No Evidence Supports Link Between Vaccines and Autism

No Evidence Supports Previously Held Link Between Vaccines and Autism

Laurie Barclay, MD
from Medscape
February 9, 2009 — There is no cause for parental concern that childhood immunization might cause autism, according to the results of a new review that shows no link between vaccines and autism. The review is published in the February 15 issue of Clinical Infectious Diseases.

“Vaccines don’t cause autism — 20 studies now show no link between vaccines and autism,” senior author Paul A. Offit, MD, chief of infectious diseases, The Children’s Hospital of Philadelphia in Pennsylvania, told Medscape Infectious Diseases. “I think that many people are reassured by these studies, although there are still a group of parents who hold that vaccines cause autism, much as some people hold a religious belief. To those people, it really doesn’t matter how many studies you do, it’s not going to change their minds.”

More education is needed to prevent further disease resurgence among children whose parents have refused vaccination based on this unfounded fear, he added.

Three Theoretical Links

Three specific hypotheses have been offered to suggest a theoretical link between vaccines and autism. The review describes how each of these theories originated and summarizes the pertinent epidemiological data, which refute the 3 hypotheses.

“The first theory concerned the Measles-Mumps-Rubella (MMR) vaccine; the second, that it wasn’t the MMR vaccine specifically but a mercury-containing preservative, thimerosal; and the third, that the simultaneous administration of many vaccines is just too much for a young child’s immune system,” Bryan H. King, MD, co-chair, American Academy of Child and Adolescent Psychiatry Autism and Intellectual Disabilities Committee, told Medscape Infectious Diseases when asked for independent comment.

The first hypothesis is that the combination MMR vaccine damages the gastrointestinal lining, thereby permitting the entrance of encephalopathic proteins and causing autism. After publication of a 1998 study in The Lancet suggesting an association between MMR vaccine and autism, 13 subsequent studies performed in 5 different countries showed no such link. The reviewers concluded that no data supported any causal connection between the MMR vaccine and autism, and that any apparent association was coincidental, because the MMR vaccine is typically administered at the age when symptoms of autism first emerge.

“While rates of immunization have been constant or declined, the incidence of autism has increased, and the rate of autism in vaccinated and unvaccinated children is the same,” said Dr. King, who is professor and vice chair of Psychiatry and Behavioral Sciences and director of Child and Adolescent Psychiatry at University of Washington and Seattle Children’s Hospital. “Neither the timing of onset, nor the severity of autism, differ whether or when a child gets immunized,”

The second hypothesis is that thimerosal, an ethyl mercury–containing preservative used for more than 50 years in some vaccines, causes central nervous system toxicity. However, the review describes 7 studies from 5 countries demonstrating that autism rates were not affected by the presence or absence of thimerosal in vaccines.

These 20 epidemiologic studies showing that neither thimerosal nor MMR vaccine causes autism were conducted by many different investigators, using a variety of epidemiologic and statistical methods.

“Even very rare associations, if they existed, would have been detectable given the large size of studied populations,” Dr. King said. “Studies on the causes of autism should focus on more promising leads.”

The third hypothesis is that giving multiple vaccines simultaneously overwhelms or weakens the immune system. In rebuttal, the review authors point out that the immune system in childhood routinely processes far more antigenic material than the relatively small amount contained in vaccines, and that it is biologically implausible that vaccines overwhelm a child’s immune system, even if the system is still immature.

“The challenge to the immune system from modern vaccines — even in multiple combinations — is actually significantly less than was given routinely to children back in 1980 (long before the autism epidemic),” Dr. King said.

Finally, the review authors note that autism is not triggered by an immune response, and they suggest that future research on the biological basis of autism should prove or refute alternative, more plausible hypotheses.

While the risks of vaccination concerning autism are theoretical and shown not to be valid, the risks of not being vaccinated are real and sometimes fatal.

“We’ve already seen the outcomes of choosing not to comply — over the last 10 years or so, we’ve had outbreaks of pertussis among a relatively unvaccinated population of children,” Dr. Offit said. “We had a measles outbreak in this country that was bigger than anything we’ve had in a decade. Now we have a cluster of cases of Haemophilus Influenzae meningitis where 3 parents chose not to have their child vaccinated; all 3 children got meningitis, and all 3 of them died.”

Dr. Offit noted, “The question becomes, ultimately, when do we reach the tipping point? When do we say that exempting from vaccines is creating a problem not only for those children whose parents choose not to vaccinate but for those children in the community?”

Education of the lay public, as well as the healthcare community, is needed if unfounded fears of vaccination are to be dispelled.

The “Right to Catch and Transmit Potentially Fatal Infection”

“Public health officials and the academic community are really trying to communicate this science to the public, but it’s a real challenge,” Dr. Offit said. “Is it your right to catch and transmit a potentially fatal infection? Right now, the answer to that question is yes, but we’ll see how long it takes before the answer to that question is no.”

