Introduction
Immunization procedures are implemented on a global scale in uniformity under the organization of the WHO. Millions of children are being saved from childhood illnesses like measles, mumps, rubella, diphtheria and polio. This mass effort is commendable so long as the medicines used and techniques employed are above board.
One must be sure that the lives of these children are being saved from illnesses which could harm them and not expose them to other forms of harm meanwhile. Doubts had arisen about the association of autism following MMR vaccination in the UK in the late 1990s. Studies have been conducted since then by many enterprising researchers. Some view the MMR with suspicion, others condemn it outright and still others deign to conclude that it is doing no harm. This researcher is taking the reader through the various studies and views expressed by the intelligent world and the news articles that convey general opinions. Many have even made insinuations about the agenda of the Government authorities in hastily continuing the MMR vaccination without lending their ears to scientists who have voiced strong adverse opinions. The majority however are for the vaccine.
Autism
Classic autism was considered a singular illness earlier and the prevalence was thought to be 4 to 6 per ten thousand (Lotter, 1967). Now a spectrum of disorders comes under autism and the incidence has been found to be 60 per ten thousand. School professionals identify more of these students and these children are being served in special education programmes (Hansen, 2006, p. 1). With the IDEA (Individuals with Disabilities Education Act) autism is well served in the United States and education authorities are able to do commendable work. Autistic spectrum of disorders now include autistic disorder, Asperger’s disorder, Rett’s disorder, Childhood Integrative disorder and Pervasive development disorder (Hansen, 2006, p. 4).
Autism is heritable or has a genetic predisposition (Muhle et al, 2004). An interaction between genetic, environmental and neurological factors contributes to the etiology (Hansen, 2006, p. 10). Developmental shortfalls with impaired social interactions and communications are the result. The neuroanatomical differences are seen in the “hippocampus and amygdala, cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem” of the brain (Tharp, 2003). Many researchers believe that the brain differences have a prenatal origin but some opine that postnatal factors could also affect the brain plasticity (Newschaffer et al, 2002, p. 138). Among post natal causes, encephalitis and infections like chickenpox have been associated. However the MMR vaccine is specifically upheld not to have any adverse effect on children. Current research has not found any relationship between the “measles-mumps-rubella vaccine, nor mercury and thimerosal-containing vaccines” and autism. (Newschaffer et al., 2002). According to the Institute of Medicine’s Immunization Safety Review Committee (2004), the evidence spoke for a rejection of a relationship between thimerosal-containing vaccines like MMR and autism (p.16). Treatment includes those targeted for special educational skills which require the services of resource specialists, speech and language pathologists, occupational therapists and physical therapists and psychologists (Hansen R.L., 2006, p. 88). Behaviors are managed with psychopharmacologic therapy and services of the psychologist (Hansen R.L., 2006, p.94). Using peers for the various interventions helps create many changes in the behaviors of autistic children (Hansen R.L., 2006, p.91).
MMR Vaccine
This is a vaccine which provides protection against measles, mumps and rubella. Prior to the MMR, the live-attenuated measles and rubella vaccines were developed independently of each other (Dubey, 2003, p. 579). They were effectively used for preventing the transmission of these viruses. In 1971, the trivalent vaccine was prepared for use in the United States. Most developed countries use this trivalent vaccine. The measles and rubella components are prepared from human diploid cells while the mumps vaccine is prepared using chick’s embryo (Dubey, 2003, p. 579). The individual harvests from the infected cells are blended so that the virus concentration of measles virus is not less than 1000 TCID50, mumps virus not less than 5000 TCID50 and rubella virus not less than 1000 TCID50. The trivalent vaccine has the same results as when vaccines are administered singly in different sites. Being a safe vaccine with high levels of immunogenecity and low levels of reactogenecity, it produces a marked reduction in the incidence of these illnesses through adequate seroconversion. The MMR vaccine has produced almost total seroconversion for measles and rubella and 90% conversion for mumps in India (Dubey, 2003, p 579).
