, commentaries, and evaluations of a link between gastrointestinal symptoms in autistic children and MMR immunization were excluded. CONCLUSIONS: Based upon the current literature, it appears that there is no relationship between MMR vaccination and the development of autism.

http://www.ncbi.nlm.nih.gov/pubmed/1497 ... d_RVDocSum
Med Sci Monit. 2004 Mar;10(3):PI33-9. Epub 2004 Mar 1.Click here to read Links

Comment in:
Med Sci Monit. 2005 Oct;11(10):LE13-4.

A comparative evaluation of the effects of MMR immunization and mercury doses from thimerosal-containing childhood vaccines on the population prevalence of autism.
Geier DA, Geier MR.

President, MedCon, Inc, Silver Spring, MD, USA.

BACKGROUND: The purpose of the study was to evaluate the effects of MMR immunization and mercury from thimerosal-containing childhood vaccines on the prevalence of autism. MATERIAL/METHODS: Evaluations of the Biological Surveillance Summaries of the Centers for Disease Control and Prevention (CDC), the U.S. Department of Education datasets, and the CDC's yearly live birth estimates were undertaken RESULTS: It was determined that there was a close correlation between mercury doses from thimerosal--containing childhood vaccines and the prevalence of autism from the late 1980s through the mid-1990s. In contrast, there was a potential correlation between the number of primary pediatric measles-containing vaccines administered and the prevalence of autism during the 1980s. In addition, it was found that there were statistically significant odds ratios for the development of autism following increasing doses of mercury from thimerosal-containing vaccines (birth cohorts: 1985 and 1990-1995) in comparison to a baseline measurement (birth cohort: 1984). The contribution of thimerosal from childhood vaccines (>50% effect) was greater than MMR vaccine on the prevalence of autism observed in this study. CONCLUSIONS: The results of this study agree with a number of previously published studies. These studies have shown that there is biological plausibility and epidemiological evidence showing a direct relationship between increasing doses of mercury from thimerosal-containing vaccines and neurodevelopmental disorders, and measles-containing vaccines and serious neurological disorders. It is recommended that thimerosal be removed from all vaccines, and additional research be undertaken to produce a MMR vaccine with an improved safety profile.

http://www.ncbi.nlm.nih.gov/pubmed/1475 ... d_RVDocSum
Pediatrics. 2004 Feb;113(2):259-66.Click here to read Links
Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta.
DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C.

National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. [email protected]

OBJECTIVE: To compare ages at first measles-mumps-rubella (MMR) vaccination between children with autism and children who did not have autism in the total population and in selected subgroups, including children with regression in development. METHODS: A case-control study was conducted in metropolitan Atlanta. Case children (N = 624) were identified from multiple sources and matched to control children (N = 1824) on age, gender, and school. Vaccination data were abstracted from immunization forms required for school entry. Records of children who were born in Georgia were linked to Georgia birth certificates for information on maternal and birth factors. Conditional logistic regression was used to estimate odds ratios (ORs). RESULTS: The overall distribution of ages at MMR vaccination among children with autism was similar to that of matched control children; most case (70.5%) and control children (67.5%) were vaccinated between 12 and 17 months of age. Similar proportions of case and control children had been vaccinated before 18 or before 24 months. No significant associations for either of these age cutoffs were found for specific case subgroups, including those with evidence of developmental regression. More case (93.4%) than control children (90.6%) were vaccinated before 36 months (OR: 1.49; 95% confidence interval: 1.04-2.14 in the total sample; OR: 1.23; 95% confidence interval: 0.64-2.36 in the birth certificate sample). This association was strongest in the 3- to 5-year age group. CONCLUSIONS: Similar proportions of case and control children were vaccinated by the recommended age or shortly after (ie, before 18 months) and before the age by which atypical development is usually recognized in children with autism (ie, 24 months). Vaccination before 36 months was more common among case children than control children, especially among children 3 to 5 years of age, likely reflecting immunization requirements for enrollment in early intervention programs.

http://www.ncbi.nlm.nih.gov/pubmed/1458 ... d_RVDocSum
Dev Med Child Neurol. 2003 Nov;45(11):724-30.Click here to read Links

Comment in:
Dev Med Child Neurol. 2003 Nov;45(11):723.

Autism spectrum disorders in children with active epilepsy and learning disability: comorbidity, pre- and perinatal background, and seizure characteristics.
Steffenburg S, Steffenburg U, Gillberg C.

Department of Child and Adolescent Psychiatry, Göteborg University, Kungsgatan 12, SE-411 19 Göteborg, Sweden.