He added that it would be unethical to do a prospective study in which some children were not vaccinated, given the known harms of failure to vaccinate, and that retrospective studies would have methodological issues because the groups would differ in characteristics other than their vaccination status.

“Focusing our precious research time and talent on questions that have been asked and answered not only contributes to ongoing confusion — for example, about whether or not to be immunized — but also will delay us from finding real answers to this critical problem,” Dr. King concluded. “Parents and clinicians should have candid discussions about the risks and benefits of vaccination including the avoidance of potentially catastrophic diseases. It will be hard not to mention autism in this context, as it may give the impression that doctors are trying to hide something, and parents should feel empowered to ask these and any other questions of their clinicians, but on the other hand, constantly linking autism and vaccines in the same sentence may continue to suggest that a relationship exists when there is no evidence to support it.”

Doctors’Dilemma: Caught Between Patients and Insurers

JC is an active, 50 plus year old male who was gardening outdoors when he was stung by a yellow jacket. Within 15 minutes, he got dizzy and collapsed. His family called EMS and the paramedics arrived 5 minutes later and injected him with epinephrine and started IV fluids. He was transported to the nearest ER where he got more IV fluids, steroids, and Benadryl. He was observed in the hospital overnight and discharged with an epinephrine autoinjector and a referral to the local allergist. He saw the allergist and one month later was found to be allergic to yellow jacket, wasp, and hornet venom and started venom allergy injections which would protect JC from any further episodes of anaphylaxis for the rest of his life.

A simple happy ending, right? Wrong! Unfortunately, medical care in this country is no longer that simple or straightforward. For some reason only known to itself, JC’s insurer decides to cut payments for venom allergy injections down to half of acquisition cost (meaning half the price of buying the venom from the manufacturer, not even including the price of needles, syringes, alcohol pads, and the nurse giving the injection). Calls are made and letters are written to medical directors, without avail. This now puts JC’s doctor in a bind:

How can you continue providing a service or a product when you are losing money on that service/ product?

The answer is, you can’t. Bakers stop making cakes, carmakers stop making cars, shops close down. And yet, this is not just a cake, or a car, or a shop. This is JC’s health and life.

JC’s insurer is playing games with patients’ health care. It doesn’t want to get the rap for not covering a very important therapeutic intervention, BUT it doesn’t want to pay for it either. So, who gets left holding the bag? JC’s doctor, for now. But since you can’t continue practicing at a loss, eventually JC and all the other patients will not have access to this therapy, even as they religiously pay their insurance premiums every month. This scenario is seen in slightly different settings all over the country, from chemotherapy and vaccinations, to mental health services.

Patients deserve good health care and doctors should not be penalized for practicing good medicine. Insurers should be helping patients and physicians, not making it more difficult. Stop playing games, or we all lose.

Household Poison Safety

I thought I’d get a jump on National Poison Prevention Week which is from March 18 to 24 this year. I had dinner recently with a neurotoxicologist friend who told me the sad story of a child who died from drinking silver cleaner which had been left out when his mom was interrupted while doing chores.

We are so paranoid about child seats and bike helmets, but sometimes we forget the dangers that are in our own closets.

Here are some important prevention tips from the National Capital Poison Center

Facts On Poison Exposures:
• On average, poison centers handle one poison exposure every 14 seconds.
• Over two million poison exposures were reported to local poison centers in
2000.
• Most poisonings involve everyday household items such as cleaning supplies,
medicines, cosmetics and personal care items.
• 89 percent of all poison exposures occur in the home.
• 92 percent of exposures involve only one poisonous substance.
• 86.7 percent of poison exposures are unintentional.
• 75 percent of poison exposures involve ingestion of a poisonous substance.
Other causes include breathing in poison gas, getting foreign substances in
the eyes or on the skin, and bites and stings.
• 77 percent of all exposures are treated on the site where they occurred,
generally the patient’s home with phone advice and assistance from local
poison control experts.

Children and Poison:
• 53 percent of poison exposures occur in children under the age of six.
• The most common forms of poison exposure for children under the age of six
are cosmetics and personal care products (13.3%), cleaning substances
(10.7%), analgesics (7.6%) and plants (6.9%).

The Most Dangerous Poisons for Children

The most dangerous poisons for children include the following. Be sure to check the poison prevention tips to protect your loved ones.

Medicines: these are OK in the right amount for the right person. They can be dangerous for children who take the wrong medicine or swallow too much.

Iron pills: adult-strength iron pills are very dangerous for children to swallow. Children can start throwing up blood or having bloody diarrhea in less than an hour.