Side effects have been associated with vaccinations. Confirmed safety is essential for successful immunizations programmes in the Public Health administration. Sufficient vaccination coverage is required for the prevention of infective diseases. Illnesses like Autistic spectrum disorders, meningitis, inflammatory bowel disease and Guillain Barre syndrome have been related to MMR vaccination. These controversies were mostly unfounded. Such an incident in the UK caused a sudden spurt of measles caused by reduced vaccinations (Dubey, 2003, p. 579).
MMR and Autistic Spectrum disorders
In 1998, 12 children were referred to a gastroenterologist in the United Kingdom for evaluating gastrointestinal illnesses associated with developmental regression. The parents of 8 of the children connected the illness to the MMR vaccine taken by the mother before and during her pregnancy (Dubey, 2003, p. 579). Wakefield conducted a study using these children and concluded that regressive autism is associated with an increased frequency of gastrointestinal (GI) disorders and symptoms (1998). The suggestion that MMR triggered both regression and GI disorders was propounded. He found that 12 children lost their skills after having been normal for a short while. All the children had gastro intestinal symptoms like diarrhea, abdominal pain, bloating and food intolerance. They also had the diagnosis of autism (Richler, 2006, p. 300). Wakefield et al believed that the vaccine could have triggered the bowel dysfunction which caused an increased absorption of gut-derived peptides from food. This may have disturbed normal brain development too. Recently 10 of the 13 authors changed their earlier statement with Wakefield (Murch et al, 2004).
One suggestion was that a G alpha protein defect in genetically predisposed children could be predisposed to autism. Live measles vaccine is believed to deplete Vitamin A stores which could lead to behavioral changes through metabolic and immunologic changes. These could be stopped by Vitamin A supplements.
Research in UK
A detailed study was conducted in UK attempting to co-relate the MMR with cases of autism. Developmental regression was not noted in the four months after the MMR vaccination. No association was found over a period of six months. (Dubey, 2003, p.580). However a general practice research revealed an exacerbation of autism cases of 2-5 year old boys born between 1988 and 1993. The MMR coverage or prevalence was constant at 95%. So a rise of cases due to a failure of MMR immunization was not the cause. The cases reported did not rise in incidence.
Similarly in California too, a relationship between MMR and the increased number of cases was studied. It was found that only a small increase was noted in the number of MMR vaccinated children whereas there was a six fold increase in the number of autistic spectrum disorders. 1.8 million Finnish children were followed for 8 years. They too did not exhibit any relationship between MMR and autistic spectrum disorders. (Dubey, 2006, p. 580).
What is a vaccine?
A preparation aimed at inducing immunity to a disease by triggering the production of antibodies is a vaccine (Vaccines, WHO 2008). It is made up of suspensions of killed or attenuated microorganisms or products or derivatives of microorganisms. Inoculation is the commonest method of delivery.
The significance of vaccination against measles
The only way to prevent measles, one of the most contagious diseases known to humans, is through vaccination. An estimated 242000 people, the majority of them children, died from measles in 2006. The failure to deliver at least one dose of measles vaccine to all infants remains the primary reason for high measles mortality (Urgent funding, 2008). Immunizing a child against measles is a very cost effective measure as it involves less than $1. Investing in this public health intervention would reduce the measles deaths by 90% by 2010. This significantly contributes to the United Nations Millennium Development Goal Four of reducing the under-five mortality by two thirds by 2015 (Urgent funding, 2008). The Measles Initiative Investment of $430 million for measles control activities has saved 2.3 million lives. Measles mortality has been reduced by 68% through the vaccinating of all children before their first birthday through the routine health services and providing a second opportunity for vaccination through mass campaigns. Funding initiatives for the period beyond 2010 are being stepped up to prevent a fall in the gains achieved recently which has been producing outbreaks. The Measles Initiative which has been backed by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Prevention and Control, UNICEF and the World Health Organization has supported the vaccination of 500 million children in 50 countries and reduced the measles incidence globally by 68% and 91% in Africa alone. (Urgent funding, 2008).
The Quality of the Vaccine
The WHO has norms and standards by which it maintains the quality of vaccinations (Quality and Standards, 2008). The production and control of biological preparations and innovative technologies have been streamlined as per the recommendations and guidelines of the WHO under the International Biological Reference Preparations (Quality and Standards, 2008). The norms and standards have been derived after widespread consultation and international consensus. These standards are to be maintained by member states of the WHO. The Expert Committee on Biological Standardization regulates the activity through collaboration with international scientists, professionals and regulatory authorities, manufacturers and laboratories. (Quality and Standards, 2008).
The WHO Initiative for Research (IVR) guides and facilitates the ‘development, clinical evaluation and world-wide access to safe, effective and affordable vaccines against infectious diseases of public health importance’ with emphasis on developing countries. The main goal is to deliver optimal cost-effective vaccines for IVR (Vaccine Research and Development, 2008). The immunization safety website of WHO provides information on the project’s background and promptly and efficiently to global issues of vaccine safety (Global Advisory Committee, 2008). The Immunization, surveillance and monitoring wing assesses the strategies and activities for reducing morbidity and mortality of vaccine-preventable diseases. The current burden of vaccine-preventable diseases and the future burden are all assessed and monitored for evaluation as the job of the Surveillance wing. The Global Immunization Vision and Strategy has an aim to immunize more people against more diseases, to provide new vaccines, to conduct surveillance and manage immunization activities within ‘a context of global interdependence’. $ 35 billion has been tagged for immunization activities in the poor countries; one third would be spent on vaccines and the rest for immunization delivery systems. With an additional $ 1 billion per year, immunization could save 10 million more lives in the next ten years and 41 million premature deaths would be prevented by 2015. (GIVS, 2008).
The Cochrane Review
Litigations were being triggered off in the UK following a series of allegations that the administration of MMR vaccine had led to regressive autism and illnesses coming within the spectrum of autistic disorders in presumably normally developing children. The cases were against the manufacturers (Miller, 2006, p. 111). The Cochrane Review of 2005 of MMR safety and effectiveness appeared against this background of litigations. The Cochrane Review had the evidence or lack of it in the 31 epidemiological studies that it considered after rejecting 5000 papers (Miller, 2006, p. 113). The review’s aim was to assess the MMR vaccine’s effectiveness and safety. There was really no intact evidence to state that the MMR was completely safe. The Cochrane Review however contradicted them and concluded that the MMR was absolutely safe just because millions of doses had been administered (Miller, 2006, p.111). The review synopsis said there was no credible evidence for associating MMR with autism or Crohn’s disease (Miller, 2006, p.113). The conclusion said that the safety of MMR lay in its universal use. The studies selected for evaluation had not said anything about the adversity of effects and the extent of this adversity. They could not be taken as scientifically adequate for stating that the vaccine was safe. These facts had been mentioned in the body of the review.
The discrepancies were worsened by the fact that this paper of 2005 was identical to an earlier paper of 2003. The team members were the same and they said almost the same things in both papers (Miller, 2006, p.113). However as required by ethical principles, the fact that an earlier paper had been presented was just not referred to in the 2005 paper though the same things were mentioned in both. A duplicated publication was considered unethical. The attempt to conceal the earlier paper was considered purposeful (Miller, 2006, p. 111).
What could have made the Oxford University-based Cochrane Collaboration which had an ‘internationally respected reputation’ resort to such underhand tactics? Cochrane reviews had been sought after for being up-to-date accurate information about the effects of healthcare (Miller, 2006, p. 111). Prior to 2004, Cochrane had no dearth of British Government funds. A change that had occurred since then had made them vulnerable and open to undue influence from commercial and government funding. Could conflicts over the funding and undue political interference have ‘tightened their belts’ and loosened their policies a little to adjust to the interests of the Government? (Miller, 2006, p. 111). After 2004, they had to think of commercial funds.