The aim of this study was to examine the comorbidity pattern, seizure characteristics, and aetiology in a representative group of children with a combination of autism spectrum disorder (ASD), active epilepsy, and learning disability. Ninety children (47 males, 43 females; mean age 11 years 2 months, range 8 to 16 years at the time of psychiatric examination) with active epilepsy and learning disability, identified in a population-based study in Göteborg, Sweden, were subdivided into those with and those without ASD and compared with respect to aetiology, additional neuroimpairments, and seizure characteristics. In addition, the cohorts were examined for trends of prevalence over a period of time. Results indicated that established aetiology was much more often present in the prenatal period than in the peri- or postnatal periods in the ASD group. Cerebral palsy and visual impairment were under-represented in the ASD group. Partial seizures tended to be more common and generalized seizures less common in the ASD group compared with the non-ASD group. Seizure onset was later in the ASD group. Many of the significant differences were accounted for by a large group of psychiatrically unclassifiable participants in the non-ASD group. There was no trend towards an increase of affected children over the 12-year period. There was no increase in the prevalence of active epilepsy and learning disability nor in the rate of autism with active epilepsy and learning disability in children born between 1981 and 1986 compared with those born from 1976 to 1980, indicating no statistical association with the general measles-mumps-rubella vaccination introduced in the early 1980s.

http://www.ncbi.nlm.nih.gov/pubmed/1451 ... d_RVDocSum
JAMA. 2003 Oct 1;290(13):1763-6.Click here to read Links

Comment in:
J Fam Pract. 2004 Feb;53(2):94-6.
JAMA. 2004 Jan 14;291(2):180; author reply 180-1.
JAMA. 2004 Jan 14;291(2):180; author reply 180-1.

Association between thimerosal-containing vaccine and autism.
Hviid A, Stellfeld M, Wohlfahrt J, Melbye M.

Danish Epidemiology Science Centre, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. [email protected]

CONTEXT: Mercuric compounds are nephrotoxic and neurotoxic at high doses. Thimerosal, a preservative used widely in vaccine formulations, contains ethylmercury. Thus it has been suggested that childhood vaccination with thimerosal-containing vaccine could be causally related to neurodevelopmental disorders such as autism. OBJECTIVE: To determine whether vaccination with a thimerosal-containing vaccine is associated with development of autism. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study of all children born in Denmark from January 1, 1990, until December 31, 1996 (N = 467 450) comparing children vaccinated with a thimerosal-containing vaccine with children vaccinated with a thimerosal-free formulation of the same vaccine. MAIN OUTCOME MEASURES: Rate ratio (RR) for autism and other autistic-spectrum disorders, including trend with dose of ethylmercury. RESULTS: During 2 986 654 person-years, we identified 440 autism cases and 787 cases of other autistic-spectrum disorders. The risk of autism and other autistic-spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine (RR, 0.85 [95% confidence interval [CI], 0.60-1.20] for autism; RR, 1.12 [95% CI, 0.88-1.43] for other autistic-spectrum disorders). Furthermore, we found no evidence of a dose-response association (increase in RR per 25 microg of ethylmercury, 0.98 [95% CI, 0.90-1.06] for autism and 1.03 [95% CI, 0.98-1.09] for other autistic-spectrum disorders). CONCLUSION: The results do not support a causal relationship between childhood vaccination with thimerosal-containing vaccines and development of autistic-spectrum disorders.

http://www.ncbi.nlm.nih.gov/pubmed/1294 ... d_RVDocSum
Jpn J Infect Dis. 2003 Jun;56(3):114-7.Click here to read Links
An epidemiological study on Japanese autism concerning routine childhood immunization history.
Takahashi H, Suzumura S, Shirakizawa F, Wada N, Tanaka-Taya K, Arai S, Okabe N, Ichikawa H, Sato T.

Institute for International Cooperation, Japan International Cooperation Agency, Tokyo 162-8433, Japan. [email protected]

To assess the causal association of autism with measles, mumps, and rubella (MMR) vaccine versus that with monovalent measles, mumps, and rubella immunization, a 1:2 sex-adjusted logistic regression analysis was conducted using data on subjects who were growing up in the Tokyo area between 1988 and 1992. When MMR immunization was used as a reference, monovalent measles immunization (odds ratio [OR] = 5.33, 99% confidence interval [CI]: 1.03-27.74), non-mumps immunization (OR = 8, 99%CI: 1.33-48.2), and non-rubella immunization (OR = 8.57, 99%CI: 1.30-56.4) with development of autistic spectrum disorders (ASD) were significantly increased. These results suggest a decreased risk of developing ASD with MMR compared to monovalent antigens. However, our findings may reflect potential selection bias due to requiring written consent, possible delayed vaccination in suspected autism cases, and small sample size (case = 21). For the case group and the control group, immunization completeness rate of each antigen, regardless of the timing of immunization, was 90.5% versus 100% in measles, 42.9% versus 78.6% in mumps (P < 0.01), 52.3% versus 83.3% in rubella (P < 0.01), 14.3% versus 45.2% in varicella (P < 0.01), 100% versus 90.5% in polio>2, 100% versus 97.6% in Diphtheria (D), pertussis, and tetanus (T)>3, 85.7% versus 66.7% in DT, 95.2% versus 92.9% in BCG, and 52.4% versus 81.0% in Japanese encephalitis>3 (P<0.01). Only two case subjects and four control subjects received their measles, mumps, and rubella immunizations separately, suggesting that few Japanese parents might have had concerns about the safety of MMR vaccine. A nation-wide study would be a practical measure to scientifically judge the safety of MMR and other routine childhood immunizations.

http://www.ncbi.nlm.nih.gov/pubmed/1292 ... d_RVDocSum
Vaccine. 2003 Sep 8;21(25-26):3954-60.Click here to read Links

Comment in:
Vaccine. 2004 Oct 22;22(31-32):4135-6.