Cleaning products that cause chemical burns: these can be just as bad as burns from fire. Products that cause chemical burns include include drain openers, toilet bowl cleaners, rust removers, and oven cleaners.

Nail glue remover and nail primer: some products used for artificial nails can be poisonous in surprising ways. Some nail glue removers have caused cyanide poisoning when swallowed by children. Some nail primers have caused burns to the skin and mouth of children who tried to drink them.

Hydrocarbons: this is a broad category that includes gasoline, kerosene, lamp oil, motor oil, lighter fluid, furniture polish, and paint thinner. These liquids are easy to choke on if someone tries to swallow them. If that happens, they can go down the wrong way, into the lungs instead of the stomach. If they get into someone’s lungs, they make it hard to breathe. They can also cause lung inflammation (like pneumonia). Hydrocarbons are among the leading causes of poisoning death in children.

Pesticides: chemicals to kill bugs and other pests must be used carefully to keep from harming humans. Many pesticides can be absorbed through skin. Many can also enter the body by breathing in the fumes. Some can affect the nervous system and can make it hard to breathe.

Windshield washer solution and antifreeze: Small amounts of these liquids are poisonous to humans and pets. Windshield washer solution can cause blindness and death if swallowed. Antifreeze can cause kidney failure and death if swallowed.

Wild mushrooms: many types of mushrooms grow in many areas of the country. Some are deadly to eat. Only experts in mushroom identification can tell the difference between poisonous mushrooms and safe mushrooms.

Alcohol: when children swallow alcohol, they can have seizures, go into a coma, or even die. This is true no matter where the alcohol comes from. Mouthwash, facial cleaners, and hair tonics can have as much alcohol in them as alcoholic beverages.

Household Poisons
The Yukkiest Poisons
These are especially hazardous household items. Buy small quantities. Discard unneeded extras. Make sure they are always out of a child’s reach.

antifreeze
windshield washer solutions
drain cleaners
toilet bowl cleaners
insecticides
artificial nail removers
topical anesthetics (i.e. Products that may be used for sunburn pain)
medicines, medicines, medicines.
Did you know that even these common household items can poison little children?
detergents
automatic dishwasher detergents
furniture polish
perfume & aftershave
mouthwash
gasoline, kerosene, and lamp oil
paint and paint thinner
mothballs
alcoholic beverages
miniature batteries
flaking paint
cigarettes, tobacco products
rat and mouse poison

Pet Poison Prevention Tips:
Your pets can be poisoned too. Follow the same poison prevention tips given for children to protect you animals. The following are some additional poison prevention tips specifically for your pet:

-Never give your pet any medications unless specifically instructed to do so by a veterinarian. Many human medications can have dire consequences to animals, even in small amounts.
-Never give your dog chocolate. Dogs are particularly sensitive to chocolate, and it is considered extremely poisonous for dogs.
-Be aware of you houseplants. Many common household plants can cause kidney damage to your pets if ingested.
Keep all medications out of an animals reach, even they can get into a closed medicine bottle.
-Keep hydrogen peroxide available in case you need to make your animal vomit due to a poisoning. Do not give the peroxide unless instructed to do so by a veterinarian or a Poison Center.
-When treating you animal for ticks and fleas, read all product labels before you begin. Follow the safety recommendations given for you and for the animal.
-Hose-down areas in your driveway or garage in which chemicals have been drained or leaked. A small amount of many chemicals can be fatal to an animal.
-Be aware of neighborhood poisons that may be lurking for your pet.
slug or snail baits put out in gardens
yards and gardens recently treated with insecticides
mushrooms and outdoor plants
rat and mouse poisons
snakes and frogs (frogs may be very poisonous if eaten by a pet)

Finally, Act Fast
What to do if a poisoning occurs:

1. Remain calm
2. Call 911 if you have a poison emergency and the victim has collapsed or is not breathing. If the victim is awake and alert, dial 1-800-222-1222. Try to have this information ready:
-the victim’s age and weight
-the container or bottle of the poison if available
the time of the poison exposure
-the address where the poisoning occurred
3.Stay on the phone and follow the instructions from the emergency operator or poison control center.

P.S.DON’T FORGET TO VISIT BLOG MD FOR PEDIATRIC GRAND ROUNDS 1:24

Welcome to the Red Carpet: Pediatric Grand Rounds (1:23)

Good evening all, and welcome to the Red Carpet PGR!
Tonight we will be encountering many interesting posts from all over the pediatric blogosphere, dressed in their red carpet best.

However, unlike the Oscars, no actual awards will be given due to the recent report from Stanford psychologist Carol Dweck and colleagues cited in New York Magazine and featured in Treatmentonline.com that certain types of praise can be harmful. Apparently, praising a child for being “smart” or “intelligent” may raise their self-esteem, but makes them hesitant to try new tasks or fail because they are afraid of not being perceived as “smart/ intelligent”. Instead, we should be praising them for trying, for a job well done and for doing specific tasks and developing specific skills. Yikes! have we turned the next generation into “praise junkies”?