Professor Sir John Grimley Evans explained that the ‘core funding’ now available from government would not be sufficient for survival. They would therefore be looking to ‘selling their product’ to magnanimous benefactors. The Cochrane Review of MMR in 2005 was one document which relayed the interests of and supported the British Government. Even the direct commercial funding of Cochrane activities is permitted till 2010 only and thenceforth, non-core commercial funding only would be allowed (Miller, 2006, p. 111).
Vaccine damage compensation
By this scheme, the children who suffered damage were compensated by the public.UK vaccine suppliers were not free from litigations while US suppliers were legally immune. However litigations produce more compensation in the US than in the UK. It had been noted that the legal contract which the British Government had made with the Glaxo Company for supplying the MMR had been lost (Miller, 2006, p. 112). So the details of the financial arrangements had not been found. This also applied to the other contracts for MMR. Litigations would have forced the British Government to foot the bills for the children’s legal claims and Glaxo’s bills too. Did the circumstances make the Government stop the litigations by withdrawing the fund for compensation? History has it that the British Legal Services Commission withdrew the MMR Litigation Fund on October 1st 2003 (Miller, 2006, p.113). In September 2004, funding was restored for 11 children who had autism after MMR. Again the fund was denied for some others.
Regressive Autism
Most autistic children tend to show developmental differences right from birth. 20-40% of them tend to show some social and communicative skills which they subsequently lost at about the 15 -24th months age range (Richler, 2006, p. 299). The losses could be that of eye contact, gestures and participating in games like peek-a-boo.
Children with regression were found to have superior social and communicative skills before the loss of these symptoms when compared to children with autism and no regression. However children with regression and autism do not develop as much social and communicative skills as normal children (Werner, Dawson, Munson, & Osterling, 2005). Regressive autism has been associated with gastro-intestinal disorders and a relationship was found with MMR which was thought to trigger regression as well as gastrointestinal symptoms (Wakefield et al, 1998). Wakefield’s study investigated 12 children who were believed to have lost their skills between 24 hours and 2 months of MMR vaccination. The MMR was thought to have disturbed bowel function and an increased absorption of gut-derived peptides from food disturbed the normal brain development. However recent studies have found no increased risk in autistic children with or without regression (Molloy & Manning-Courtney, 2003).
Researchers have reasoned that regressive autism could be a new phenotype of Autistic Spectrum of Disorders. Fombonne and Chakraborti (2001) believed that if regressive autism were different, the symptoms and severity would be different in autism without regression. The regressive type would then be found at the age of vaccination and not at preschool age as in autism without the regression (Richler et al, 2006, p.300).
The Revised Autistic Diagnostic Interview (ADI-R) was used to interview the parents in a study and discover when the children first started their symptoms. Autism by definition in the US has its onset before three years of age and is usually in the second year (Richler et al, 2006, p. 314). Diagnostic criteria say that an autistic child fails to acquire behaviors typically seen in the ninth month to the eighteenth month or acquire them only to lose them at the age of three. Word loss was the indicator used here. Had the autism been related to the MMR, the word loss would have started immediately after. This did not happen in Richler’s study. This study did not divulge whether a child acquired a skill between 24 months and 36 months and whether a child who lost a skill ever regained it (Richler et al, 2006, p. 314). Recognition of autistic behaviors and gastrointestinal symptoms were provided by the parent. Medical records which were not used here would have given a better picture. The parents of children who underwent regression were the ones most likely to blame it on other events like MMR (Lingam et al, 2003). Even the parents of autistic children without regression are likely to report about autism being due to MMR due to the publicity accorded to the issue.