Unintended events following immunization with MMR: a systematic review.
Jefferson T, Price D, Demicheli V, Bianco E; European Research Program for Improved Vaccine Safety Surveillance (EUSAFEVAC) Project.

Reparto Epidemiologia Clinica, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161 Rome, Italy. [email protected]

Public debate over the safety of the trivalent measles, mumps and rubella (MMR) vaccine and the drop in vaccination rates in several countries persists despite its almost universal use and accepted effectiveness. We carried out a systematic review to assess the evidence of unintended effects (beneficial or harmful) associated with MMR and the applicability of systematic reviewing methods to the field of safety evaluation. Eligible studies were comparative prospective or retrospective on healthy individuals up to 15 years of age, carried out or published by 2003. We identified 120 articles satisfying our inclusion criteria and included 22. MMR is associated with a lower incidence of upper respiratory tract infections, a higher incidence of irritability, similar incidence of other adverse effects compared to placebo and is likely to be associated with benign thrombocytopenic purpura (TP), parotitis, joint and limb complaints and aseptic meningitis (mumps Urabe strain-containing MMR). Exposure to MMR is unlikely to be associated with Crohn's disease, ulcerative colitis, autism or aseptic meningitis (mumps Jeryl-Lynn strain-containing MMR). The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunization with MMR cannot be separated from its role in preventing the target diseases.

http://www.ncbi.nlm.nih.gov/pubmed/1291 ... d_RVDocSum
Semin Pediatr Infect Dis. 2003 Jul;14(3):199-206.Click here to read Links
Measles-mumps-rubella vaccine and the development of autism.
Miller E.

Immunisation Division, Public Health Laboratory Service, 61 Colindale Avenue, London NW9 5EQ, UK. [email protected]

The measles-mumps-rubella (MMR) vaccine has been postulated to cause a form of autism characterized by regression and bowel symptoms, and onset occurring shortly after vaccination. It is also claimed that, as a result, there has been a dramatic increase in autism prevalence. These hypotheses have now been tested in a number of epidemiologic studies that are reviewed in this article. None has found any evidence of the existence of a phenotypically distinct form of autism in children who received the MMR vaccine or of a clustering of onset symptoms in children who are autistic after receiving the MMR vaccine. There is no proof that the overall risk of autism is higher in children who were vaccinated with MMR or of an increase in autism prevalence associated with the use of the MMR vaccine. No epidemiologic evidence suggests an association between MMR vaccination and autism. Moreover, epidemiologic evidence against such an association is compelling.

http://www.ncbi.nlm.nih.gov/pubmed/1290 ... d_RVDocSum
Expert Opin Drug Saf. 2002 Jul;1(2):115-20.Click here to read Links
MMR vaccination and autism: is there a link?
DeStefano F, Thompson WW.

In 1998, a report was published describing 12 patients with inflammatory bowel conditions and regressive developmental disorders consisting primarily of autism. The authors hypothesised that MMR vaccine may have been responsible for the bowel dysfunction which subsequently resulted in the neurodevelopmental disorders. The suggestion that measles vaccine may cause autism through a persistent bowel infection generated much interest since it provided a possible biological mechanism for a causal association. Epidemiological studies, however, have not found an association between MMR vaccination and autism. Autism has a strong genetic component and its associated neurological defects probably occur during embryonic development. It seems unlikely that a vaccination that is given after birth could cause autism. In a minority of cases, autism may have onset after 1 year of age (regressive autism) but the one epidemiological study that included such cases did not find an association with MMR vaccination. Currently, the weight of the available epidemiological and related evidence does not support a causal link between MMR vaccine and autism.

http://www.ncbi.nlm.nih.gov/pubmed/1288 ... d_RVDocSum
Am J Prev Med. 2003 Aug;25(2):101-6.Click here to read Links

Comment in:
Am J Prev Med. 2004 Jan;26(1):91; reply 91-2.

Autism and thimerosal-containing vaccines: lack of consistent evidence for an association.
Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D.

Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA. [email protected]

BACKGROUND: In 1999, concerns were raised that vaccines containing the preservative Thimerosal might increase the risk of autism and/or other neurodevelopmental disorders. METHODS: Between the mid-1980s through the late-1990s, we compared the prevalence/incidence of autism in California, Sweden, and Denmark with average exposures to Thimerosal-containing vaccines. Graphic ecologic analyses were used to examine population-based data from the United States (national immunization coverage surveys and counts of children diagnosed with autism-like disorders seeking special education services in California); Sweden (national inpatient data on autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal); and Denmark (national registry of inpatient/outpatient-diagnosed autism cases, national vaccination coverage levels, and information on use of all vaccines and vaccine-specific amounts of Thimerosal). RESULTS: In all three countries, the incidence and prevalence of autism-like disorders began to rise in the 1985-1989 period, and the rate of increase accelerated in the early 1990s. However, in contrast to the situation in the United States, where the average Thimerosal dose from vaccines increased throughout the 1990s, Thimerosal exposures from vaccines in both Sweden and Denmark-already low throughout the 1970s and 1980s-began to decrease in the late 1980s and were eliminated in the early 1990s. CONCLUSIONS: The body of existing data, including the ecologic data presented herein, is not consistent with the hypothesis that increased exposure to Thimerosal-containing vaccines is responsible for the apparent increase in the rates of autism in young children being observed worldwide.

