Controversy MMR Vacsine that Cause Autism

JUNIANI NIANDINI

030.08.133

JAKARTA, 14 JUL 2011

TRISAKTI UNIVERSITY of MEDICINE

Contents :

Contents .......................................................................................................................ii

Abstract ........................................................................................................................1

Introduction ..................................................................................................................2

MMR Vaccine...............................................................................................................3

Autism...........................................................................................................................5

Controversy MMR Vacsine that Cause Autism............................................................8

Conclusion ..................................................................................................................14

References ..................................................................................................................15

Abstract

The publication of Dr. Wakefield’s study in 1998, along with profuse media coverage

of immunizations and Autism, has lead to an enormous amount of research studies examining

whether a link between the MMR vaccination and Autism actually exists but One

populational study, centered in Yokohama, Japan in 2005, is heralded as one of the most

decisive studies proving no connection between the MMR vaccine and Autism. Particularly,

this study examined the rate of development of Autism Spectrum Disorders (ASD) during an

MMR vaccination program and after the MMR vaccination program had been discontinued

Although child vaccination rates remain high, some parental concern persists that

vaccines might cause autism. Three specific hypotheses have been proposed: (1) the

combination measles-mumps-rubella vaccine causes autism by damaging the intestinal lining,

which allows the entrance of encephalopathic proteins; (2) thimerosal, an ethylmercury-

containing preservative in some vaccines, is toxic to the central nervous system; and (3) the

simultaneous administration of multiple vaccines overwhelms or weakens the immune

system. We will discuss the genesis of each of these theories and review the relevant

epidemiological evidence.

Introduction

The MMR vaccine controversy refers to claims that autism is caused by the MMR

vaccine against measles, mumps, and rubella. Particularly, the childhood Measles, Mumps

and Rubella (MMR) vaccine has been connected to the appearance of Autism in children, and

has led to the formation of anti-vaccination groups and increased rates of vaccination

exemption within schools. The scientific consensus is that no credible scientific evidence

links the vaccine to autism, and that the vaccine's benefits greatly outweigh its risks.

Claims of a connection between the vaccine and autism were initially raised in a 1998

paper in the respected British medical journal The Lancet. After it was discovered that

Andrew Wakefield, the paper's lead author, had received major funding from British trial

lawyers seeking evidence, ten of the paper's twelve coauthors retracted its interpretation of an

association between MMR vaccine and autism. Why are vaccinations such as the MMR

seemingly necessary? What are the popular beliefs driving the rejection of vaccines? Finally,

is there really a link between vaccinations and Autism? The following sections will review

both common information surrounding vaccinations and scientific research specifically

studying the correlation of the MMR vaccine and Autism.

MMR Vaccine

Vaccine

Firstly, vaccinations are preparations used as preventative measures to develop

immunity against a specific disease through the injection of an innocuous form of the disease

agent, or through injection of a weakened bacteria or virus to stimulate antibody production.

Vaccinations, according to the Centers for Disease Control and Prevention, are crucial in

helping protect the population and individuals from disease and the subsequent spread of

disease. Vaccinations are responsible for eliminating many of the infectious diseases no

longer common today, and children are especially at risk for infectious diseases because their

immune systems are not as strong as adults, leading to higher mortality rates if infected.

MMR Vaccine

        The Measles, Mumps and Rubella Immunization, better known as the MMR

immunization, is a 3-in-1 vaccine that protects against measles, mumps and rubella, all of

which are potentially dangerous childhood illnesses. This immunization first released in 1988

is a shot composed of freeze-dried live attenuated measles, mumps and rubella viruses. The

immunization causes a 90% protection rate against measles and mumps, and 95% protection

rate against rubella. Measles - this can cause ear infections, pneumonia, fits and encephalitis

(inflammation of the brain). Sometimes it can be fatal.

- Mumps - this can cause meningitis, which can result in deafness. It may cause

inflammation of the pancreas, leading to pain, nausea and vomiting. In boys it can

damage the testicles and cause infertility.

- Rubella - this is also known as German measles and is usually a minor illness.

However, it's harmful to pregnant women. If you become infected during the first 10

weeks of pregnancy, it's very likely to cause problems in your unborn baby. These

include heart damage, blindness, deafness and brain damage. It can also lead to

miscarriage. If you become infected with rubella between 10 and 16 weeks, your baby

may still be harmed but the risk is smaller.

