Search results for 'encephalitis'

Studies on the autism-vaccine hypothesis

15 Apr

Below is a collection of studies which the American Academy of Pediatrics put together on the autism/vaccine question. Why bring this up now? Because with the indictment of Poul Thorsen, I’ve read a number of comments where people are claiming that he worked on the study that debunked the connection. Hardly. Going through these quickly, I find 2 articles that Poul Thorsen worked on (the two Madsen studies). No one has made a credible claim that even the studies Mr. Thorsen worked on are tainted.

The comparison to Andrew Wakefield has already been made. Mr. Wakefield promoted the idea that the MMR vaccine caused autism, and was later was found guilty of a number of ethical lapses in his research efforts. The major difference between Wakefield and Thorsen is this: Wakefield was wrong. His assertion that the MMR was related to autism causation when he stated: “…but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.” It was a statement not even supported by his own paper (even if it hadn’t been based on fraudulent research), much less has ever been supported by research by any other team. By contrast, the work that Mr. Thorsen worked on has been replicated.

Lack of Association Between Measles-Mumps-Rubella Vaccination and Autism in Children: A Case-Control Study
Budzyn D, et al. The Pediatric Infectious Disease Journal. Vol. 29, No. 5, May 2010
Researchers in Poland compared vaccination history and autism diagnosis in 96 children with autism, ages 2 to 15, as well as 192 children in a control group. For children diagnosed before a diagnosis of autism, the autism risk was lower in children who received MMR vaccine than in nonvaccinated children. A similar result was achieved for the single-antigen measles vaccine.
AUTHOR CONCLUSION: The study provides evidence against the association of autism with either MMR or a single measles vaccine.

Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study
Hornig M et al., PLoS ONE 2008, 3(9): e3140 doi:10.1371/journal.pone.0003140
Researchers looked for measles virus in the guts of 25 children with both autism and gastrointestinal disorders, and another 13 children with the same gastrointestinal disorders but no autism. The virus was detected in one child from each group.
AUTHOR CONCLUSION: This study provides strong evidence against association of autism with persistent measles virus RNA in the gastrointestinal tract or with measles, mumps and rubella (MMR) vaccine exposure.

Measles Vaccination and Antibody Response in Autism Spectrum Disorders
Baird G et al., Archives of Disease in Childhood 2008; 93(10):832-7
Case-control study of 98 vaccinated children aged 10-12 years in the UK with autism spectrum disorder (ASD) and two control groups of similar age: 52 children with special educational needs but no ASD and 90 children in the typically developing group. No difference was found between cases and controls for measles antibody response. There was no dose-response relationship between autism symptoms and antibody concentrations.
AUTHOR CONCLUSION: No association between measles vaccination and ASD was shown.

MMR-Vaccine and Regression in Autism Spectrum Disorders: Negative Results Presented from Japan
Uchiyama T et al. Journal of Autism and Developmental Disorders, 2007; 37(2):210-7
Study of 904 patients with Autism Spectrum Disorders (ASD). During the period of measles, mumps and rubella vaccine (MMR) usage, no significant difference was found in the incidence of regression between MMR-vaccinated children and nonvaccinated children. Among the proportion and incidence of regression across the three MMR-program-related periods (before, during and after MMR usage), no significant difference was found between those who had received MMR and those who had not. Moreover, the incidence of regression did not change significantly across the three periods.
AUTHOR CONCLUSION: The data do not support an association between MMR and autism.

No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells from Children with Autism Spectrum Disorder
D’Souza Y et al. Pediatrics 2006; 118(4):1664-75
Peripheral blood mononuclear cells were isolated from 54 children with Autism Spectrum Disorders (ASD) and 34 developmentally normal children, and up to 4 realtime polymerase chain reaction assays and 2 nested polymerase chain reaction assays were performed. No sample from either ASD 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.
AUTHOR CONCLUSION: There is no evidence of measles virus persistence in the peripheral blood mononuclear cells of children with ASD.

Immunizations and Autism: A Review of the Literature
Doja A, Roberts W. The Canadian Journal of Neurological Sciences 2006; 33(4):341-6
Literature review found very few studies supporting an association between vaccines and autism, with the overwhelming majority showing no causal association between the measles, mumps and rubella (MMR) vaccine and autism. The vaccine preservative thimerosal has alternatively been hypothesized to have a possible causal role in autism. No convincing evidence was found to support an association between the vaccine preservative thimerosal and autism, nor for the use of chelation therapy in autism.
AUTHOR CONCLUSION: 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.

Pervasive Developmental Disorders in Montreal and Quebec, Canada: Prevalence and Links with Immunizations
Fombonne E et al. Pediatrics. 2006; 118(1):e139-50
Study of thimerosal and measles, mumps and rubella (MMR) vaccine uptake in 28,000 Canadian children born between 1987 and 1998, of whom 180 were identified with a pervasive developmental disorder.
AUTHOR CONCLUSION: The data rule out an association between pervasive developmental disorder and either high levels of ethyl mercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose MMR vaccinations.

Is there a ‘regressive phenotype’ of Autism Spectrum Disorder associated with the measles mumps-rubella vaccine? ACPEA Study
Richler et al. Journal of Autism and Developmental Disorders. 2006
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.
AUTHOR CONCLUSION: No evidence that onset of autistic symptoms or of regression was related to measles, mumps and rubella vaccination.

Relationship between MMR Vaccine and Autism
Klein KC, Diehl EB. The Annals of Pharmacotherapy. 2004; 38(7-8):1297-300
Ten articles that specifically evaluated the possible relationship between the measles, mumps and rubella (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.
AUTHOR CONCLUSION: Based upon the current literature, it appears that there is no relationship between MMR vaccination and the development of autism.

Immunization Safety Review: Vaccines and Autism
Institute of Medicine, The National Academies Press: 2004
The IOM’s Committee on Immunization Safety Review was convened in the fall of 2000 to provide an independent review of increasingly prominent vaccine safety concerns. The 15 committee members with expertise in pediatrics, internal medicine, immunology, neurology, infectious diseases, epidemiology, biostatistics, public health, risk perception, decision analysis, nursing, genetics, ethics and health communications analyzed over 200 relevant studies.
AUTHOR CONCLUSION: The committee rejected a causal relationship between the MMR vaccine and autism as well as a causal relationship between thimerosal containing vaccines and autism.

No effect of MMR withdrawal on the incidence of autism: a total population study
Honda H et al, Journal of Child Psychology and Psychiatry 2005 June; 46(6):572-9
Study examined incidence of Autism Spectrum Disorders (ASD) to age 7 for children born between 1988 and 1996 in Yokohama, Japan. The measles, mumps and rubella (MMR) vaccination rate in Yokohama declined significantly in the birth cohorts of years 1988-92, and no MMR vaccines were administered in 1993 or thereafter. In contrast, cumulative incidence of ASD up to age 7 increased significantly in the birth cohorts of years 1988 through 1996 and most notably rose dramatically beginning with the birth cohort of 1993.
AUTHOR CONCLUSION: MMR vaccination is not likely to be a main cause of ASD, and cannot explain the rise over time in the incidence of ASD. Withdrawal of MMR in countries where it is still being used cannot be expected to lead to a reduction in the incidence of ASD.

No evidence for links between autism, MMR and measles virus
Chen W et al, Psychological Medicine 2004 April;34(3):543-53
Study compared 2,407 persons with autism born between 1959 and 1993; to 4,640 Down syndrome subjects born between 1966 and 1993.
AUTHOR CONCLUSION: No increased risk of autism was found following exposures to wild measles and vaccinations with monovalent measles, and Urabe or Jeryl-Lynn variants of measles, mumps and rubella (MMR) vaccine.

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 et al. Pediatrics 2004; 113(2): 259-66
Study compared ages at first measles, mumps and 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.
AUTHOR CONCLUSION: 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).

MMR Vaccination and Pervasive Developmental Disorders: A Case-Control Study
Smeeth L et al. Lancet 2004; 364(9438):963-9
Matched case-control of 1,295 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 (4,469) were matched on age, sex and general practice. 1,010 cases (78.1%) had measles, mumps and rubella (MMR) vaccination recorded before diagnosis, compared with 3,671 controls (82.1%) before the age at which their matched case was diagnosed,
AUTHOR CONCLUSION: Data suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.

Prevalence of Autism and Parentally Reported Triggers in a North East London Population
Lingam R et al. Archives of Disease in Childhood. 2003; 88(8):666-70
Study of reported age of onset of Autism Spectrum Disorder (ASD) among 567 children in northeast London born between 1979 and 1998. The age at diagnosis of ASD was estimated to have decreased per five-year period since 1983, by 8.7% for childhood autism and by 11.0% for atypical autism.
AUTHOR CONCLUSION: The data suggest that a rise in autism prevalence was likely due to factors such as increased recognition, a greater willingness on the part of educators and families to accept the diagnostic label, and better recording systems. The proportion of parents attributing their child’s autism to MMR appears to have increased since August 1997.