http://www.ncbi.nlm.nih.gov/pubmed/1286 ... d_RVDocSum
Arch Pediatr Adolesc Med. 2003 Jul;157(7):628-34.Click here to read Links

Comment in:
Arch Pediatr Adolesc Med. 2003 Jul;157(7):619-21.
Evid Based Nurs. 2004 Jan;7(1):25.

Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence.
Wilson K, Mills E, Ross C, McGowan J, Jadad A.

Department of Medicine and Health Policy, University of Toronto, Ontario, Canada.

OBJECTIVE: To systematically review the evidence for and against the existence of an association between autistic spectrum disorder (ASD) and the measles, mumps, and rubella (MMR) vaccine.Study DESIGN: We conducted a systematic review of the medical literature to identify all controlled epidemiological articles examining for an association between ASD and the MMR vaccine. We extracted data from the articles on the characteristics and objectives of the study as well as evidence of an association. RESULTS: Twelve articles met the inclusion criteria. One study found no difference in the rates of ASD and the MMR vaccine in children who were vaccinated and those who were not. Six studies examined for evidence of an increase in ASD associated with an increase in the MMR vaccine coverage, none of which showed evidence of an association. Four studies examined if a variant form of ASD was associated with the MMR vaccine, none of which showed evidence of an association. Eight studies attempted to determine if there was a temporal association between developing ASD and receiving the MMR vaccine. Of these, 1 study identified an increase in parental concern in the 6-month period following vaccination with MMR in one of its analyses. The results of all other studies showed no association between ASD and the MMR vaccine. CONCLUSIONS: The current literature does not suggest an association between ASD and the MMR vaccine; however, limited epidemiological evidence exists to rule out a link between a rare variant form of ASD and the MMR vaccine. Given the real risks of not vaccinating and that the risks and existence of variant ASD remain theoretical, current policies should continue to advocate the use of the MMR vaccine.

http://www.ncbi.nlm.nih.gov/pubmed/1258 ... d_RVDocSum
Curr Neurol Neurosci Rep. 2003 Mar;3(2):149-56.Links
The neurobiology of autism: new pieces of the puzzle.
Acosta MT, Pearl PL.

Department of Neurology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010-2970, USA. [email protected]

The neurobiologic basis of autism is reviewed, with discussion of evidence from genetic, magnetic resonance imaging, neuropathology, and functional neuroimaging studies. Although autism is a behaviorally valid syndrome, it is remarkably heterogeneous and involves multiple developmental domains as well as a wide range of cognitive, language, and socioemotional functioning. Although multiple etiologies are implicated, recent advances have identified common themes in pathophysiology. Genetic factors play a primary role, based on evidence from family studies, identification of putative genes using genome-wide linkage analyses, and comorbidities with known genetic mutations. The RELN gene, which codes for an extracellular protein guiding neuronal migration, has been implicated in autism. Numerous neuropathologic changes have been described, including macroencephaly, acceleration and then deceleration in brain growth, increased neuronal packing and decreased cell size in the limbic system, and decreased Purkinje cell number in the cerebellum. Abnormalities in organization of the cortical minicolumn, representing the fundamental subunit of vertical cortical organization, may underlie the pathology of autism and result in altered thalamocortical connections, cortical disinhibition, and dysfunction of the arousal-modulating system of the brain. The role of acquired factors is speculative, with insufficient evidence to link the measles-mumps-rubella (MMR) vaccine with autism or to change immunization practices.

http://www.ncbi.nlm.nih.gov/pubmed/1252 ... d_RVDocSum
Ugeskr Laeger. 2002 Dec 2;164(49):5741-4.Links
[MMR vaccination and autism--a population-based follow-up study]
[Article in Danish]

Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M.

Center for Epidemiologisk Grundforskning, Institut for Epidemiologi og Socialmedicin, Aarhus Universitet, DK-8000 Arhus C. [email protected]

INTRODUCTION: It has been suggested that the measles-mumps-rubella (MMR) vaccination causes autism. MATERIAL AND METHODS: We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was established based on data from the Danish Civil Registration System. A unique person identifiable number given to all subjects enabled linkage with other national registries. MMR vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register which contains information on all diagnoses received from psychiatric hospitals, psychiatric wards, and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. RESULTS: In the cohort of 537,303 children (2,129,864 person-years), 440,655 children had been MMR vaccinated. We identified 316 children with a diagnosis of autistic disorder and 442 with a diagnosis of other spectrum disorders. After adjusting for potential confounders, the risk for autistic disorder and other spectrum disorders was not increased in vaccinated compared with unvaccinated children (relative risk 0.92; 95 percent confidence interval, 0.68 to 1.24 and relative risk 0.83; 95 percent confidence interval, 0.65 to 1.07). There was no association between age at vaccination, time since vaccination or calendar period at time of vaccination and development of autistic disorder. DISCUSSION: This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

http://www.ncbi.nlm.nih.gov/pubmed/1242 ... d_RVDocSum
Gut. 2002 Dec;51(6):816-7.Click here to read Click here to read Links
Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine.
Thjodleifsson B, Davídsdóttir K, Agnarsson U, Sigthórsson G, Kjeld M, Bjarnason I.