Autism and MMR in Japan
The circumstances in Japan were slightly different. The MMR was started in 1989 but was stopped by the Government in 1993 following the occurrence of several cases of aseptic meningitis (Uchiyama, 2006, p. 210). The MMR vaccine contained AIK-C (measles), Urabe AM9 (mumps), and To-336 (rubella) strains. The Urabe strain of the mumps virus must have caused the meningitis. The study thereby involved three populations of children: before the MMR, with the MMR and after the MMR. Psychiatrists diagnosed the cases. The regression history was retrieved from the archived database available at the hospital where the participants were selected from (Uchiyama, 2006, p. 212). The questionnaire used dealt with language problems mainly. The MMR details were obtained from the child health record. The MMR group did not show any difference in the number of autism cases when compared to the other two periods. The study expected more cases of autism related to the MMR group but this hypothesis was dispelled (Uchiyama, 2006, p. 215). The parents of the participants had no chance of hearing about the autism-MMR relationship being propounded in the UK and US. The cross-generational analyses in this study definitely were free from bias on the part of the parents and the psychiatrists. There were some drawbacks however. As this was not a population-based study but concentrated in a private clinic, a potential bias for selection existed. The proportion of children who received the MMR was too small to make generalizations. The parental reports were relied on for assessing regression and the chances of false positives arose. The diagnostic criteria used for this study could be different from other studies. Different studies use regression of different skills as assessment criteria making the autism rates different. It was 37% here but it has been found to be ranging from 49% (Hoshino et al, 1987) to 15.6% (Fombonne and Chakrabarti (2001). The latter had used a stricter definition for assessing autism.
Study in India
Indian children showed a 90% seroconversion for all the three viral illnesses of measles, mumps and rubella (Dubey, 2003, p. 579). Live-attenuated vaccines are known to cause nervous system viral infections like measles encephalitis (1 per 106 recipients), paralytic poliomyelitis (1 per 3×106 doses distributed) and rubella neuritis (1 per 104 recipients) (Dubey, 2003, p.581). However it is worth remembering that acute encephalitis and subacute sclerosing panencephalitis after natural measles infection is positively higher than after vaccination. The neurological complications after vaccination could be assumed to be due to the measles component and not to the other two as when singly used they do not produce any neurological complications. An epidemiological study in the United Kingdom indicated an association between MMR vaccine containing the Urabe strain and aseptic meningitis during the 17th -26th days after vaccination (Dubey, 2003, p. 581). Guillain Barre syndrome was originally associated with MMR but later studies did not show an association. The rubellar component is believed to produce thrombocytopenia within 2 months, with a temporal clustering after 2-3 weeks. The incidence is 1 in 25000-40000 immunized cases. The incidence is more in patients who have already had thrombocytopenia before. Children with egg allergy need not worry about the possibility of a reaction as the chick embryo fibroblast tissue culture does not contain significant amounts of egg cross-reacting protein of ovalbumin. Moreover skin tests for allergy to egg protein do not predict reactions to the vaccine. MMR can be safely taken as hypersensitivity is a rare occurrence with MMR (Dubey, 2003, p. 582).
Hydrolyzed gelatin is a stabilizer for most vaccines. This component is known to produce hypersensitivity in persons allergic to gelatin-containing products. Such patients need to be given a skin test before the vaccination. Most of the hypersensitivity to vaccines is due to the gelatin. Now many countries have modified this component. The incidence of the reactions has subsided.
Two doses had been recommended for measles vaccine in the US in 1989 (Dubey, 2006, p.580). The children had the second dose at the age of 6 or 11. It was well after the age of onset for autism. However no reports have come in of late-onset Autistic spectrum of disorders with the extra dose of measles or MMR vaccines. The Institute of Medicine in the US and the Medical Research Council in the UK concluded that though epidemiological studies do not support the link between MMR and autism, the possibility of the link cannot be ruled out at this stage and needs to be further researched (Dubey, 2003, p. 580).
Different kind of Research
A study with a difference was obtained from the search for relevant literature. Singh and his colleagues compared the sera of normal children and autistic children who had MMR vaccines. It was found that an unusual MMR antibody existed in the sera of 60% of the autistic children (Singh, 2002, p.359). This antibody was immunopositive for measles haemagglutinin (HA) protein but not positive for measles nucleoprotein (MV-NP) or rubellar or mumps viral proteins. So the measles HA protein which was indicative of the measles component of the MMR was detected by the MMR antibody in the autistic sera. Myelin basic protein (MBP) was also found associated with 90% of the MMR antibody-positive autistic sera. This puts forward a suggestion that the MMR antibody was associated with a minimal response in autistic children due to the CNS autoimmunity produced. The inappropriate response to MMR vaccine could be causing the autism (Singh, 2002, p. 359).
Children with autism have MMR antibodies which are unusual and show a temporal association with myelin basic protein (MBP) autoantibodies which can be used to mark CNS autoimmunism in autism (Singh, 2002, p. 360). MMR was used as the screening antigen as the researcher believed that the antibodies to MMR would a representative and true measure of the seroconversion for the trivalent vaccine rather than the individual antibodies which are usually measured in routine practice (Singh, 2002, p.360). To study the effect of dilution, the ELISA test was used to measure the MMR antibody level in 24 autistic children, 14 normal children and 16 children with other illnesses. The autistic children had significantly higher levels. The greatest increase was seen in the 1:50 dilution of the autistic sera (Singh, 2002, p.361). All the sera were then screened at this dilution by immunoblotting technique. This allowed the analysis of proteins bound to by the antibodies. 75 out 125 sera had antibodies to MMR but none of the controls had this antibody. The immunopositive reaction was seen in the band of 73- 75kD in the MMR blot. This was not seen in the controls and no other protein was seen. A similar band was seen in the MBP plot in the range 18.5 -20kD which is indicative of the bovine brain MBP used here. Autistic sera contained the MBP while the control sera were negative. Immunoblotting analysis showed that 75 out of 125 (60%) autistic children were positive for MMR antibodies (Singh, 2002, p. 361). 70 out of 125 (56%) autistic children had MBP autoantibodies. Normal and the children with other diseases had no evidence of these two antibodies. 90% of the MMR antibody positive autistic sera had MBP autoantibodies as well. The presence of viral components was tested by finding the reaction to MV haemagglutinin (HA) antibodies and MV (measles vaccine) nucleoprotein antibodies (MV-NP). The MMR blots showed an immunopositive reaction to the MV HA monoclonal antibodies but were immunonegative for the MV-NP monoclonal antibodies. The MMR blots were also immunonegative to the monoclonal antibodies of the Rubella virus and mumps virus (Singh, 2002, p. 362). The control children had only low levels of MMR antibodies which were immunonegative for MMR derived MV- HA antigen. This study shows the possibility of autistic children eliciting an abnormal response to MMR vaccine directed at the MV-Haemagglutinin antigen.
The Implication of Thimerosal
Thimerosal is a mercury laden preservative in vaccines (Safeminds, 2004). SafeMinds is a leading scientific organization in America which investigates the risks that mercury-containing medical products have for children. This organization believes that the Institute of Medicine which selected the studies for review for determining whether mercury had any effect on autistic children was a little premature in hastening to decide in favor of mercury-laden vaccines (Safeminds, 2004). Many studies on this topic were in the ‘green room’ when the decision was taken. Dr.Mady Hornig found that the administration of low dose mercury in children’s vaccines could produce behavioral and neurological changes in the developing brain. Dr. Hornig believes that such a finding is significant as the exposure could be controlled. The IOM being decidedly expressing the governments views could not be relied upon to accept these new studies which are being funded by an independent organization, the SAFEMINDS.
Studies with links between autism and MMR
Dr.Mady Hornig did her studies on autoimmune disease-sensitive mice. The outcomes seen were ‘delayed growth, reduced locomotion, exaggerated response to novelty with densely packed hyperchromic hippocampal neurons with altered glutamate receptors and transporters’ (Safeminds research, 2008). These findings show the involvement of genetic influences and more studies have to be conducted. Richard C. Deth’s study also showed the potential role of thimerosal in autism. Jill James’ study indicated that children with autism had an increased sensitivity to thimerosal. Thomas Burbacher performed his studies in a non-human primate. He intended to determine the changes in the absolute number of neurons in six regions of the central nervous system of the primate. MRI techniques would be used to trace the neuronic changes occurring (Safeminds Research, 2008). The above studies have not been published yet.