A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism
Madsen KM et al. New England Journal of Medicine. 2002; 347(19):1477-82
Compared relative risk of Autism Spectrum Disorder (ASD) in children vaccinated with measles, mumps and rubella (MMR) vaccine and unvaccinated children born in Denmark between 1991 and 1998. Of the 537,303 children in the cohort, 82% had received the MMR vaccine. Researchers identified 316 children with a diagnosis of autism and 422 with a diagnosis of other ASDs. 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 autism.
AUTHOR CONCLUSION: This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

Neurologic Disorders after Measles-Mumps-Rubella Vaccination
Makela A et al. Pediatrics. 2002; 110:957-63
Study of 535,544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland.
AUTHOR CONCLUSION: Data do not support an association between measles, mumps and rubella (MMR) vaccination and encephalitis, aseptic meningitis or autism.

Relation of Childhood Gastrointestinal Disorders to Autism: Nested Case Control Study Using Data from the UK General Practice Research Database
Black C et al. British Medical Journal. 2002; 325:419-21
Nested case control study of 96 children diagnosed with autism and 449 controls. The estimated odds ratio for a history of gastrointestinal disorders among children with autism compared with children without autism was 1.0 (95% confidence interval 0.5 to 2.2).
AUTHOR CONCLUSION: No evidence was found that children with autism were more likely than children without autism to have had defined gastrointestinal disorders at any time before their diagnosis of autism.

Measles, Mumps, and Rubella Vaccination and Bowel Problems or Developmental Regression in Children with Autism: Population Study
Taylor B et al. British Medical Journal. 2002; 324(7334):393-6
Population study of 278 children with core autism and 195 with atypical autism, born between 1979 and 1998. The proportion of children with developmental regression (25% overall) or bowel symptoms (17%) did not change significantly during the 20 years from 1979, a period which included the introduction of measles, mumps and rubella (MMR) vaccination in October 1988.
AUTHOR CONCLUSION: Data 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.

No Evidence for a New Variant of Measles-Mumps-Rubella-Induced Autism
Fombonne E et al. Pediatrics. 2001;108(4):E58
Study compared 96 children with a pervasive developmental disorder (PDD) born between 1992 and 1995 and who had received the measles, mumps and rubella (MMR) vaccine, to PDD patients who did not receive MMR.
AUTHOR CONCLUSION: No evidence was found to support a distinct syndrome of MMR-induced autism or of “autistic enterocolitis.” These results add to the largescale epidemiologic studies that all failed to support an association between MMR and autism at population level. These findings do not argue for changes in current immunization programs and recommendations.

Measles-Mumps-Rubella and Other Measles-Containing Vaccines Do Not Increase the Risk for Inflammatory Bowel Disease: A Case-Control Study from the Vaccine Safety Datalink Project
Davis RL et al. Archives of Pediatric and Adolescent Medicine. 2001;155(3):354-9
A case control study of 155 persons with inflammatory bowel disease with up to five controls each. Neither past vaccination nor age at vaccination with other MCV was associated with increased risk for Crohn’s disease, ulcerative colitis, or IBD. Risk for Crohn’s disease, ulcerative colitis, or IBD was not elevated in the time immediately following vaccination with either vaccine.
AUTHOR CONCLUSION: Vaccination with MMR or other MCV, or the timing of vaccination early in life, did not increase the risk for IBD.

Time Trends in Autism and in MMR Immunization Coverage in California
Dales L et al. Journal of the American Medical Association. 2001; 285(9):1183-5
Scientists looked for correlation between increases in the rate of autism diagnoses and increases in the rate of measles, mumps and rubella (MMR) vaccination in children born between 1980 and 1994.
AUTHOR CONCLUSION: These data do not suggest an association between MMR immunization among young children and an increase in autism occurrence.

MMR and autism: further evidence against a causal association

Farrington CP, et al. Vaccine. 2001; Jun 14; 19(27):3632-5
Data from an earlier measles, mumps and rubella (MMR) vaccine study (Taylor et al, 2000) were reanalyzed to test a second hypothesis.
AUTHOR CONCLUSION: Results provide further evidence against a causal association between MMR vaccination and autism.

Mumps, Measles, and Rubella Vaccine and the Incidence of Autism Recorded by General Practitioners: A Time Trend Analysis
Kaye JA et al. British Medical Journal. 2001; 322:460-63
Study compared prevalence of measles, mumps and rubella (MMR) vaccination among children in the United Kingdom to rising prevalence of autism diagnoses for children.
AUTHOR CONCLUSION: 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.

Further Evidence of the Absence of Measles Virus Genome Sequence in Full Thickness Intestinal Specimens from Patients with Crohn’s Disease
Afzal MA, et al. Journal of Medical Virology. 2000; 62(3):377-82
Study of specimens of macroscopically inflamed and normal intestine along with mesenteric lymph nodes from patients with Crohn’s disease. None of the samples examined gave any evidence of the persistence of measles virus in the intestine of Crohn’s disease patients.
AUTHOR CONCLUSION: The study supports previous findings produced by this laboratory and others using highly sensitive measles virus specific PCR diagnostic technology.

Absence of Detectable Measles Virus Genome Sequence in Inflammatory Bowel Disease Tissues and Peripheral Blood Lymphocytes

Afzal MA et al. Journal of Medical Virology. 1998; 55(3):243-9
Study looked for measles virus in 93 colonoscopic biopsies and 31 peripheral blood lymphocyte preparations, examined and obtained from patients with inflammatory bowel disease (IBD) and noninflammatory controls.
AUTHOR CONCLUSION: Measles virus was not detected using this method.

Autism and Measles, Mumps, and Rubella Vaccine: No Epidemiological Evidence for a Causal Association
Taylor B et al. Lancet. 1999;353 (9169):2026-9
Researchers looked for a change in trend in incidence or age at diagnosis associated with the introduction of measles, mumps and rubella (MMR) vaccination to the United Kingdom in 1988. The study identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger syndrome) in children born in the UK since 1979. 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. Developmental regression was not clustered in the months after vaccination.
AUTHOR CONCLUSION: Data 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.

No Evidence for Measles, Mumps, and Rubella Vaccine-Associated Inflammatory Bowel Disease or Autism in a 14-year Prospective Study
Peltola H et al. Lancet. 1998; 351:1327-8
Prospective study of 3 million adverse events in temporal relation to MMR vaccine. A form was filled and posted to the data collectors, followed by another form with further information 2-3 weeks later. Researchers traced subjects who developed gastrointestinal symptoms or signs lasting 24 hours or more at any time after MMR vaccination (apart from within the first hour). Researchers also checked hospital and health center records or interviewed the local public-health nurses.
AUTHOR CONCLUSION: Over a decade’s effort to detect all severe adverse events associated with MMR vaccine could find no data supporting the hypothesis that it would cause pervasive developmental disorder or inflammatory bowel disease.

Exposure to Measles in Utero and Crohn’s Disease: Danish Register Study
Nielsen LL et al. British Medical Journal. 1998; 316(7126):196-7
Investigators identified 472 women aged 15 to 43 years who had been admitted with measles between 1915 and 1966. Thirty-three were pregnant: 11 developed measles during the first trimester, 9 during the second, 6 during the third, and 9 had exanthema less than 14 days after delivery. Of the 26 offspring identified (including one set of twins), four died, one in infancy. The diagnoses of the other three, who died as adults, did not suggest inflammatory bowel disease. Among individuals still alive (median age 51.4 (36-79) years) none were registered as having Crohn’s disease or inflammatory bowel disease.
AUTHOR CONCLUSION: Exposure to measles in utero does not seem to be strongly associated with the development of Crohn’s disease later in life.

U.S. Court of Federal Claims decision in Omnibus Autism Proceeding
On Feb. 12, 2009, the “vaccine court” ruled in three test cases on the theory that MMR vaccine and the vaccine preservative thimerosal are linked to autism. The court found the scientific evidence is overwhelmingly contrary to this theory.

Studies looking at thimerosal:

Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism
Price C et al., Pediatrics. Vol. 126 No. 4 October 2010, pp. 656-664
Researchers reviewed managed care organization records and conducted interviews with the parents of 256 children who were verified to have ASD according to a standardized personal evaluation. Children with ASD were further categorized as having autistic disorder or ASD with regression. Another 752 children without autism, matched to the ASD children by birth year, gender and managed care organization, were also studied. For none of the autism outcomes was prenatal or early life receipt of thimerosal-containing vaccines and immunoglobulins significantly greater among children with ASD than among children without ASD.
AUTHOR CONCLUSION: These results add to the evidence that thimerosal containing vaccines do not increase the risk of autism.