Department of Medicine, University Hospital, Hringbraut, Reykjavík, Iceland.

BACKGROUND: The safety of infant vaccination has been questioned in recent years. In particular it has been suggested that the measles, mumps, and rubella (MMR) vaccination leads to brain damage manifesting as autism consequent to the development of an "enterocolitis" in the immediate post-vaccination period. AIM: To assess if MMR vaccination is associated with subclinical intestinal inflammation, which is central to the autistic "enterocolitis" theory. METHODS: We studied 109/58 infants, before and two and four weeks after immunisation with Pentavac and MMR vaccines, for the presence of intestinal inflammation (faecal calprotectin). RESULTS: Neither vaccination was associated with any significant increase in faecal calprotectin concentrations. CONCLUSIONS: The failure of the MMR vaccination to cause an intestinal inflammatory response provides evidence against the proposed gut-brain interaction that is central to the autistic "enterocolitis" hypothesis.


http://www.ncbi.nlm.nih.gov/pubmed/1242 ... d_RVDocSum
N Engl J Med. 2002 Nov 7;347(19):1477-82.Click here to read Links

Comment in:
Evid Based Ment Health. 2003 May;6(2):62.
Evid Based Nurs. 2003 Jul;6(3):89.
N Engl J Med. 2002 Nov 7;347(19):1474-5.
N Engl J Med. 2003 Mar 6;348(10):951-4; author reply 951-4.
N Engl J Med. 2003 Mar 6;348(10):951-4; author reply 951-4.
N Engl J Med. 2003 Mar 6;348(10):951-4; author reply 951-4.

A population-based study of measles, mumps, and rubella vaccination and autism.
Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M.

Danish Epidemiology Science Center, Department of Epidemiology and Social Medicine, Arhus, Denmark. [email protected]

BACKGROUND: It has been suggested that vaccination against measles, mumps, and rubella (MMR) is a cause of autism. METHODS: We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was selected on the basis of data from the Danish Civil Registration System, which assigns a unique identification number to every live-born infant and new resident in Denmark. MMR-vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register, which contains information on all diagnoses received by patients in psychiatric hospitals and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. RESULTS: Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. CONCLUSIONS: This study provides strong evidence against the hypothesis that MMR vaccination causes autism. Copyright 2002 Massachusetts Medical Society

http://www.ncbi.nlm.nih.gov/pubmed/1241 ... d_RVDocSum
Pediatrics. 2002 Nov;110(5):957-63.Click here to read Links

Comment in:
Pediatrics. 2003 Jul;112(1 Pt 1):206.

Neurologic disorders after measles-mumps-rubella vaccination.
Mäkelä A, Nuorti JP, Peltola H.

Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. [email protected]

OBJECTIVE: The possibility of adverse neurologic events has fueled much concern about the safety of measles-mumps-rubella (MMR) vaccinations. The available evidence concerning several of the postulated complications is controversial. The aim of this study was to assess whether an association prevails between MMR vaccination and encephalitis, aseptic meningitis, and autism. METHODS: A retrospective study based on linkage of individual MMR vaccination data with a hospital discharge register was conducted among 535 544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland. For encephalitis and aseptic meningitis, the numbers of events observed within a 3-month risk interval after vaccination were compared with the expected numbers estimated on the basis of occurrence of encephalitis and aseptic meningitis during the subsequent 3-month intervals. Changes in the overall number of hospitalizations for autism after vaccination throughout the study period were searched for. In addition, hospitalizations because of inflammatory bowel diseases were checked for the children with autism. RESULTS: Of the 535 544 children who were vaccinated, 199 were hospitalized for encephalitis, 161 for aseptic meningitis, and 352 for autistic disorders. In 9 children with encephalitis and 10 with meningitis, the disease developed within 3 months of vaccination, revealing no increased occurrence within this designated risk period. We detected no clustering of hospitalizations for autism after vaccination. None of the autistic children made hospital visits for inflammatory bowel diseases. CONCLUSIONS: We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.

http://www.ncbi.nlm.nih.gov/pubmed/1226 ... d_RVDocSum
Paediatr Drugs. 2002;4(10):631-5.Links
Measles, mumps and rubella vaccine, autism and inflammatory bowel disease: advising concerned parents.
Elliman DA, Bedford HE.

Department of Child Health, St George's Hospital, Tooting, London, England. [email protected]

Measles, mumps and rubella (MMR) vaccine has been used for almost 30 years in the US, 20 years in Sweden and Finland, and over 10 years in most of the rest of Europe. During this time, it has brought about a dramatic reduction in the morbidity and mortality due to measles and mumps, as well as a considerable reduction in the number of babies with the congenital rubella syndrome. In spite of extensive evidence confirming the efficacy and safety of the vaccine, concerns have recently been raised about a possible link with autism and bowel problems. These arose principally from a research group in the UK, but have now spread to other countries. In the UK this has caused a fall in the uptake of the vaccine with fears of possible outbreaks of measles and mumps in some groups of children. Over the last 3 years a number of studies have addressed this possible link between MMR and autism and inflammatory bowel disease. Studies from the US, UK, Sweden, and Finland have all failed to demonstrate a link. Amongst others, the American Academy of Pediatrics, the Royal College of Paediatrics and Child Health, the Institute of Medicine, and the World Health Organization have all considered the evidence and endorsed the continuing use of the vaccine. No regulatory body in the world has changed its policy as a result of this hypothesized link. Professionals and parents can be assured that MMR is well tried and tested and one of the most successful interventions in healthcare.

http://www.ncbi.nlm.nih.gov/pubmed/1220 ... d_RVDocSum
Med Hypotheses. 2002 Sep;59(3):283-8.Click here to read Links
Live virus vaccination near a pregnancy: flawed policies, tragic results.
Yazbak FE, Yazbak K.

TL Autism Research, West Falmouth, Massachusetts 02574-0770, USA. [email protected]

Vaccination of women with live virus vaccines around conception has always been contraindicated by the Center for Disease Control and Prevention (CDC) and the vaccine manufacturer because of potential risks to the fetus. Nevertheless this dangerous practice occurs and is associated with maternal health problems and a very high incidence of early-onset autism in the children.Postpartum vaccination with live virus vaccines has been recommended by the CDC, and described as 'convenient' by the vaccine manufacturer. This 'routine practice' may lead to health and is also associated with many health and obstetrical problems in the recipient, and is frequently associated with autism in both current and future children. Re-vaccination often fails to produce immunity, the very reason for which it was recommended.

http://www.ncbi.nlm.nih.gov/pubmed/1185 ... d_RVDocSum
BMJ. 2002 Feb 16;324(7334):393-6.Click here to read Click here to read Links

Comment in:
Mol Psychiatry. 2003 Feb;8(2):133-4.

Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study.
Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J.

Centre for Community Child Health, Royal Free and University College Medical School, University College London Royal Free Campus, London. [email protected]

Objectives: To investigate whether measles, mumps, and rubella (MMR) vaccination is associated with bowel problems and developmental regression in children with autism, looking for evidence of a "new variant" form of autism. Design: Population study with case note review linked to independently recorded vaccine data. Setting: Five health districts in north east London. Participants: 278 children with core autism and 195 with atypical autism, mainly identified from computerised disability registers and born between 1979 and 1998. Main outcome measures: Recorded bowel problems lasting at least three months, age of reported regression of the child's development where it was a feature, and relation of these to MMR vaccination. Results: The proportion of children with developmental regression (25% overall) or bowel symptoms (17%) did not change significantly (P value for trend 0.50 and 0.47, respectively) during the 20 years from 1979, a period which included the introduction of MMR vaccination in October 1988. No significant difference was found in rates of bowel problems or regression in children who received the MMR vaccine before their parents became concerned about their development (where MMR might have caused or triggered the autism with regression or bowel problem), compared with those who received it only after such concern and those who had not received the MMR vaccine. A possible association between non-specific bowel problems and regression in children with autism was seen but this was unrelated to MMR vaccination. Conclusions: These findings provide no support for an MMR associated "new variant" form of autism with developmental regression and bowel problems, and further evidence against involvement of MMR vaccine in the initiation of autism.

http://www.ncbi.nlm.nih.gov/pubmed/1170 ... d_RVDocSum
CNS Drugs. 2001;15(11):831-7.Links
Autism and measles-mumps-rubella vaccination: controversy laid to rest?
DeStefano F, Chen RT.

National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia 30341-3724, USA. [email protected]

It has been suggested that vaccination, particularly with measles-mumps-rubella (MMR) vaccine, may be related to the development of autism. The main evidence for a possible association is that the prevalence of autism has been increasing at the same time that infant vaccination coverage has increased, and that in some cases there is an apparent temporal association in which autistic characteristics are first noted shortly after vaccination. Although the prevalence of autism and similar disorders appears to have increased recently, it is not clear if this is an actual increase or the result of increased recognition and changes in diagnostic criteria. The apparent onset of autism in close proximity to vaccination may be a coincidental temporal association. The clinical evidence in support of an association derives from a series of 12 patients with inflammatory bowel conditions and regressive developmental disorders, mostly autism. The possibility that measles vaccine may cause autism through a persistent bowel infection has generated much interest, since it provides a possible biological mechanism. Epidemiological studies, however, have not found an association between MMR vaccination and autism. The epidemiological findings are consistent with current understanding of the pathogenesis of autism, which has a strong genetic component and in which the neurological defects probably occur early in embryonic development. It seems unlikely that a vaccination that is given after birth could cause autism. A minority of cases of autism may have onset after 1 year of age (regressive autism), but the single epidemiological study that included such cases did not find an association with MMR vaccination. Currently, the weight of the available epidemiological and related evidence does not support a causal association between MMR vaccine, or any other vaccine or vaccine constituent, and autism.

http://www.ncbi.nlm.nih.gov/pubmed/1139 ... d_RVDocSum
Vaccine. 2001 Jun 14;19(27):3632-5.Click here to read Links
MMR and autism: further evidence against a causal association.
Farrington CP, Miller E, Taylor B.

Department of Statistics, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK. [email protected]

The hypothesis that MMR vaccines cause autism was first raised by reports of cases in which developmental regression occurred soon after MMR vaccination. A previous study found no evidence to support this hypothesis. It has recently been suggested that MMR vaccine might cause autism, but that the induction interval need not be short. The data from the earlier study were reanalysed to test this second hypothesis. Our results do not support this hypothesis, and provide further evidence against a causal association between MMR vaccination and autism.

http://www.ncbi.nlm.nih.gov/pubmed/1125 ... d_RVDocSum
Br J Gen Pract. 2001 Mar;51(464):226-7.Click here to read Click here to read Links
Do children who become autistic consult more often after MMR vaccination?
DeWilde S, Carey IM, Richards N, Hilton SR, Cook DG.

Department of General Practice and Primary Care, George's Hospital Medical School, London SW17 0RE.

A close temporal association has been reported between the measles, mumps, and rubella (MMR) vaccination and dramatic behavioural decline in children subsequently diagnosed as autistic. We hypothesised that such a decline would be reflected in increased consultations with the child's general practitioner. The Doctor's Independent Network database was used to examine whether children subsequently diagnosed as autistic consulted more frequently than controls after MMR vaccination. No difference in consulting behaviour was seen in the six months post MMR. Any dramatic effect of MMR on behaviour seems unlikely.

http://www.ncbi.nlm.nih.gov/pubmed/1123 ... d_RVDocSum
JAMA. 2001 Mar 7;285(9):1183-5.Click here to read Links

Comment in:
JAMA. 2001 Jun 13;285(22):2852-3.

Time trends in autism and in MMR immunization coverage in California.
Dales L, Hammer SJ, Smith NJ.

Immunization Branch, California Department of Health Services, 2151 Berkeley Way, Room 712, Berkeley, CA 94704, USA. [email protected]

CONTEXT: Considerable concern has been generated in the lay and medical communities by a theory that increased measles-mumps-rubella (MMR) immunization among young children may be the cause of an apparent marked increase in autism occurrence. OBJECTIVE: To determine if a correlation exists in secular trends of MMR immunization coverage among young children and autism occurrence. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analyses of MMR immunization coverage rates among children born in 1980-1994 who were enrolled in California kindergartens (survey samples of 600-1900 children each year) and whose school immunization records were reviewed to retrospectively determine the age at which they first received MMR immunization; and of autism caseloads among children born in these years who were diagnosed with autism and were enrolled in the California Department of Developmental Services regional service center system. MAIN OUTCOME MEASURES: Measles-mumps-rubella immunization coverage rates as of ages 17 months and 24 months and numbers of Department of Developmental Services system enrollees diagnosed with autism, grouped by year of birth. RESULTS: Essentially no correlation was observed between the secular trend of early childhood MMR immunization rates in California and the secular trend in numbers of children with autism enrolled in California's regional service center system. For the 1980-1994 birth cohorts, a marked, sustained increase in autism case numbers was noted, from 44 cases per 100 000 live births in the 1980 cohort to 208 cases per 100 000 live births in the 1994 cohort (a 373% relative increase), but changes in early childhood MMR immunization coverage over the same time period were much smaller and of shorter duration. Immunization coverage by the age of 24 months increased from 72% to 82%, a relative increase of only 14%, over the same time period. CONCLUSIONS: These data do not suggest an association between MMR immunization among young children and an increase in autism occurrence.

http://www.ncbi.nlm.nih.gov/pubmed/1122 ... d_RVDocSum
BMJ. 2001 Feb 24;322(7284):460-3.Click here to read Click here to read Links

Comment in:
BMJ. 2001 Jul 21;323(7305):163-4.
BMJ. 2001 Jul 21;323(7305):163; author reply 164.
BMJ. 2001 Jul 21;323(7305):163; author reply 164.
Epidemiology. 2003 Sep;14(5):630-2.

Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis.
Kaye JA, del Mar Melero-Montes M, Jick H.

Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421, USA. [email protected]

OBJECTIVE: To estimate changes in the risk of autism and assess the relation of autism to the mumps, measles, and rubella (MMR) vaccine. DESIGN: Time trend analysis of data from the UK general practice research database (GPRD). SETTING: General practices in the United Kingdom. SUBJECTS: Children aged 12 years or younger diagnosed with autism 1988-99, with further analysis of boys aged 2 to 5 years born 1988-93. Main outcome measures: Annual and age specific incidence for first recorded diagnoses of autism (that is, when the diagnosis of autism was first recorded) in the children aged 12 years or younger; annual, birth cohort specific risk of autism diagnosed in the 2 to 5 year old boys; coverage (prevalence) of MMR vaccination in the same birth cohorts. RESULTS: The incidence of newly diagnosed autism increased sevenfold, from 0.3 per 10 000 person years in 1988 to 2.1 per 10 000 person years in 1999. The peak incidence was among 3 and 4 year olds, and 83% (254/305) of cases were boys. In an annual birth cohort analysis of 114 boys born in 1988-93, the risk of autism in 2 to 5 year old boys increased nearly fourfold over time, from 8 (95% confidence interval 4 to 14) per 10 000 for boys born in 1988 to 29 (20 to 43) per 10 000 for boys born in 1993. For the same annual birth cohorts the prevalence of MMR vaccination was over 95%. CONCLUSIONS: Because the incidence of autism among 2 to 5 year olds increased markedly among boys born in each year separately from 1988 to 1993 while MMR vaccine coverage was over 95% for successive annual birth cohorts, the data provide evidence that no correlation exists between the prevalence of MMR vaccination and the rapid increase in the risk of autism over time. The explanation for the marked increase in risk of the diagnosis of autism in the past decade remains uncertain.

http://www.ncbi.nlm.nih.gov/pubmed/1037 ... d_RVDocSum
Lancet. 1999 Jun 12;353(9169):2026-9.Click here to read Links

Comment in:
Lancet. 1999 Jun 12;353(9169):1987-8.
Lancet. 1999 Sep 11;354(9182):949-50.
Lancet. 1999 Sep 11;354(9182):951.
Lancet. 2000 Jan 29;355(9201):409-10.
Lancet. 2000 Jul 8;356(9224):160-1.
Lancet. 2000 Jul 8;356(9224):161-2.

Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association.
Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, Waight PA.

Department of Community Child Health, Royal Free and University College Medical School, University College London, UK.

BACKGROUND: We undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism. METHODS: Children with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method. FINDINGS: We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 [82%] core autism, 52 [31%] atypical autism, 27 [38%] Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0.94 [95% CI 0.60-1.47] and 1.09 [0.79-1.52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0.92 [0.38-2.21] and 1.00 [0.52-1.95]). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder. INTERPRETATION: Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.

Fine then, substitute "you" with "the author." Really though, posting this stuff would seem to be at least an implicit endorsement of the views expressed, especially as you did not specify otherwise.

I would not assume that posting an article implies any endorsement of its contents, but I agree that this is a misleading article. It fails to question the assumption that the "epidemic" is caused by increasing rates of autism spectrum disorders, as opposed to increasing rates of diagnosis.

Of course, think about the case of Hannah who was on the news this morning because her parents got some sort of settlement from the government because they were supposedly able to trace her autistic symptoms back to a day in which Hannah was given 9 (yes, count them 9) shots in one day.

Now, first of all, who would do that? I mean really. And secondly, there has never been any conclusive evidence that the two are even related. The studies show that vaccinated children have almost identical rates of autism as non-vaccinated.

Here's the problem I have with that:

In 2002, the New England Journal of Medicine, a well respected medical journals, announced they were no longer requiring reviewers to not have financial ties to drug companies whose medicines were being analyzed.

The reason? The journal was unable to find enough independent experts because almost everyone was paid off in some way by the drug companies.

http://www.cancertutor.com/Other/NoCancer2.html

If you want to read about past corruption, you should look into the Council for Tobacco Research. They conducted 1,500 studies by 1,100 independent scientists and they all concluded that cigarettes and tobacco don't cause cancer.

""Far from being independent, the activities of the CTR [Council for Tobacco Research] and SAB [Scientific Advisory Board] activities were monitored and controlled by industry representatives, including tobacco company lawyers and public relations consultants.

"Although the industry funded a number of other 'outside' research projects, it did so only when it received clear advance assurances of a 'favorable' outcome."

http://tobaccodocuments.org/landman/375 ... d_page=462

The current situation:
Researchers know that if they conduct a study and the drug companies or government don't like the results, then they will never get another research grant again. Therefore, they have to make the results agreeable to the gov't and drug companies.

I don't know whether vaccines cause many cases of autism. But from what I've read, hardly any researchers would dare conclude that they are involved because they could lose access to future grants, forcing them to choose another occupation, be mocked by their colleagues, and would have difficult finding another high paying career to replace their current occupation.

Disclaimer: Everything above is based on what I read on the Internet. We all know that "if it's on the Internet, it has to be true."

It was NINE??? I heard it was five - but that's still no excuse.

If I heard correctly, Hannah was ill and the vaccination program was delayed (as it should have been under those circumstances), but multiple vaccinations in one day is just asking for trouble. If a child is ill, the priority should be to get the child better - before proceeding with the vaccinations. One at a time!

Some problems I have with his debate
1. Why didn't anyone mention that test again (I think that if there is a vaccine autism link that it is something that exacerbates autism not something that causes it in the first place)
2. I don't want them to find what causes Autism because if they do they'll likely eliminate that cause or if it turns out to be genetic encourage screening or restraint by parents who could pass it on
3. They could try to find a cure for Autism based on the cause and force the cure on us