The MMR Controversy

There is a lot of controversy at the moment regarding the MMR vaccine, specifically the measles portion of it. Many parents are nervous about allowing their children to have the MMR vaccination due mainly, I believe, to its link with autism.

Most people have quite a fixed opinion I have found, though are unsure what the actual evidence is that they are believing. There is no shortage of information about MMR and autism, and it is easily found on the internet. However there seems to be a lot of junk science available, and those scientifically untrained may be unable to separate the junk from the real thing. They therefore tend to believe that which affects them most.

= = = = THE START = = = =

The whole debate started in 1998 when gastroenterologist Andrew Wakefield, in association with others, claimed that MMR might trigger autism. Based on only 12 children, most of the others who authored the paper later retracted the findings. It was based on the possibility of the measles virus, given live as part of the vaccine, causing enterocolitis (bowel inflammation) and releasing toxins which attack the brain, causing autism.

Parents panicked, vaccination rates dropped dramatically and Wakefield cited data from California which showed the number of autism cases increasing 600% between 1980 and 1994. However, this also supports other evidence that autism rates are increasing: In fact that they were increasing before the introduction of MMR in 1988. During the period when the proportion of MMR vaccinations was fairly steady autism still increased, and continued to increase when the MMR vaccine uptake in the UK dropped to 60%. This is poor evidence to suggest a link.

= = = = THE PROBLEMS = = = =

What the autism studies have failed to take into account are:

* They are based on numbers and do not take population growth or changes in its composition into account.

* The cases in the original study were referred to the researchers, and there were only 12 of them, and did not represent the population.

* Diagnostic definitions of autism have changed over the years, and various studies have failed to take this into account. Minor symptoms have increasingly been diagnosed as autism.

* Children are now being diagnosed at an earlier age and so the cases must increase.

* No account has been taken of the increase of environmental pollution by chemicals and fumes.

A large study in Finland, involving 1.8 million people who received 3 million doses of the MMR vaccine over 14 years, found only a few reactions. It failed, however, take into account the background cases of autism normally expected of the general population. Nevertheless, it provides good evidence that the link is tenuous at best.

A recent analysis in the UK supports this, showing a steadily increasing rate of autism against a steady uptake of the MMR vaccine. So autism is increasing despite MMR remaining steady.

A study in Denmark, often quoted, showed an increase in autism in children who had the MMR vaccination. However, this has been used both by governments and other researchers to either disprove or prove the link. I have not seen the evidence but it must be flawed if it can be used by both sides.

A recent study in Japan, who withdrew the MMR vaccine in 1993 for other reasons showed that in over 31,000 children born in one district of Yokohama between 1988 and 1996, cases of children diagnosed as autistic by the age of 7 continued to increase from 48 to 86 per 10,000 prior to MMR withdrawal to 97 to 161 per 10,000 after withdrawal. This equates to:

* A 56% increase in autism prior to the withdrawal of MMR

* A 60% increase in autism after the withdrawal of MMR

Remember, all children in the Yokohama test were examined up till they were 7 years old, so age was not a factor.

This is the first study undertaken on what happens after the MMR vaccine is withdrawn and it suggests that the rate of autism and the vaccine are not connected.

= = = = THE FLAWS = = = =

The Lancet has recently admitted that the original paper by Wakefield would never have been published had it known certain facts. It has been alleged by a Channel 4 and Sunday Times investigation that Andrew Wakefield was being paid to carry out other studies by a group involved in a multibillion lawsuit against the MMR vaccine’s makers. Wakefield was backing this claim behind the scenes.

The investigation also alleges that there were a number of patents from him and the London Free Hospital for individual treatments involved, which were dependent on MMR’s reputation being damaged and parents opting for individual vaccines. There has also been an unreported study from Wakefield’s lab which showed his theories to be wrong. The original study seems fatally damaged by these revelations, and Dr. Wakefield has not yet taken the step of attempting to sue Brian Deer who carried out the investigation.

The main problem with the MMR vaccine appears to be the measles portion. If this is the case why should a singles measles vaccine be any better than the MMR? This, in itself, has not been properly explained, and Wakefield’s vaccine patents seem to indicate something funny was going on.

There are two camps, and little between. Parents are caught between the two sets of information. Unfortunately, there is a great deal of politics involved in both camps. The pro-connection camp are talking about litigation and class action and the anti-connection camp, naturally, are trying to defend against this and governments are becoming worried. The real scientists are becoming worried that we may regress to the pre-1960’s situation before any measles vaccine was available, and millions died from the diseases annually.

The potential legal situation is starting to affect the figures. Review of case records has shown that the child’s history given by some parents changed after the publicity. Prior to the publicity some parents reported they were concerned about their children from an early age, normally before they reached one year. The current history for the same children now show the same children’s symptoms only occurring after the MMR vaccination. This is certain to damage future studies which even now are being accused by both sides of being slanted or biased one way or another depending on what side of the possible litigation you are.

= = = = THE FUTURE = = = =

There is now too much media interest and the bias which now seems to have flawed the initial study will continue to be the main subject of debate, rather than whether or not there is really a link, and this is potentially damaging to children. Children are being damaged: they are either being given a vaccine which promotes autism or they are being denied a vaccine necessary to prevent them contracting three serious diseases

It is of extreme importance that the truth come out, whether there are financial implications or not. Both sides should be forced to get together to come to a conclusion which helps the parents, not the lawyers or corporations or governments.

In the UK alone uptake of MMR has reduced dramatically and children have started to die again from measles. Once the current young girls grow up they will be almost certain to have problems with foetal abnormalities, unless they make sure they are immune to rubella prior to puberty. This is especially true now, with so many teenage births. The problem is that today’s parents have never seen the era prior to vaccination, when deaths from measles were commonplace, when infant abnormality was common and young men dreaded the mumps.

Any parents who refuse the MMR vaccination must ensure that their child is immunised against these diseases with separate vaccines. They must not send their children to measles parties. Mumps and German measles (rubella) parties are OK since these diseases are not dangerous till puberty. Measles on the other is a killer disease, especially dangerous in young children. Of the 400,000 measles deaths worldwide, 25% are of children under 1 year. Almost 80% of measles deaths are from pneumonia: measles is a respiratory disease.

My own belief is that the MMR vaccine is not a specific problem. If there is a problem it lies in the measles virus itself, since it is that which is claimed by Dr Wakefield to cause the enterocolitis. The single measles vaccine will therefore have the same problem. In my opinion, the choice is not between MMR vaccine and the single vaccine, but between either vaccine and posssible autism, or no vaccine and the measles and possible death (and autism), not to mention all the nasty side effects such as hearing problems, meningitis and brain damage.

= = = = WHAT DO YOU THINK? = = = =

So, what is your opinion? Do you think that MMR causes autism? Would you let your child have the MMR vaccination when the time comes (13 – 15 months generally)?