Continuing increases in autism reported to California’s developmental services system: mercury in retrograde
Schechter and Grether, 2008, Archives of General Psychiatry. 65(1):19-24
Study analyzed autism client data from the California Department of Developmental Services between 1995 and 2007. Even though thimerosal was absent from scheduled childhood vaccines after 2002, cases of autism continued to climb quarter by quarter.
AUTHOR CONCLUSION: The California DDS data do not show any recent decrease in autism in California despite the exclusion of more than trace levels of thimerosal from nearly all childhood vaccines. The data do not support the hypothesis that exposure to thimerosal during childhood is a primary cause of autism.

Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines
Pichichero, et al., Pediatrics. Vol. 121 No. 2, 2008, pp. e208-e214
Study assessed blood mercury levels of 216 healthy children prior to immunization with thimerosal-containing vaccines, and 12 hours to 30 days after. The blood mercury half-life was calculated to be 3.7 days and returned to prevaccination levels by day 30.
AUTHOR CONCLUSION: The blood half-life of intramuscular ethyl mercury from thimerosal in vaccines in infants is substantially shorter than that of oral methyl mercury in adults. Increased mercury levels were detected in stools after vaccination, suggesting that the gastrointestinal tract is involved in ethyl mercury elimination. Because of the differing pharmacokinetics of ethyl and methyl mercury, exposure guidelines based on oral methyl mercury in adults may not be accurate for risk assessments in children who receive thimerosal-containing vaccines.

Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
Thompson, et al. 2007, New England Journal of Medicine. 357:1281-1292
Study compared early exposure to thimerosal-containing vaccines to 42 neuropsychological outcomes in 1,047 children between the ages of 7 and 10 years. Exposure to mercury from thimerosal was determined from computerized immunization records, medical records, personal immunization records and parent interviews.
AUTHOR CONCLUSION: The study does not support a causal association between early exposure to mercury from thimerosal-containing vaccines and immune globulins and deficits in neuropsychological functioning at the age of 7 to 10 years.

Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations
Fombonne, et al., Pediatrics. Vol. 118 No. 1, 2006, pp. e139-e150
Quantified thimerosal and measles, mumps rubella (MMR) vaccine uptake in 28,000 Canadian children born between 1987 and 1998, of whom180 were identified with a pervasive developmental disorder.
AUTHOR CONCLUSION: The data rule out an association between pervasive developmental disorder and either high levels of ethyl mercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measlesmumps-rubella vaccinations.

Immunization Safety Review: Vaccines and Autism
Institute of Medicine, The National Academies Press: 2004
The IOM’s Committee on Immunization Safety Review was convened in the fall of 2000 to provide an independent review of increasingly prominent vaccine safety concerns. The 15 committee members with expertise in pediatrics, internal medicine, immunology, neurology, infectious diseases, epidemiology, biostatistics, public health, risk perception, decision analysis, nursing, genetics, ethics and health communications analyzed over 200 relevant studies.
AUTHOR CONCLUSION: The committee rejected a causal relationship between the MMR vaccine and autism as well as a causal relationship between thimerosal containing vaccines and autism.

Thimerosal Exposure in Infants and Developmental Disorders: A Retrospective Cohort Study in the United Kingdom Does Not Support a Causal Association
Andrews N et al., Pediatrics. Vol. 114 No. 3, 2004, pp. 584-591
Study analyzed thimerosal exposure and possible development delays in 109,863 children born in the United Kingdom from 1988-97. 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.
AUTHOR CONCLUSION: With the possible exception of tics, there was no evidence that thimerosal exposure via DTP/DT vaccines causes neurodevelopmental disorders.

Autism and thimerosal-containing vaccines: Lack of consistent evidence for an association
Stehr-Green P et al., American Journal of Preventive Medicine. 2003; 25(2):101-6
Study compared the prevalence/incidence of autism in California, Sweden and Denmark from the mid-80s to the late 90s with average exposures to thimerosal containing vaccines. In all three countries, the incidence and prevalence of Autism Spectrum Disorders began to rise in the 1985-1989 period, and the rate of increase accelerated in the early 1990s.
AUTHOR CONCLUSION: The data 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.

Thimerosal and the Occurrence of Autism: Negative Ecological Evidence From Danish Population-Based Data
Madsen et al., Pediatrics; Vol. 112 No. 3, 2003, pp. 604-606
Analyzed data from the Danish Psychiatric Central Research Register recording all psychiatric admissions since 1971, and all outpatient contacts in psychiatric departments in Denmark since 1995. There was no trend toward an increase in the incidence of autism during that period when thimerosal was used in Denmark, up through 1990. From 1991 until 2000 the incidence increased and continued to rise after the removal of thimerosal from vaccines, including increases among children born after the discontinuation of thimerosal.
AUTHOR CONCLUSION: The discontinuation of thimerosal-containing vaccines in Denmark in 1992 was followed by an increase in the incidence of autism. The data do not support a correlation between thimerosal-containing vaccines and the incidence of autism.

Association Between Thimerosal-Containing Vaccine and Autism
Hviid et al., Journal of the American Medical Association, 2003; 290(13):1763-6
Study of 467,000 children born in Denmark between 1990 and 1996 compared children who were vaccinated with a thimerosal-containing vaccine to children who received a thimerosal-free formulation of the same vaccine. The risk of autism and other autism spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine.
AUTHOR CONCLUSION: The results do not support a causal relationship between childhood vaccination with thimerosal-containing vaccines and development of autistic-spectrum disorders.

Thimerosal Exposure in Infants and Developmental Disorders: A Prospective Cohort Study in the United Kingdom Does Not Support a Causal Association

Heron et al., Pediatrics. Vol. 114 No. 3, 2004, pp. 577-583
The researchers monitored the thimerosal exposure of more than 14,000 children born in the UK between 1991 and 1992. The age at which doses of thimerosal-containing vaccines were administered was recorded, and measures of mercury exposure by 3, 4 and 6 months of age were calculated and compared with measures of childhood cognitive and behavioral development covering from 6 to 91 months of age.
AUTHOR CONCLUSION: No convincing evidence was found that early exposure to thimerosal had any deleterious effect on neurologic or psychological outcome.

Additional studies looking at vaccine safety:

On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes

Smith M and Woods C, Pediatrics. Vol. 125 No. 6 June 2010, pp. 1134-1141

The study of data on more than 1,000 children born between 1993 and 1997 looked at their vaccination schedules up to 1 year of age, and studied their performance 7 to 10 years later on 42 different neuropsychological outcomes. Timely vaccination was associated with better performance on numerous outcomes. The less-vaccinated children did not do significantly better on any of the outcomes.
AUTHOR CONCLUSION: This comparison of children vaccinated on time with children whose vaccinations were delayed or incomplete found no benefit in delaying immunizations during the first year of life. For parents who are concerned that children receive too many vaccines too soon, these data may provide reassurance that timely vaccination during infancy has no adverse effect on long-term neuropsychological outcomes.

The Autism-Vaccine Debate: Why It Won’t Go Away

11 Feb

Who said it was? Backstory: “The Autism-Vaccine Debate: Why It Won’t Go Away” is a recent blog post by David Kirby at the Huffington Post. Yes, he’s come back to talk about autism and vaccines.

I say again: who says the debate is going away? The scientific debate on the main issues: thimerosal and the MMR is over. That scientific debate has been over for some time. The rising autism “rate” wasn’t caused by mercury. It wasn’t caused by MMR. Autism isn’t a “novel” form of mercury poisoning. These facts don’t stop activist groups and online discussions, or the debate elsewhere for that matter.

The debate isn’t going away, but is is morphing. From the piece by David Kirby:

There is clearly no single cause of autism, and we are not going to find answers looking only at genes, or for that matter, only at thimerosal or MMR.

David Kirby’s main contribution to the discussion was his book: Evidence of Harm, Mercury in Vaccines and the Autism Epidemic: A Medical Controversy. Mr. Kirby has been a major proponent of the mercury hypothesis since he started on that book, fed by research garnered by SafeMinds founder Lyn Redwood. The book wasn’t about “vaccines” and the autism epidemic, or “environmental causes of an autism epidemic”, it was about “mercury in vaccines and the autism epidemic”.

The debate isn’t going away, but it is getting weaker. And it’s just moving a few goalposts: Let’s play down mercury. Let’s play down MMR. It’s the “Autism-vaccine” debate, not “Mercury in vaccines and the autism epidemic”.

Mr. Kirby does in this blog post what he has done so well for the past few years. He puts the current talking points out there, nicely packaged. Here’s a good example, where he even manages to include a plug for the latest pseudo-research. It’s amazing, really:

That’s because evidence of a vaccine-autism link did not come to them via a 12-year-old study published in a British medical journal, nor from Hollywood celebrities: Not very many had heard of Wakefield until recently.

Some of these parents actually keep up with the science, including a new review of autism studies in the Journal of Immunotoxicology which concludes: “Documented causes of autism include genetic mutations and/or deletions, viral infections, and encephalitis following vaccination.”

Simply amazing. People haven’t heard of Wakefield, but they know about a paper that just came out yesterday in a relatively obscure medical journal? It’s product placement. Very slick. Mr. Kirby plugs this paper as though it is as natural as all the judges on “American Idol” drinking from great big red Coca Cola cups.

He also gets in the “the discussion isn’t all about Wakefield” theme that is in the current responses to the disclosure of fraud in Mr. Wakefield’s research. “Not many people had heard of Wakefield until recently.” As a side note, the obscure Mr. Wakefield appears on 30 pages of Mr. Kirby’s book, Evidence of Harm.

Let’s check whether people have heard about Mr. Wakefield. According to a recent Harris poll (one that Mr. Kirby cites, by the way):

In the new Harris Interactive/HealthDay poll, 69 percent of respondents said they had heard about the autism-vaccination theory — but only half (47 percent) knew that the original Lancet study had been retracted, and that some of that research is now alleged to be fraudulent.

The question “Are you aware that the medical journal that published the paper linking vaccines to autism has now withdrawn the paper, and a published account describes the research as fraudulent?” 47% of people asked said yes.

That’s a pretty big number of people who not only (a) knew about Mr. Wakefield’s paper but also (b) knew it had been retracted and described as fraudulent. What other research paper would the public know about in such great numbers, 12 years after publication?

To state the obvious, yes, Mr. Wakefield and his research was known. Well known. It has been a big piece of the vaccines-cause-autism debate.

Here’s the table from that Harris poll question, showing that 47% of people had heard about the retraction and fraud. Even more important, take note of the fact that people who are informed about the retraction and the fraud are much less likely to believe that vaccines cause autism (click image to make big):

Yep, 65% of people who have heard about the retraction and fraud say that the vaccines-cause-autism idea is “not true”. Mr. Wakefield’s work was known and important to the vaccines-cause-autism cause.

Mr. Kirby then goes into the standard talking points of the day: only two vaccines (MMR) and one ingredient (thimerosal) have been explored for relationship to autism, followed closely by a denial that any of those studies were of any value because they are performed by people who have a “vested interest”.

Of course, “vested interests” in those promoting the vaccine hypothesis, both professional and financial (of which Andrew Wakefield is only the most prominent example) are ignored. As we quickly see as Mr. Kirby warns us that the expected SafeMinds response is on the way to the recent paper showing no link between thimerosal exposure and autism.

Mr. Kirby finishes with “The CDC estimates that there are about 760,000 Americans under 21 with an ASD. Even if just 1 percent of those cases was linked to vaccines (though I believe it is higher), that would mean 7,600 young Americans with a vaccine-associated ASD. ”

Yes, Mr. Kirby is adapting. Adapting in much the way that I have said the vaccine-causation community needs to adapt in order to stay alive. They need to abandon the “epidemic” rhetoric. Claim that if there are people with vaccine-induced autism, the number is very small, too small to be picked up by epidemiology.

Rather than really adapt, Mr. Kirby wants to play both sides of this. He wants to say, “what if the number is really small” and say that the data available show that the rise in autism prevalence is correlated with vaccines.

At the risk of being accused of “product placement” myself, I can’t help but bring up an incident discussed in the book “The Panic Virus“. I don’t have the book handy, so I apologize if I get this not 100% accurate. Seth Mnookin tells of talking to Dr. Jon Poling, father of Hannah Poling, during an AutismOne conference. While Dr. Poling is telling Mr. Mnookin that, yes, the concession in the vaccine court isn’t about causation, David Kirby is giving his talk saying exactly the opposite.

One question I know I will face soon is: why do I bring up David Kirby again? Why not move on from the vaccine debate. In the end it is because of statements like this:

In my opinion, many children with autism are toxic.

After over five years as a self-described member of the autism community, David Kirby still uses damaging language. Children are not “toxic”. Even children who have demonstrated heavy metal poisoning (which autism is not) are not “toxic”. If you touch them, you don’t get poisoned. They are “intoxicated”. But, that doesn’t read well, does it? I’ll say it again, autism is not a form of mercury poisoning. I really don’t need my kid labeled “toxic”.

I don’t know if David Kirby is “anti vaccine” or not. If you notice, I rarely use the term. I don’t care if David Kirby is anti vaccine. It isn’t the label “anti-vaccine” that matters. David Kirby is intellectually dishonest and his actions are irresponsible. On a more personal note, he puts forth an image of autism that is damaging to my kid.

Sloppy science – a perfect example of how the anti-vaccine crowd will listen to anything

11 Feb

Both Age of Autism and David Kirby have recently reported on a new review paper with Age of Autism describing it as ‘pretty interesting’ and David repeating a part of the abstract:

Documented causes of autism include genetic mutations and/or deletions, viral infections, and encephalitis following vaccination.

So, should we all in the skeptic camp be reaching for our humble pie and our knife and fork? Not exactly. Lets take a look at the contents of this paper. Lets start here:

The vaccine organism itself could be a culprit. For example, one hypothesis of the cause of autism is that the pertussis toxin in the DPT vaccine causes a separation of the G-alpha protein from retinoid receptors in genetically at-risk children (Farfel et al., 1999; Megson, 2000). The pertussis toxin creates a chronic autoimmune monocytic infiltration of the gut mucosa lamina propia and may disconnect the G-alpha protein pathways, leaving some G-alphamodulated pathways unopposed. In turn, the non-specific branch of the immune system is turned on and, without retinoid switching, cannot be down regulated.

Wow, blinded with the cool science yet? No, me neither. Go back to line one where it says ‘one hypothesis’. All that follows from that point is mere opinion. There’s no science to back it up.

Another organism of suspect is the live measles virus…

Yeah except its really not. The issues with the Wakefield hypothesis are so many and so thoroughly debunked, it really isn;t worth my time or yours going through them again and again.

There is evidence that Thimerosal (which is 49% ethyl mercury) is indeed harmful. Since the 1930s, Thimerosal has been extensively used as an antibacterial agent in vaccines (Geier et al., 2007). Thimerosal has been implicated as a cause of autism. Not only is every major symptom of autism documented in cases of mercury poisoning but also biological
abnormalities in autism are very similar to the side effects of mercury poisoning itself (Bernard et al., 2001)

Oh dear. Reliance on more thoroughly debunked rubbish in the form of well, anything by the Geier’s and the ridiculous Bernard ‘paper’. I’m happy to go through why these are rubbish but I think I’d be preaching to the converted.

The rest of the paper is a rogues gallery of debunked and fringe science. Helen Ratajczak cites the Geier’s numerous times, DeSoto and Hitlan, Nataf and Rossignol to name but a few. This isn’t a paper so much as an advert for the sort of poor science that was examined in the Autism Omnibus proceedings and roundly rejected by the Special Masters. For goodness sake, she even cites David Ayoub of the Black Helicopter infamy.

When it comes to this paper – handle with extreme caution. Its toxic rubbish.

Andrew Wakefield sets out his talking points in a new book

27 May

Only a few years ago it seemed you couldn’t go into an online discussion without hearing David Kirby’s talking points from his book Evidence of Harm. I recall hearing over and over about pink’s disease, Minimata disease and many more “facts” that had really nothing to do with autism.

Now it seems to be Dr. Wakefield’s chance to shape (again) the discussion. His book “Callous Disregard” is sort of published (published but not generally available from what I can see). Luckily, a blogger for seems to have a copy and he lays out Mr. Wakefield’s responses to the ethics lapses which cost him his license in the UK. The talking points seem mostly to be about Mr. Wakefield, rather than about autism, but let’s go through them and see how they stand up to scrutiny, shall we?

Keep one thing in mind, Mr. Wakefield’s arguments seem to this observer to be of the type to mire people in details and confuse the issues with sidetracks.

Regarding financial conflicts of interest, Wakefield says that the funds for the Lancet 12 study came from the National Health Service. According to Wakefield, the money he received from lawyer Richard Barr was for a separate study looking for measles in the intestine of affected children. Wakefield states that the parents of the 12 children in the Lancet study came to him before he was hired as an expert on MMR litigation.

Wakefield writes that he was not required in 1997 to publish in the Lancet article his role of being an expert on MMR litigation but he did notify appropriate officials: “Long before publication ? details of my involvement as an expert in the litigation had been provided to my senior coauthors, the dean of the medical school, and the editor of The Lancet.”

As with much of Mr. Wakefield’s explanation, Brian Deer has responded to this one. But, let’s take a different look:

Andrew Wakefield was the key person in the Royal Free Hospital’s press conference on his paper in the Lancet. At that time, Mr. Wakefield was in the employ of lawyers seeking to litigate MMR injury cases. At that time he called into question the safety of the MMR vaccine.

INTERVIEWER: But if you say there’s at least a question mark over it now, should the vaccine continue to be administered while you’re investigating?

DR ANDREW WAKEFIELD: I think if you asked members of the team that have investigated this they would give you different answers. And I have to say that there is sufficient anxiety in my own mind of the safety, the long term safety of the polyvalent, that is the MMR vaccination in combination, that I think that it should be suspended in favour of the single vaccines, that is continued use of the individual measles, mumps and rubella components.

What do you think? Should a person working as a paid expert in MMR litigation announce this in a press conference where he calls for the suspension of the MMR vaccine? I would suggest that pretty much anyone who looked at this would say, “Yes, he should have made his conflict of interest public”.

Mr. Frandsen continues:

In a letter to pediatric gastroenterologist John Walker-Smith in February 1997, Wakefield explained his reasons for acting as an expert:

“Vaccination is designed to protect the majority, and it does so at the expense of a minority of individuals who suffer adverse consequenses…If this disease is caused by the MMR vaccination, then these childen (sic) are the few unfortunates that have been sacrificed to protect the majority of the children in this country. If that is the case, our society has an absolute obligation to compensate and care for those who have been damaged by the vaccine for the greater good.”

Which is irrelevant to the question of whether Mr. Wakefield’s actions were ethical. Really, how does the above apply to, say, whether Mr Wakefield had a conflict of interest or performed procedures without ethical approval? It doesn’t.

Wakefield was accused of conducting unnecessary and invasive medical procedures such as lumbar puncture on children with autism. Wakefield states that the history of developmental regression justified lumbar punctures. Later it would be discovered that neuro-inflammation in children in autism showed abnormal cytokine levels in cerebral spinal fluid. In addition, Swedish autism expert Christopher Gillberg advocates lumbar punctures to exclude encephalitis, and the procedure is conducted on children with autism in the U.S.

First, many lumbar punctures were performed before ethical approval was granted. Second, and more importantly, many of the lumbar punctures were found to be unnecessary. Here is but one comment from the GMC finding on Mr. Wakefield:

The Panel has taken into account that there is no evidence in Child 3’s clinical notes to indicate that a lumbar puncture was required. Professor Rutter and Dr Thomas, experts on both sides, considered that such a test was not clinically indicated.

Note–experts from both sides considered that the test was not clinically indicated. So, even Mr. Wakefield’s expert agreed that there was no reason to do a lumbar puncture on this child.

Anecdote here–I don’t think I have ever run into a parent who had their autistic child undergo a lumbar puncture. Autism is not a general indication for lumbar puncture. How many times have you read in the comments on, say, the Age of Autism blog, “When we got our lumbar puncture…”

Mr. Frandsen continues:

Regarding “data fixing” alleged by a British journalist, Wakefield said there were no allegations by the GMC that he manipulated data: “In the hands of someone determined to discredit the work, discrepancies between the routine clinical report (which may have come, for example, from a pathologist with an interest in brain disease or gynecological pathology) and the standardized expert analysis were falsely reported in the national media as ‘fixing’ of the data.”

One good reason why “data fixing” was not a charge by the GMC is very simple–the information on “data fixing” came out from the GMC hearings. The charges were, not surprisingly, made before the hearings.

I would like to see what an investigation into the question of data fixing would conclude.

On the decision by the Lancet’s editors to retract the article because the 12 patients in the study were not “consecutively referred,” Wakefield responds, “This is bizarre, since it is factually entirely correct – these were the first 12 children to be referred to the care of Walker-Smith with a regressive developmental disorder and intestinal symptoms.” Wakefield writes in the book that he indeed did have ethics committee approval to conduct the research elements of the Lancet study.

Let’s look at this in pieces–Mr. Wakefield is redefining “consecutively referred” to suit his needs. How did the GMC interpret “consecutively referred”?

The Panel is satisfied that a general reader would interpret the wording in 30a to mean that children were referred to the gastroenterology department with gastrointestinal symptoms and that the investigators had played no active part in that referral.

But, Mr. Wakefield’s team did play an active part in the recruitment of at least some of the children involved in the study. Not all of the children were referred for GI complaints.

Or, to put it quite simply: the statement “consecutively referred” was supposed to tell us all that there was no bias in how the patients came to be in the care of the Royal Free. But the truth was that there were huge biases involved.

Here is what the GMC had to say on this question:

Having regard to its findings in relation to Child 1, 9, 5 and 10, namely that these children were admitted to undergo a programme of investigations for research purposes, and that they all lacked a history of gastrointestinal symptoms, the Panel is satisfied that these referrals did not constitute routine referrals to the gastroenterology department.

Now let’s address the last sentence in that section above “Wakefield writes in the book that he indeed did have ethics committee approval to conduct the research elements of the Lancet study.”

This is one of those things where Mr. Wakefield and his supporters try to bury people in the details to create doubt. He claims that there was an approval in place, for project 162-95. The GMC rejected that idea:

The Panel has heard that ethical approval had been sought and granted for other trials and it has been specifically suggested that Project 172-96 was never undertaken and that in fact, the Lancet 12 children’s investigations were clinically indicated and the research parts of those clinically justified investigations were covered by Project 162-95. In the light of all the available evidence, the Panel rejected this proposition.

Why would they reject the idea? Project 162-95 allowed Prof. Walker-Smith to take two extra biopsies for research purposes when he did colonoscopies on patients.

Rather than get mired in the details ask a simple question: How does that allow the team to, say, perform lumbar punctures? Simple answer, it doesn’t.

Wakefield also cites conflict of interest among his critics. Professor Michael Rutter of the Institute of Psychiatry, a witness for the prosecution in the GMC case, had been a paid expert by vaccine manufacturers and the U.S. government. Dean Arie Zuckerman of the Royal Free Hospital wrote to the British Medical Association in October 1996 worried that Wakefield’s study could lead to a case against the government.

Assume it is all true. Does it change anything about Mr. Wakefield’s ethical lapses? It is the researcher version of “But mom, the other kids shoplift too”.

Wakefield answers the charges that it was unethical to take blood samples from children at his own child’s birthday party in 1999 to compare with samples of children with autism. “The blood was taken by a suitably qualified medical practitioner with standard aseptic precautions. Children were rewarded with the equivalent of just over $7. The entire procedure passed off without mishap or complaint. This process did not have the approval of an EC (Ethics Committee), which I now accept was naïve, but it was most certainly not unethical,” Wakefield writes.

Let’s boil this down to the basics: Mr. Wakefield made children into study subjects without first obtaining ethics approval.

That is unethical. By definition. Mr. Wakefield is not in a position to say “it wasn’t that bad an ethical breach” or “it happened safely”. What he really can’t say is “well, it would have been approved if I had asked”. None of those excuses work at all. His actions were unethical.

As if to make that point, the article goes on:

Wakefield compares that to a measles and rubella (MR) campaign the UK administered to approximately 8 million school children in November 1994: “In contrast, the MR campaign had multiple ethical failings on many levels, but the most staggering omission of all seems to me to have been the failure to alert parents to the known threat of severe adverse reactions – to deny them the fundamental right of informed consent in making a decision about their child. It puts the birthday party into the shade and rather makes a mockery of the post-GMC headlines about my callous disregard.”

Basically, Mr. Wakefield is saying, “other people were more unethical, so you should ignore my small ethical breaches”.

The birthday party story just fills in the narrative that Mr. Wakefield had a “callous disregard” for obtaining ethics approvals. Whether it was for very serious procedures on disabled children (lumbar punctures) or smaller actions like blood draws from non-autistic young children, he exhibited a pattern of unethical behavior.

“My experience serves as a cynical example to discourage others,” writes Wakefield. “As a consequence, many physicians in the United Kingdom and United States will not risk providing the care that is due to these children.”

This is a diversionary tactic. He’s using disabled children as a shield. Doctors in the US and the UK–and the world over–should not provide “care” that is not clinically required and potentially risky in order to obtain research results to support litigation. And that is where Mr. Wakefield failed.

In his piece, Mike Frandsen goes on with another talking point by Dr. Wakefield: that the US Government has acknowledged that vaccines cause autism. He cites the Hannah Poling case, the Bailey Banks case and the Hiatt case.

Again, let’s avoid getting bogged down in the details of those case and ask the simple question: did any of them involve Mr. Wakefield’s hypothesis of persistent measles in the gut? Answer, no.

This is another diversion.

Mr. Frandsen goes on to state:

Injury claims filed with the National Vaccine Injury Compensation Program since 1989 total 12,356. Claims involving deaths from vaccines number 1,035 in the same time period. According the VICP website, 52 cases have been filed for deaths since 1989 involving MMR and 19 cases filed for deaths involving the measles vaccine. Of those cases alleging injury or death due to vaccines, the U.S. government has compensated 2,440 awards totaling more than 1.8 billion dollars, though none of the awards have been compensated specifically for autism, according to the government’s statistics.

Again, what does any of this have to do with Mr. Wakefield’s research? Nothing. If they had a single case that was on point, they’d use it.

More to the point, what does this have to do with whether Mr. Wakefield’s research was performed *ethically*? Answer: nothing.

That’s always a good question to ask as Mr. Wakefield attempts to reinvent his image: does his excuse really address the issues? Mostly, do they address the issues of whether he acted ethically in his research activities? The answer is a very clear “no”.