The MMR vaccination is a recommended childhood immunization that is typically required

for school entry. The immunization consists of two shots, one of which is to be given at 14-

15 months old, and the other between 4-6 years old. The vaccine is sold by Merck as M-M-R

II, GlaxoSmithKline Biologicals as Priorix, Serum Institute of India as Tresivac, and sanofi

pasteur as Trimovax. Although children usually recover from measles, mumps or rubella,

each illness can be unpleasant and have serious consequences.

Immunization Schedule in Indonesia1

Autism

Definition

Autism is a complex disorder of the central nervous system that has the following 3

defining core features:

- Problems with social interactions

- Impaired verbal and nonverbal communication

- A pattern of repetitive behavior with narrow, restricted interests 

A number of other associated symptoms frequently coexist with autism. Most people with

autism have problems using language, forming relationships, and appropriately interpreting

and responding to the external world around them.5

Autism is a behaviorally defined neurodevelopmental disorder that begins in early

childhood. Although the diagnosis of autism may not be made until a child reaches preschool

or school age, the signs and symptoms of autism may be apparent by the time the child is

aged 12-18 months, and the behavioral characteristics of autism are almost always evident by

the time the child is aged 3 years. Language delay in the preschool years (younger than 5

years) is typically the presenting problem for more severely affected children with autism.

Higher functioning children with autism are generally identified with behavioral problems

when they are aged approximately 4-5 years or with social problems later in childhood9

Causes of Autism3

Although autism is the result of a neurologic abnormality, the cause of these problems

with the nervous system is unknown in most cases. Research findings indicate a strong

genetic component. Most likely, environmental, immunologic, and metabolic factors also

influence the development of the disorder.

- G enetic defect that is responsible for autism. Researchers suspect that there are a

number of different genes that, when combined together, increase the risk of getting

autism. In families with one child with autism, the risk of having another child with

autism is 3-8%. The concordance of autism in monozygotic twins is 30%. A number

of studies have found that first-degree relatives of children with autism also have an

increased risk of autism spectrum disorders.

- Neurobiology. Recent development in brain imaging techniques allow for much more

sophisticated investigation of the neurological definicts underlying ASD. Various

abnormalities have been identified(in the fusiform gyrus, amygdala, cerebellum,

cerebral cortex and in overall brain size). Postmortem and neuroimaging studies also

suggest that decreased functional connectivity may play a significant role. However,

the sample size in these studies is typically very small, the diagnostic criteria are often

unclear, intellectual impairment or language level is rarely assessed.

- Environmental factors and exposures may interact with genetic factors to cause an

increased risk of autism in some families.

- Emotional trauma . Some believed that emotional trauma at an early age, especially

bad parenting, was to blame. This theory has been rejected.

- Vaccines Although the mercury preservative used in some vaccines is known to be

neurotoxic, the most recent research on this subject does not suggest a specific link

between vaccines and autism.

Risk Factor of Autism4

Autism affects children of all races and nationalities, but certain factors are known to

increase a child's risk. They include:

- Your child's sex. Studies show that boys are three to four times more likely to develop

autism than girls are.

- Family history. Families who have one child with autism have an increased risk of

having another child with the disorder. It's also not uncommon for the parents or

relatives of an autistic child to have minor problems with social or communication

skills themselves or to engage in certain autistic behaviors.

- Other disorders. Children with certain medical conditions have a higher than normal

risk of having autism. These conditions include fragile X syndrome, an inherited

disorder that causes intellectual impairment; tuberous sclerosis, a condition in which

benign tumors develop in the brain; the neurological disorder.

- Paternal age. Research increasingly suggests that having an older father may increase

a child's risk of autism. One large study showed that children born to men 40 years or

older were almost six times more likely to have autism spectrum disorder than were

children born to men younger than 30 years. Maternal age, on the other hand, seems

to have little effect on autism risk.

Controversy MMR Vacsine that Cause Autism

  In February 1998, the Lancet published an article titled “Illeal-Lymphoid-Nodular

Hyperplasia, Non-Specific Colitis and Pervasive Developmental Disorder in Children,”

which suggested that MMR vaccine could contribute to the development of autism. Intense

media coverage of the article followed its publication, and many parents, particularly in the

UK,refuse MMR vaccination of their children. Dr. Andrew Wakefield, a doctor in

experimental gastroenterology at London’s Royal Free Hospital. He published a description

of 12 cases in which toddler patients receiving the MMR vaccine developed gastrointestinal

disorders that led to an increased risk in developing developmental disorders, such as Autism2

Finally, many parents believe the MMR vaccine causes Autism because of the timing

of the proximity in injection/development of the MMR immunization and onset symptoms of

Autism. Controversy MMR Vaccine that cause autism make many people to study and

research The MMR Immunization and Autism: Does correlation mean causation?