Studies with no links between autism and MMR
Honda (et al, 2005) found that MMR is most unlikely to have caused autism in a study in Japan.
Media reports have disproved the link between the MMR and autism in children as indicated by UK researchers (No link, 2008). 240 children were analyzed and it was found that autistic children and normal children react the same way to MMR. The blood samples were collected from children between 10 and 12 years of age in the South Thames area. 92 children had autistic spectrum disorder. 52 other children with special education needs were also included. 90 normally developing children were there too.
All had been given at least one dose of the MMR vaccine. No difference was seen in the levels of virus or antibodies in all the 3 groups.
David Ayoub’s video presentation- True or not?
David Ayoub, a Radiologist by profession, has expressed himself using statistic evidence on studies of various authentications to prove his points. He is a strong contender for saying that MMR triggers autism. Listening to him raises our doubts as to whether he is after all right. I admit he is a good speaker. The way he remarks about how a company which was selling thimerosal containing vaccines to the US after Denmark decided that mercury is not good for the children is interesting. The way Denmark decided finally that autism is not related to MMR is another story. In their first assumption they decided that MMR and autism have a link after counting the autism cases who were inpatients only.
When they decided that there was no link, they had counted all the outpatient cases too. It is a funny way to do things. Where is the scientific basis for either study? Comparison should have been made using a similar background.
He speaks about a study by an authority in the US whose findings were not published for obvious reasons. They found that the mercury containing thimerosal had caused a problem in the first year of study. Slowly the figure reduced till it reached a ‘no link’ status five years later. Then they relied on this last figure to claim a ‘no link’.
Simpsonwood saw a meeting between the CDC (Center for Disease Prevention and Control, US), international pediatricians and legislative representatives where it was generally understood that there was a link or at least a doubt about it. In one study,
the blood mercury level was assessed from the third day onwards when it should have been done on the first day itself. Ayoub ‘reveals’ that the head of the Institute of Medicine was an Eli Lilly man. Eli Lilly Company has made billions of dollars in the business of vaccines. Ayoub also says that a vaccine bottle if broken spills mercury on the floor which is toxic but when it is injected, it is not considered so. He wonders about the argument behind it.
Reaction to Ayoub
I have read comments on the internet saying that Dr Ayoub is not the authority to speak about autism and that he does not treat autism. My opinion is that anyone can speak against injustice. Why cannot a common man do so? I agree that Dr Ayoub may not be totally right and his interpretations of the statistics must be questioned. The authorities and the scientists working in this field need to look into the various studies and refute his allegations, at least to appease the millions of other human beings who still are not convinced. However the way the business of health is moving in this 21st century,
Dr Ayoub’s allegations may be justified after all. Human beings are materialistic in nature and believe in making easy money to line their pockets, at the risk of even killing others.
Summary
The autistic spectrum of disorders has a fairly high incidence among children who need special education programmes for their school life. Genetic, environmental and neurological factors constitute the etiology (Hansen R.L., 2006, p. 10). The IDEA establishment serves the autistic children well. Developmental shortfalls with social and communication impairment are the consequences of autism. Neuroanatomical differences have been discovered in the hippocampus and amygdala, cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem (Tharp, 2003). Therapy would include psychopharmacology, services of the psychologist, resource specialist, speech and language pathologists and peer-initiated interventions for moulding the behaviorally disoriented and developmentally backward autistic children (Hansen R.L., 2006).
The trivalent live-attenuated vaccine of MMR prepared from chick embryo (mumps) and human diploid cells (measles and rubella) is given as two doses in some nations and one dose in others. The mumps vaccine could vary in strain from country to country. MMR saves children from getting measles, mumps and rubella.