The WakefieldWatch blog has also discussed the book “Callous Disregard” in “Who’s Callous Disregard

An example of how people earn the title “denialist”

16 Dec

Denialist. One who denies. It is a phrase that gets thrown around a lot on the internet. You don’t agree with me? Well, you must be a denialist. The term has risen in prominence lately with Michael Specter’s recent book, “Denialism, How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives” One of his prime examples is the anti-vaccine movement, so this book has been discussed on a number of autism blogs (including this one).

Denial–here are definitions from

1. an assertion that something said, believed, alleged, etc., is false: Despite his denials, we knew he had taken the purse. The politician issued a denial of his opponent’s charges.
2. refusal to believe a doctrine, theory, or the like.
3. disbelief in the existence or reality of a thing.
4. the refusal to satisfy a claim, request, desire, etc., or the refusal of a person making it.
5. refusal to recognize or acknowledge; a disowning or disavowal: the traitor’s denial of his country; Peter’s denial of Christ.
6. Law. refusal to acknowledge the validity of a claim, suit, or the like; a plea that denies allegations of fact in an adversary’s plea: Although she sued for libel, he entered a general denial.
7. sacrifice of one’s own wants or needs; self-denial.
8. Psychology. an unconscious defense mechanism used to reduce anxiety by denying thoughts, feelings, or facts that are consciously intolerable.

Many people “deny” that vaccines work. Many people “deny” that the diseases vaccines prevent are dangerous. People who do so are, in my book, denialists.

Case in point, a recent blog post by Kim Stagliano of the Age of Autism blog: An Autism Mom Goes Back to Christmas 1962. In it, she presents a doll from 1962. A doll with a changeable face, and one face shows the baby doll with measles. The message of the blog post is clear: measles wasn’t so bad. Ms. Stagliano writes:

Yes, in 1962, measles were a common childhood illness. And little girls played with dollies that had the measles, and made them all better. So did doctors for children who got the measles.

Well, yes. Most of the time children got better.

Let’s check what people wrote about measles in the early 1960’s, shall we? From Time Magazine, 1961 (with emphasis added by me).

When famed Harvard Nobel Laureate John Franklin Enders announced at a Manhattan meeting three years ago that he had isolated measles virus, his fellow virologists stood up and cheered. It would not be long, they hoped, before a vaccine could be developed to wipe out a disease that sends one child in 4,000 to institutions for the feebleminded. But the first live virus vaccine developed by Enders left much to be desired; four of five children got severe fevers, roughly half developed a rash. Last week, after much toil by Enders and others, a group of Pennsylvania physicians and virologists announced that they had successfully tested a measles vaccination technique. Children are first inoculated with Enders vaccine, which gives nearly 100% protection. Then, almost immediately, they are injected in the same arm with gamma globulin, which holds undesirable side effects, such as fever and rash, to a minimum. The Public Health Service still must approve the new measles technique, establish manufacturing standards. If all goes well, a vaccine will be on the market next year, just as measles heads toward its next cyclical peak.

Yes, virologists cheered, 1 in 4,000 children were sent to institutions.

Life Magazine, in 1963, discussed the new vaccines for Measles.

Though often joked about, this commonplace disease kills about 400 Americans each year–twice the number that polio now kills. Several thousand cases each year develop encephalitis, which can damage the brain.

The Age of Autism, where Ms. Stagliano blogs, was quite upset by Mr. Specter and his book for singling out anti-vaccine groups as denialists. My suggestion: if you don’t want to be labeled denialist, don’t be a denialist.

Fever Plus Mitochondrial Disease Could Be Risk Factors for Autistic Regression

24 Sep

Autism, regression, mitochondrial disease and vaccines. With a combination like that, this paper is likely going to be very important.

Fever Plus Mitochondrial Disease Could Be Risk Factors for Autistic Regression

Here is the abstract:

Autistic spectrum disorders encompass etiologically heterogeneous persons, with many genetic causes. A subgroup of these individuals has mitochondrial disease. Because a variety of metabolic disorders, including mitochondrial disease show regression with fever, a retrospective chart review was performed and identified 28 patients who met diagnostic criteria for autistic spectrum disorders and mitochondrial disease. Autistic regression occurred in 60.7% (17 of 28), a statistically significant increase over the general autistic spectrum disorder population (P < .0001). Of the 17 individuals with autistic regression, 70.6% (12 of 17) regressed with fever and 29.4% (5 of 17) regressed without identifiable linkage to fever or vaccinations. None showed regression with vaccination unless a febrile response was present. Although the study is small, a subgroup of patients with mitochondrial disease may be at risk of autistic regression with fever. Although recommended vaccinations schedules are appropriate in mitochondrial disease, fever management appears important for decreasing regression risk.

The authors note neurologic regression in general (not just autistic regression) is observed with patients who have metabolic diseases:

Patients with mitochondrial diseases, like many patients with metabolic diseases, are at increased risk of neurologic regression in conjunction with stressors such as fever, infection, and dehydration.

They studied 28 patients who met DSM-IV criteria for autism and diagnostic criteria for mitochondrial disease.

They define regression and whether it is related to fever thusly:

Autistic regression was defined as loss of developmental skills that included speech, receptive skills, eye contact, and social interests in individuals ❤ years of age. A relationship between fever and autistic regression is defined as regression beginning within 2 weeks of a febrile episode without the suggestion of infectious meningitis or encephalitis.

One comment–the definition of regression is somewhat vague to me. What is also critically important in this discussion is whether there were any signs of autism before the regression. Or, as some may put it, is this regression into autism or autistics undergoing regression? Is there a mix of pathways?

They state that 17 of the 28 patients studied underwent an autistic regression. This is higher than the roughly 25% value for autistic regression they assumed for the general autism population, and statistically significant.

In other words, they are saying that autistic regression may occur more often with kids with mitochondrial diseases.

They note that some of the fevers could be linked to vaccination:

The 17 individuals with autistic regression could be divided into 2 groups, those who regressed with fever (70.6%, 12 of 17) and those who regressed without identifiable linkage to fever or vaccinations (29.4%, 5 of 17).


No individual showed regression with vaccination unless a febrile response was present.

They discuss the concerns with vaccination in the conclusion, noting that vaccination is still recommended for children with mitochondrial diseases. My experience in discussing this issue with mitochondrial disease experts is that they find vaccination to be extremely important. If, for some reason, they decide to not vaccinate a child with mitochondrial disease, they insure that all family members are vaccinated to protect the child.

Children with identified mitochondrial diseases are routinely managed carefully by their physicians with aggressive fever control and hydration. In this context, vaccination of children with mitochondrial diseases is recommended. In our experience, the vast majority of patients with mitochondrial diseases receives a full vaccination schedule according to American Academy of Pediatric guidelines without consequences, particularly when physicians are sensitive to fever control and hydration. In our patients with mitochondrial disease and autistic spectrum disorders, the vaccines did not appear related to the neurologic regression.

I will note again that I feel autistic regression as defined is too vague. Were the patients on the spectrum before the regression? Were they typically developing before the regression?

At least two children were noted to have multiple regressions (a sibling pair). That indicates that at least in some cases, regressions occurred in people already autistic. There just isn’t other information on this.

Another area I would like to see discussed further is on siblings:

Affected siblings were identified in 35.7% (10 of 28).

Affected how? Mitochondrial disease. But, are they also autistic? It would seem not since they included one sibling pair.

This is a big question to me. While the spotlight has been shown on the possibility of mitochondrial disorders being linked to autistic regression, the more general question is more important: could fevers induced by vaccination result in any regression (autistic or otherwise) in people with mitochondrial disorders.

Another question in my mind in this study. Are there patients who underwent regression from non-autistic to autistic) after age 3? According to the Johns Hopkins group, this doesn’t happen. According to them, there is an age window where the regressions could result in autism. This is a very important question in how these patients might fit in to the broader spectrum of autism.

Lessons from the Vaccine–Autism Wars

27 May

A very interesting (and long) read from Public Library of Science (PLoS) entitiled A Broken Trust: Lessons from the Vaccine–Autism Wars was published today. It takes apart the history of the vaccine/autism wars and tries to involve scientists on why they think – or what their particular discipline leads them to conclude – the autism/vaccine wars have become so protracted and bitter.

I’ve mentioned before – its always a bit of a strange, unreal sensation to see events in which you’ve been involved with – even as remotely as blogging about them – talked about as history. They say history is always written by the winning side. I hope articles like this don’t lead scientists to think that the war is over, the history is being written and they can go back to academia with no more comment necessary.

The PLoS article ends thusly:

Personal stories resonate most with those who see trust in experts as a risk in itself—a possibility whenever people must grapple with science-based decisions that affect them, whether they’re asked to make sacrifices to help curb global warming or vaccinate their kids for public health. Researchers might consider taking a page out of the hero’s handbook by embracing the power of stories—that is, adding a bit of drama—to show that even though scientists can’t say just what causes autism or how to prevent it, the evidence tells us not to blame vaccines. As news of epidemics spreads along with newly unfettered infectious diseases, those clinging to doubt about vaccines may come to realize that several potentially deadly diseases are just a plane ride, or playground, away—and that vaccines really do save lives.

I don’t disagree with any of that but I’ll now directly quote comment No.2 left after the PLoS article. A comment posted by a user called ‘bensmyson’ (and already I’m sure the battle hardened amongst us have recognised the type of person with a username like that).

Not that anything I say matters, but vaccines are not safe. My son at 12 months received ProQuad, a MMRV, later that month Merck pulled it from the market. My normally developed child with superior language skills developed encephalitis and as a result lost all those skills and developmental milestones and regressed into what has been diagnosed as autism. I know they aren’t safe because my son suffered a brain injury as a result. According to VAERS, 8 people have died because of ProQuad, Merck filed two of those reports themselves.

I’m not a scientist, just a parent of a child that got lost immediately after his 12 month vaccines.

With all due respect to the PLoS article which I really did enjoy reading and made very good points, I think the main point they either missed or that they are too polite to state out loud is that quite a lot of people _really don’t want_ to think it wasn’t vaccines.

The quoted comment demonstrates a lot of the hallmarks of what I think of as a sub-genre of anti-vaccine ideology – the autism antivaxer.

1) The immediate portrayal of themselves (not their child you’ll note) in the role of victim (‘Not that anything I say matters…’)
2) A coincidental regression into autism following vaccination with overtones of fault on the behalf of a vaccine maker/doctor/scientist
3) A statement that they _know_ (not think, not believe, not ‘are sure’) vaccines aren’t safe because their child _was_ damaged ) _as a result_ (‘I know they aren’t safe because…’) of having one. Note the lack of any sort of logic or requirement for evidence.
5) A reliance on a ‘sciency’ sounding method of backup which in reality offers no such thing (‘According to VAERS…’)
6) An emotive sign off with an appeal to false knowledge (‘I’m not a scientist, just a parent…’)

These are people who have spent a long time online and offline sharing time with other people of a like mind. They have stopped thinking critically and have started thinking communally. Stepping away from the voice of the community would be dangerous for both their continuing friendships and also for their own state of mind, therefore it is easier all round to simply lock out everything that presents any sort of difficulty or challenge to their belief system. If PLoS or anyone else thinks that these people (those clinging to doubt about vaccines) ‘may come to realize that several potentially deadly diseases are just a plane ride, or playground, away—and that vaccines really do save lives.’ then I’m afraid they are deluding themselves. I’ve had conversations with people just like ‘bensmyson’. Here’s a choice quote from one such debate from Twitter:

kids without #vaccinations more likely to get whooping cough. isn’t that better than getting shot up with #antifreeze ?

Doesn’t that make your head hurt just reading it? This person is happy to announce that:

1) There is anti-freeze in vaccines, which there most definitely is not.
2) Its better to get whooping cough than a DTP jab. I wonder if the poor parents of Dana McCaffery feel that way?
3) The reason its better to get whooping cough (a potentially fatal illness) is that the vaccine has antifreeze in it (which it doesn’t).

The level of arrogance, conspiracy mongering, self-pity and anger amongst too many of these people is so very much more than the PLoS article accounts for. Good as the article is, I fear its far too early to begin the dissection of this stage of the recent past.

Edited for typos via email by Sully. Ta 😉

Who is antivaccine?

25 Mar

The group that wants to bring the third world up to modern standards of vaccination or the group that wants to bring the US to current third world standards?

I’ve been trying to avoid responding to Age of Autism blog posts. I have a full time job, I don’t need another one. But, this one struck me as worth a few minutes.

Mr. Olmsted posted the blog piece, “WHO is Anti-Vaccine?” In it, he quotes a newspaper article that stated

“In the first nine months of life, the World Health Organization recommends vaccines for tuberculosis, diphtheria, tetanus, whooping cough, polio and measles.”

Mr. Olmsted then tries to draw a parallel between his own organization (Generation Rescue et al.) and the World Health Organization (WHO). Since both organizations recommend fewer vaccines than in the current US schedule, supposedly his group is mainstream.

Mr. Olmsted chafes at the reputation he has earned (and earn it he did) for not digging very deep into a story. He won his battle star, as it were, by missing out on a big part of the Amish story, the Clinic for Special Children. No doubt the revisionist history, complete with stories by angry Amish, will fill at least a chapter in his upcoming book.

Why bring this up? Because once again, Mr. Olmsted looked only far enough to support his preconceived ideas. The WHO campaign he is discussing is well covered on…well, the cryptically named World Health Organization website.

Page 15 of this presentation, gives a good idea of WHO’s goals: by 2015, introduce new vaccines. They discuss adding HepB, Hib and also:

Japanese Encephalitis
Yellow Fever
Pneumo (Conjugate vaccines)
Rotavirus Diarrhoea
Typhoid Fever
Mening Conjugate A

Here is fact #2 in the WHO 10 facts about immunization. Would Mr. Olmsted and his organization agree?

Immunization currently saves between 2 and 3 million lives per year. It is one of the most successful and cost-effective public health interventions.

Mr. Olmsted: enter “autism” into the search box on the WHO website.

First hit MMR and autism.

Based on the extensive review presented, GACVS concluded that no evidence exists of a causal association between MMR vaccine and autism or autistic disorders.

Another of the top links–a page from the WHO Bulletin. The story? ‘Science vs ‘‘scaremongering’’ over measles-mumps-rubella vaccine’.

How about this link, also on the first page: “No vaccine for the scaremongers”. Here’s a nice quote from that article:

While parents in developing countries have, for example, first-hand experience of measles and welcome vaccination against it, the uptake by parents for the combined measles, mumps and rubella vaccine in many developed countries has yet to recover almost 10 years after a study linking it to autism, even though the original study has long since been discredited and there is overwhelming scientific evidence that refutes the link.

Frankly, I think Mr. Olmsted is squarely in the group the WHO would call “scaremongers”. It is ridiculous in the extreme for him to try to draw a parallel between him and his organizations and WHO.

Again I will ask, who is antivaccine, the group that wants to bring the third world up to modern standards of vaccination or the group that wants to bring the US to current third world standards?

The myth of mild measles

9 Oct

One of the common arguments from vaccine rejectionists is “These diseases aren’t really that bad”. Often this includes graphs of death rates over time, with the suggestion that the diseases were already going away by themselves when the vaccination program started. It boggles the mind that intelligent people can make that claim, but they do.

The other argument is that with modern medicine and sanitation, the diseases were not a big problem. Again, mind boggling.

People will say, without any hint of irony, “I got the disease and I didn’t die.” The response being so obvious (the dead people aren’t here to speak) that I am astounded that these people make this claim.

More recently, I’ve seen a few blog posts where old news stories are picked out and people say, “See, they didn’t think these were that dangerous”. How many times can I say “mind boggling” in one post?

That all said, I decided to look through old news stories to see what people thought of Measles over time. As it turns out, some really good stories were in Time Magazine, so I will use that as the source.

Let’s scroll back to 1934. In a piece simply titled Measles, Time states:

New York City’s Health Commissioner Rice warned parents to beware of measles as a “very serious malady,” but assured them that this is not a “measles year” in New York. In the first ten weeks of last year the city had 9.562 cases and 44 deaths, against 413 cases and two deaths for the same period this year.

It wasn’t a “measles year”, as in, this wasn’t a big outbreak. Yet, 44 2 people died. [see comments for correction]

OK, people will say, that’s before good medicine and sanitation. (boggle boggle boggle). How about more recently? How about 1966, just as the vaccine was being rolled out (or, as the rejectionists would have it, just about the time when measles decided to coincidentally morph into a mild disease). The title of the piece in Time magazine? End Measles Now. Take a look at the opening paragraph:

To the casual observer, the heavy snow, gale winds and high tides that struck most of the Northeast last week seemed to have turned Rhode Island into a disaster area. Like homeless refugees, long lines of crying children clinging to their parents snaked through the gloom. But it was not the storm that turned out the Sunday crowds. Rhode Island was engaged in a well-planned exercise in preventive medicine.

Yes, people were braving huge storms to go out and get their kids vaccinated against measles. Why? People realized that measles was still, in advanced-medicine-good-sanitation 1966, a major problem.

All over the country concern about measles is increasing. At the research level, physicians and other virologists have long been puzzled about how and when the measles virus attacks the brain, as it does in an estimated 4,000 U.S. cases of encephalitis each year

1966: 4,000 cases of encephalitis every year.

How about 1977? Clean, advanced 1977? An Alarming Comeback for Measles.

Adds Dr. Colette Rasmussen of the Cook County, Ill., public health department: “Too often the disease is looked upon as a sickness all children once had, as a kind of joke.” Unfortunately, measles is no laughing matter. While the overwhelming majority of victims recover in a week to ten days, some develop pneumonia or encephalitis. If the measles virus spreads to the brain, it can cause convulsions, coma and brain damage, and sometimes death.

1977: People still scared of the measles. But, people are starting to forget how bad measles was pre-vaccine.

And, then there’s today. In a piece, How My Son Spread the Measles, Time interviewed the mother of the child who imported the measles from Switzerland this year. They couldn’t use her real name, so they called her “Jane”. She describes the situation:

Jane says she did not know her son had been exposed to the measles while visiting Europe; and she didn’t know that her son was infectious. She and her husband select vaccinations for their children based on their age, their body’s ability to fight the infection, and the risks of the vaccination. Her infected son was not inoculated against measles. “We analyze the diseases and we analyze the risk of disease, and that’s how my husband and I make our decision about what vaccines to give our children.”

She gambled not only with her son’s life and health, but with the lives and health of other children. Other children, including those too young to be vaccinated against measles. But, she does feel “horrible” for the other people affected:

She adds about the outbreak, “I feel horrible for those children and their parents, but I want to protect all children from harm. And so by making sure there is more research done, we can help all children.”

Vaccines in general are a good thing, she says, but the problem is in the ingredients. Many vaccines contain mercury, formaldehyde, and aluminum, Jane argues. Thimerosal, which contains a mercury derivative, was once a common preservative in vaccines, she says. “This just can’t be good for you. Injecting yourself with aluminum can’t be good.”

She weighed the known risks of measles (death, brain damage, pneumonia, to name a few) against the perceived risks of vaccines (with the vague: “Injecting yourself with aluminum can’t be good”). Not a very quantitative comparison. But, she can make this decision because:

Because her children are healthy and well-nourished, Jane said they will sail through childhood diseases such as measles and chicken pox without trouble — and get lifelong immunity from the exposure. And she said, because the U.S. is a relatively healthy first-world country with a well-functioning health care system, she feels safe in making the choice to vaccinate selectively.

Let’s take a quick look at how an actual measles survivor recalls the measles:

I’m in a hospital bed, gasping for breath. Through the clear plastic of an oxygen tent, I see my Mom. Her face is red and she’s crying and crying. I feel hot. Every few hours a nurse opens the oxygen tent and gives me a shot. It hurts.

It’s 1959. I’m in second grade. I’d caught the measles, just like my brothers and sisters and friends. Except unlike them, my measles didn’t go away. It got worse and turned into something I’d never heard of: pneumonia. I spent a month in the hospital, survived, and spent a few more months recovering at home. But more than four million children got measles in the United States in that year and 385 died.

He doesn’t mention poor sanitation or bad medical care. Yes, it was 1959, but that’s supposedly when measles was becoming a “mild” disease. Yes, modern medicine kept him alive. Want to bet what his chances would have been 50 years earlier?

But, let’s look back at how “Jane” made her decision:

“Looking at the diseases mumps, measles and rubella in a country like the U.S…. it doesn’t tend to be a problem,” Jane said. “Children will do fine with these diseases in a developed country that has good nutrition. And because I live in a country where the norm is vaccine, I can delay my vaccines.”

Yes, because the rest of us are vaccinated and we vaccinate our children, she can delay vaccinating her kids. Well, sort of. Evidence shows that in reality, her kid did get a vaccine preventable disease because she “delayed” the vaccine. (It is an open question in my mind whether he child was ever going to get the MMR, but let’s move on).

What are the real risks of the measles….today…in the United States? From the Atlanta Constitution Journal piece:

Along with the pneumonia I had as a kid (1 to 6 percent of measles cases), the risks of measles include severe encephalitis (one per 1,000 cases) — about a third of which result in mental retardation. They also include one to 10 deaths for every 10,000 measles cases. Another risk is subacute sclerosing panencephalitis, a rare fatal illness (one per 100,000 measles cases) caused by an ongoing measles virus infection of the brain, in which symptoms of brain damage usually begin seven to 10 years after infection.

“Jane” made a decision that put a dozen kids at risk of death or brain damage. The odds were in her favor, and they seem to be OK (if you can call taking an infant to the hospital, “OK”). “Jane” won’t know for seven to ten years whether her child, or any of the 12 he infected, will come down with subacute sclerosing panencephalitis (SSPE). At 1 in 100,000 , the odds are pretty good that they will all be OK. But, not zero.

But, let’s compare that to the real risk of MMR. Again from the AJC piece:

And the side effects of MMR? Fever, malaise, a mild rash, swollen glands and a stiff neck in about 5 percent of the patients, febrile seizures in about three out of 10,000, and temporary low platelet count in about three per 100,000 patients. About one in 1 million have an easily treated anaphylactic reaction. And no deaths. Not one.

Because of the relationship of the measles virus to encephalitis, vaccine safety experts have had an ongoing concern that the MMR vaccine might be a rare cause of this disease. Fortunately, all studies with controls have found no association between the MMR vaccine and encephalitis.

So, on the one hand (catching the measles), you have a 1 in 100,000 chance of death by SSPE, a 1 to 10 per 10,000 chance of death right away, about 0.3 per 10,000 chance of mental retardation. On the other hand (getting the vaccine) you have no deaths, febrile seizures in about 3 per 10,000, anaphylactic reaction in 1 per 1,000,000 and 5% with more mild symptoms. Yes, those are all real reactions. But, the balance is clearly tilted towards vaccination. Except, as “Jane” put it, “And because I live in a country where the norm is vaccine, I can delay my vaccines.” Yes, if others are protecting your child, you can “delay” vaccinating and, usually, get away with it.

Let’s do the comparison for “Outbreak Jane”, shall we? With about 10 people affected, the odds were roughly

0.3% that someone could have suffered brain injury
0.1 to 1% that someone could have died
0.01% chance that in the next 10 years one of these people will die of SSPE. Pretty low odds, but, that’s a lot of chips on the table. Would you be happy if someone made that bet for you or your child?

And, that last bit is important. “Jane” made the decision for other people. Some were people whose children were too young to vaccinate.

Still, Jane says she was surprised by the number of calls she got from friends who wanted to bring their unvaccinated children over to play with her kids while they were infectious. Like Jane, they see getting the measles as far healthier than the vaccine.

That’s just a googleplex of boggles.

She said the recent measles outbreak in her region prompted her to do more research. That work has made her even more certain that she and her husband are choosing wisely to be very selective about vaccinations. “This is a difficult choice for parents; choose the vaccine or choose the disease. I have chosen the disease by not vaccinating.”

She chose wisely? She chose “the disease by not vaccinating”? Yes, I agree, she did. The problem is, she also chose the disease for many people other than her own family.

Measles is far from mild. And, no, it isn’t as though people in the past thought so. They just accepted the sickness and death that inevitably came with measles outbreaks. Dr. Keily is quite correct in his piece on the AJC

My mother wasn’t wrong to be crying, back in 1959. The risks of measles are real. Americans were right to be elated when the measles vaccine became available.

The MMR vaccine doesn’t hurt kids. Letting them go without it will.

[note: some small changes have been made since this was first published. Most notably, I corrected a mistake where I put the odds of SSPE at 1 in a million, instead of the correct 1 in 100,000]

Endemic in the UK

25 Aug


Adj. 1. endemic – of or relating to a disease (or anything resembling a disease) constantly present to greater or lesser extent in a particular locality; “diseases endemic to the tropics”; “endemic malaria”; “food shortages and starvation are endemic in certain parts of the world”

Or, another example is measles in the UK.

How very shameful in the year 2008 that we have allowed one person to create an all-encompassing atmosphere of fear – groundless fear at that – that has allowed a disease that 10 years ago was virtually unheard of to return with such vengeance that two children have died in the past two years and many more have been hospitalised.

There are two reasons I find this shameful. Firstly, there is the fact that as an autism parent I am ‘judged’ every time I leave the house. We all are. The people who stare, the people who do double takes, the people whispering behind their hands. What are they saying now? How long will it be before the general public cotton on to the fact that measles _is_ now endemic is largely due to autism parents and the quacks they pay huge amounts of money to? As a community of parents we are divided and when people ask why that is or ‘can’t we just come together?’ on this issue, this is why.

*I cannot condone or stand by quietly whilst the autism community sinks into becoming a convenient media scapegoat. Neither can I stand by and say nothing whilst autism parents sink deeper and deeper into anti-vaccinationism and pretend that hospitalisation and death in the name of chasing a belief for which there is no proof is OK.*

The CDC’s Jane Seward (deputy director of the division of viral diseases) is interviewed today by Scientific American.

…in the 1960s, right before the vaccine was developed, it killed 400 to 500 children every year out of 500,000 reported cases at that time.

That’s a death every 1,111 reported cases. The current US measles epidemic has 163 cases. You’re nearly 15% there already.

Seward also says there were 4,000 cases of encephalitis a year resulting from measles in the 60’s and goes on to describe some of things that can follow on from encephalitis. Quite a lot of anti-vaccine believers say that encephalitis can lead to autism. Taste the irony.