MMR Vaccine controversy case study5,6,7,8

1. Study in UK

- The goal of this case-control, community-based study was to test the hypothesis that

measles vaccination was involved in the pathogenesis of ASD.

- Evidence for that hypothesis was defined a priori as signs of a persistent measles

infection or abnormally persistent immune response shown by circulating measles

virus or raised antibody titers in MMR-vaccinated children with ASD and with a

history of regression vs controls.

- Based on these findings, the investigators concluded that there was no association

demonstrated between measles vaccination and ASD.

- Limitations of the study include subjects in the typical development group not

randomly selected from the whole population; parents being informed that the study

was about MMR vaccination may have led to response bias; satisfactory blood

samples not obtained in 100 children, both ASD cases and control group with special

educational needs; and lack of gut mucosal samples for ethical reasons.

- After diagnosis of a developmental problem, children were less likely to receive the

MMR2, which the investigators suggested may reflect parental concern about

vaccination after a diagnosis of a developmental abnormality.

- Both ASD cases and the control group with special educational needs had lower

uptake of MMR2 and, hence, less exposure to the measles virus.

2. Study from The Lancet

- 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.

3. Study in Denmark

A 2002 retrospective cohort study of all 537,303 children born in Denmark from

January 1991 through December 1998 found no statistically significant difference in

risk of autism among the 440,655 who were vaccinated with MMR. This study

provided strong evidence against the hypothesis that MMR vaccination causes autism.

4. Report from ScienceDaily

Scientists at Columbia University Mailman School of Public Health's Center

for Infection and Immunity and researchers at the Centers for Disease Control and

Prevention, Massachusetts General Hospital, and Trinity College Dublin, evaluated

bowel tissues from 25 children with autism and GI disturbances and 13 children with

GI disturbances alone (controls) by real-time reverse transcription (RT)-PCR for the

presence of measles virus RNA. Samples were analyzed in three laboratories blinded

to diagnosis, including one wherein the original findings suggesting a link between

measles virus and autism had been reported.

"The work reported here eliminates the remaining support for the hypothesis

that autism with GI complaints is related to MMR vaccine exposure. We found no

relationship between the timing of MMR vaccine and the onset of either GI

complaints or autism."

5. In 1999, a large population-based study in England looked at the vaccination status of

498 children with autism and control subjects without autism and found no link

between the timing of vaccination with MMR and the onset of autism.

Conclusion

Reviewing both general information found on the scientific literature, it is evident that

there is no proven link between Autism and the receipt of the MMR immunization. The

multiple scientific studies researched in different countries have shown that a global increase

in Autism has occurred even with the decrease and elimination of thimerosal and the MMR

vaccination.

The number of reports on neurologic disorders is very small, other than evidence for

an association between a form of the MMR vaccine containing the Urabe mumps strain and

rare adverse events of aseptic meningitis, a transient mild form of viral meningitis. Evidence

suggests that almost everyone who has had a successful immunisation is protected against

these diseases for life.

References :

1. Ikatan Dokter Anak Indonesia. Jadwal Imunisasi. Available at

http://dranak.blogspot.com/2007/03/jadwal-imunisasi.html. Accessed January

17,2010.

2. Immunization Action Coalition. MMR Vaccine Does Not Cause Autism. Available at

http://www.immunize.org/catg.d/p4026.pdf. Accessed January 17, 2010.

3. Cynthia R Ellis. Autism. Available at

http://www.emedicinehealth.com/autism/page18_em.htm. Accessed January 17, 2010.

4. Mayo Clinic. Autism Risk Factors. Available at

http://www.mayoclinic.com/health/autism/DS00348/DSECTION=risk-factors.

Accessed January 17, 2010.

5. Marlene Busko. MMR Vaccine Not Linked to Autism in Virologic Case Control

Study. Available at http://www.medscape.com/viewarticle/569974. Accessed January

23, 2010.

6. The Lancet. MMR Vaccination and Pervasive Developmental Disorder: a Case-

Control Study. Available at

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17020-7/abstract.

Accessed January 23, 2010.

7. MMR Vaccine Controversy. Available at http://www.answers.com/topic/mmr-

vaccine-controversy. Accessed January 30, 2010.

8. ScienceDaily. No Connection Between Mumps, Measles, Rubella (MMR) Vaccine

and Autism, Study Suggest. Available at

http://www.sciencedaily.com/releases/2008/09/080904145218.htm. Accessed January

30,2010.

9. F. Weems, Carl. Journal of Autism and Developmental Disorders. 2010