Autistic spectrum disorders have been attributed to the MMR. Wakefield’s study in the UK was the first to suggest that regressive autism and gastrointestinal symptoms were associated with MMR. A whole multitude of people making suggestions for and against the link between MMR and autism became the order of the day. Many studies were positively blaming the thimerosal component of the vaccines which was the mercury-containing preservative. Several studies also cancelled the link. The authorities who depended on these researches for their decisions were flabbergasted by the different interpretations and the inadequacy of these studies which were mostly epidemiological.
What made the situation impossible was that the methods and matters discussed were so different and not uniformly done to make appropriate interpretations.
The Cochrane Reviews which were famous for their integrity and credibility were for the first time doubted for taking a stand that there was no link. This was considered pro-Government or helping the government to dismiss the litigation cases against it resulting from the link between autism and the MMR. Both the Cochrane Reviews and the UK Government were in the dock. The public belief was that the Cochrane Reviews’ change of funding had made it vulnerable. They could not uphold righteousness compromising the scope of commercial funding which they needed badly. The impression was that they could have been forced to relax their ‘correct’ attitude in order to ensure some commercial funding. The words the Cochrane Collaboration used in their review synopsis of 2005 were again ambiguous: that the safety of the vaccine lay in its universal use. (Miller, 2006, p. 113). There have been accusations that the review was done in a hurry knowing that many studies were being done but not endorsing them. The criteria for including 31 studies and excluding many more have been questioned. Why were not the studies in the making included? These have been the points of discussion of many researchers and observers. The next point of controversy was that the earlier paper of 2003 said the same things as detailed in the review synopsis of 2005 but the earlier paper was not even mentioned as a reference. Was not this a hoodwinking of the public at large? A duplicated publication was considered unethical especially when it came from a prestigious institution like the Cochrane Collaboration (Miller, 2006, p. 111).
Another drastic gaffe noticed was the loss of the legal contract with the Glaxo company which the UK government had lost. Could it have been purposefully lost to suit some people? (Miller, 2006, p. 112).
The quality of the MMR vaccine like all vaccines need not be doubted. The norms and standards by the WHO set our minds at ease. A Global Advisory Committee and the Global Immunization Vision and Strategy appear to be reliable sources for the maintenance of the safe immunization practices all over the world. Sufficient funding and the ability to deliver cost-effective medicines and supervision of global practices of delivering safe vaccines appear to be adequate and appreciable (Global Advisory Committee, 2008). However there has been a doubt about the Institute of Medicine which may not be authentic which says that the head was an Eli Lilly associate. The research scientists at SAFEMINDS which provides the funds for the researches also give this impression that the Institute may be adjusting its findings to the tune of the Government policies and for the sake of business. This implies that decisions taken at the level of the Institute of Medicine could have been biased in its assumption that the MMR vaccine is not linked to subsequent autism (Safeminds research, 2008).
The studies mostly concentrate on epidemiology. The studies have been conducted in India, Japan, Denmark, London and the United States. What can be noticed is that various differences are seen in the method of study, the vaccines used and the manner in which the inferences are made. This researcher’s search for literature has revealed one study which appeared to be impressive in that the association of myelin basic protein with the MMR vaccine antibodies was demonstrated. When researchers have time and again spoken of MMR vaccine leading to neurological problems and causing autism which is related to neurological changes, the attempt taken by Singh in 2002 appears to be appropriate and more convincing than the other studies. Singh has found a relationship of the MMR antibodies with the measles vaccine haemagglutinin antibodies. This finding was not present in normal children. This study elicited a possibility of autistic children showing an abnormal response to the MMR. More studies on this line should be done to further expand or disprove the link or specify in no uncertain terms that there is no link. The lives of our children depend on these studies.
References
Ayoub, David. (2005). “Mercury, autism and global vaccine agenda”, 2008. Web.
Fombonne, E., & Chakrabarti, S. (2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics, 108, e58.
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