Next on the red carpet, we have the dashing Dr. Clark Bartram of Unintelligent Design and the always lovely NICU nurse Judy, from Tiggers Don’t Jump who both had bad experiences with ALTE’s. That’s “Apparent Life Threatening Events” for those of you “not in the know”. Treatment and evaluation of these episodes seem to require some basic equipment: a working brain and a good dose of common sense, both of which Dr. Bartram and Nurse Judy have in abundance.

Speaking of babies with life threatening problems, we have grrlscientist from Scientist, Interrupted with a post about Viagra being used in Newcastle, England to improve circulation in a premature baby, thus saving the child’s life. Leave it to the Brits to find a new market for Viagra. Another example of ingenuity comes from the suave Scot Trauma Queen who tells the tale of a wee lad with a Lego up his noggin.

And what’s a PGR without vaccines? Dr. Sidharth Sethi from Pediatricsinfo online tells us about the cost-effectiveness of pneumococcal vaccines in developing countries. Regarding the reports of intususception associated with the new rotavirus vaccination, we have not one, but two rants from our friends Dr. Sam Blackman at Blog MD and the prolific Dr. Flea. Flea also weighed in on Merck’s recent decision to cease and desist its lobbying for mandatory HPV vaccination of adolescent girls. Nurse Marcia of Ants Marching also objected to Merck’s campaign, which turned what should be a medical/ preventive health issue into a political one.

This might be “so last year” (actually, 6 months ago), but the IOM Report on the future of Emergency Care, pointed out the lack of adequate trained personnel, facilities, resources, and disaster preparedness for pediatric emergency care in this country, has there been any progress since the report came out? Methinks we should continue talking about it till we see some. Docwhisperer just whispered in my ear that in addition to these issues, there is a growing rift in the ER community between the “career” ER physicians and the residency trained docs.

Dr. Sam Blackman of Blog MD deserves an award (although we’re not handing out any), not only for having 2 posts in this edition of PGR, and for riding in the PanMassachusetts Challenge, a 192 mile bike ride to raise money for the Dana Farber Institute, but also for evangelizing and exhorting others to join the good fight versus pediatric cancer. Thanks to Shinga too for introducing me to Lucia, a plucky 17 year old on a soapbox. In this edition, she talks about JimmyTeensTV.com, a videoproject by teens for teens to help them deal with cancer. To complete the triangle, we also hear from Cancer Dad who shares some of the difficult decisions involved in parenting a seriously ill child.

Illness is difficult enough even when parents and physicians agree on treatment, complications multiply exponentially when they don’t. Dr. Steven Novella of Neurologica Blog points out the ethical and legal issues involved when parents and physicians disagree on the therapeutic plan, particularly when unproven or controversial procedures (like psychic healing) are being used.

Preemies have been in the spotlight lately. Aside from the aforementioned Viagra baby, there is Amilla Sonja Taylor, the earliest surviving preemie, born at 22 weeks gestation. NICU Nurse Laura from Adventures in Juggling weighs in on the realities and costs of caring for very early preemies and The Preemie Experiment discusses the ambivalent emotions many parents have and asks whether they are given sufficient information and counseling in making these difficult choices. Tales from the Womb also shares new information on the psychological and neurodevelopmental outlook for these kids.

Since this is a blog dedicated to allergies and asthma, we need at least one post on that topic. My thanks to Shinga from BreathSpa for Kids for submitting an excellent post debunking the increasingly common (and immensely profitable) use of IgG levels to “diagnose” food intolerance or allergy. Brava! You can also check the Food Allergy page on this blog for more information. I’d also like to thank Shinga for trolling the blogosphere and helping me find many of the excellent blogs featured today.

Wait! The orchestra’s starting to play and I haven’t thanked my agent yet! Since it is Oscars night, I’d like to plug three excellent films this year involving children (although not necessarily suitable for children), namely Pan’s Labyrinth, Little Children, and Little Miss Sunshine.
I’m also taking the liberty of pushing my current favorite children’s book: The Secret Science Project That almost Ate the School (click to download the podcast)

I’d also like to thank everyone who contributed to this PGR, and to anonymous black puppy in the cooler, I couldn’t have done it without you!
Darn! There’s that music again, no, wait it’s my current favorite children’s Indie rock band, the Sippy Cups! Before we rock out, don’t forget next PGR is at Blog, MD on March 11, 2007.

Ladies and Gentlemen, the Sippy Cups!

Pirates of the Health Care-ibbean

For anyone who has had trouble with their health insurance company, you will appreciate this cartoon video: