MMR - Autism links if child is over 2?

[firststeps]

DS is 2.3, he couldn't have the MMR when he was called as I was pregnant with DS2 and was found to be non rubella immune. We are now deliberating whether to go for the MMR or pay for single injections, does anyone have any experience of immunising an older child, and advise on whether the autism link would still apply?

Immunising at this age is really no different at all, he is older so, if anything, will probably deal with it better than a younger child.

If you believe MMR is linked to autism then I would guess the risk is applicable whatever age you vaccinate at.

There is no autism link at any age but as you know some people still think otherwise so you have to make your own mind up. Rubella poses serious dangers to child health. My friend is a carer in a home for young adults, 3 of whom have severe brain damage due to rubella exposure in the womb.

The numbers affected by MMR appear to be small (less than 10% of cases of autism triggered by MMR). Even the research supposedly proving the safety of the MMR concedes that it cannot detect a regression being triggered at this rate. MMR has been shown to be safe for the majority of children. Autistic enterocolisits is accepted as a genuine if reasonably uncommon condition, and afaik there haven't been any other suggestions made as to what may trigger it.

The children I know who have ended up in ICU following MMR have had their big reaction after the first jab. I do know an adult who has been diagnosed with permament brain damage following a single measles jab years ago, which i think might have been given at an older age, but I don't know- she was easily diagnosed as it being vaccine damage though which makes me suspect she was older.

Children who regress dramatically after 3 or 4 aren't going to get an autism diagnosis - it will be something like childhood disintegrative disorder so it will be hard to find figures on (although the figure relating to anything to do with vaccination are inaccuratre anyway - it is accepted that they're widely under reported).

Perhaps worth looking at the JABs website, and I always suggest Richard Halvorsen's book 'The truth about vaccinations' for anyone weighing up pros and cons. He's an NHS GP and for children without risk factors does end up recommneding most of the vaccinations schedule (although he doesn't recommend MMR, he suggests singles instead with a ??? can't remember but decent length of time between them).

Hiya,

There is NO link between autism and MMR. The only study that found a link was discredited as rubbish and very very badly done. the doctor responsible has been disciplined by the GMC for gross professional misconduct. There have now been about 100 studies showing no link at all. The risks from getting mumps (infertility, deafness, brain damage etc) far outweigh the risks of autism imo.

Actually the study has not been described as rubbish. If you go to the Cry Shame website and read the discussion surrounding the paper during the GMC trial you will find that out.

Richard Horton (editor of the Lancet at the time of the publication of the paper and no friend of Wakefield's) said this about the paper (under oath presumably):

"When Horton moved to talking about the paper published in the Lancet, it became clear that he had the highest regard for the method which the ?case series? used and the way in which it was presented. If the prosecution was expecting him to say that the paper was full of poor science, they must have been surprised when he said the absolute opposite.

Horton said that the Lancet paper was an excellent example of a ?case series?. That this was a standard and entirely reputable way of reporting on a possible new syndrome. He likened it to how the first cases of HIV/AIDS were reported in the early 80s and how the new variant CJD issue broke more recently. He said unequivocally that the science reported in the 1998 Lancet paper ?still stands? and that he 'wished, wished, wished' that the clock could be turned back and the paper be considered in the light it was first presented, without everything that followed.

Defence council spent a considerable time cross examining Horton about the declaration of ?conflict of interest? issue. Over the years this has become one of the most important issues associated with the Lancet paper. At the end of a long session, the worst that Horton could adduce was that Dr Wakefield was genuinely surprised that there was the need for him to reveal funding from the Legal Aid Board, which anyway hadn?t been used in this case-series, or at all at that point.

Horton was happy to say that Dr Wakefield had been honest throughout his dealings with the Lancet and that he had not declared any conflict of interest because he genuinely believed (and believes still) that there was no conflict to be declared. While Horton personally disagreed with Dr Wakefield?s interpretation of this, as did Professor Simon Murch and Professor Walker-Smith, he acknowledged clearly that it could be seen as a matter of opinion and not a reflection on Dr Wakefield?s honesty."

A recent US case on 'vaccine damage', although not yet concluded, heard testimony from a leading UK scientist that effectively demolished the lingering remains of UK MMR/Autism 'link' theory. Unfortunately, this information was not in the public domain until the High Court ruled on the eve of the US proceedings that the conclusive research that the MMR/theory is not based on science could at last be made freely available. It is a measure of how low Dr Wakefield's reputation now is that he himself was dropped as a witness from the U.S case as even those pursuing similar lines felt that he was an embarrassment and a liability to their own case.

He probably is a liability, although I suspect that is more to do with politics. The reports from the GMC hearing make very interesting reading. So is the research freely available now? The most recent published article I saw published this month still didn't address the actual hypothesis.

Would love to know of research that has shown that the 7% or so that are believed to have regressed following MMR actually haven't. Would love to know of research that has examined the children involved.

And of course the individual cases. There's a child on here who was very ill in the days following MMR. There's a child I know locally who had massive seizures in the days following MMR and then a big regression (whose paed said the MMR was quite possibly involved).

yurt, what are the risk factors with the MMR? Ds1 and dd both had it with no problems but I am procratinating over ds2 because he seems a lot more sensitive to life in general than they were. He doesn't sleep, he's a very fussy eater, very clingy to me, has moderate excema, all things that ds1 and dd didn't have. OTOH, he walked at 11mo, is talking in 2 word phrases at 14mo and I have no doubt that he is developing at the usual rate for his age.

I just have a nagging doubt about the MMR that I can't really articulate, that if any reaction were triggered then it would be ds2 who had it. Is there anything in the research you've seen that suggests which children are more susceptible than others?

I think Prof Steve Bustin is to present a summary of his 100 page findngs to the Lancet but I haven't seen it. I followed the case on the Autism Diva blog which gave a lot of coverage to the science and of course all the other aspects of the case.

It's impossible to comment on personal testimony about autism and regression in children following an event, whether it is having the MMR or watching television( also suggested as a trigger for autism although possibly only if you live in a rainy climate), all that can be said is there is no known scientific means by which it could happen. The lawyers in the US case (representing the anti vaccine case) concluded forlornly that it is the parents against science.

A simple answer is nothing conclusive. There are probably many paths to autism anyway. However it would generally be accepted by people like DAN doctors that children with autism (especially regressive autism) often appear to have a history of autoimmune conditions and inflammatory conditions. And gut conditions. But they wouldn't necessarily be at risk from the MMR, and many will have the potential risk factors and never progress.

A potential model for the development of autoimmune conditions due to gut problems was published in Gut journal at the end of 2006. It didn't mention autism, but some mark autism down as autoimmune (and it may be in some cases, if not all).

Ds1's history was fairly typical now I know more about it. He had eczema, repeated ear infections (something like 8 by the age of 2) treated each time with antibiotics, then a strange things around 11 months where a mole went very crinkly (was seen by a dermatologist because it was weird) it then swelled up and started leaking a whiteish fluid. It then blistered and 24 hours later he was covered head to foot in blisters. A dermatologist said it was infected eczema herpeticum (although swabs came back negative- she was still convinced though). He had 3 lots of increasingly strong antibiotics then and steroids. The regression started then, so by 15 months he'd lost all words and quite a few speech sounds and was only eating about 5 items of food (previously had eaten absolutely everything). His paediatrician seemed to think that it was likely that the blistering condition had been the trigger.

I''ve had a brief browse and it seems to centre around PCR contamination? Is that right? I think people can argue for years about PCR contamination (it is a problem & safeguards should be taken to prevent it- but I don't think its something that would destroy all evidence ever. It would mean that the work needed to be redone but it is always going to be a potential problem when working with tiny tiny traces of something you're trying to amplify.)

Some bits on it on JABS

It muddies the waters and it would make O Leary's evidence questionable but it really doesn't destroy the MMR/autism theory.

It's true that nothing can ever destroy a theory but to get beyond a theory to an established link you need evidence. I personally think the UK lawyers who solicited public money for highly speculative litigation are very much to blame - I think there is a line in a Shakespeare play (don't know which one) that says 'The first thing we have to do is to kill all the lawyers!' One of the MMR lawyers who was later questioned about the ethics of what had happened commented rather laughably that in an ideal world, they would have waited until the science had proved the case.

Anyway, these things drag on and on, I must stop mumsnet addiction and do something useful !

Yes of course you need evidence.

But reading the stuff about PCR contamination I do think the anti MMR websites are overstating it's importance (something that would usually be an accusation levelled in the other direction). I may have this wrong because I can't download the transcripts from the trial (my computer crashes everytime I try- and reading what someone like Deer of Fitzpatrick has written is pretty pointless- I always try and read the source- for evidence from both sides) but if the evidence is just that there may have been contamination - which as far as I can make out it appears to be- well you could say that about any PCR study of this sort surely? It does suggest that the PCR studies need to be repeated and need to be absolutely as robust as you can get.

I get the impression that in the middle of this there are children who have a very painful bowel disorder (and really I don't think that's under dispute) who are barely being recognised let alone receiving treatment because it's such a political hot potato. Let's remember all Wakefield said was that single vaccine should be used whilst further studies were carried out to investigate the potential problems. What a mess to end up in because of that. And - contrary to Brian Deer's allegations Wakefield was not poised to launch a rival single vaccine - he was trying to develop a potential treatment for autistic enterocolitis (together with other Royal Free researchers). Brian Deer didn't respond to my email asking why he'd not made that clear.

And the state of knowledge so far? Some children with autism have very ulcerated guts. (The majority don't although they may have other gut problems). This gut ulceration may or may not be triggered by measles vaccination (whether in the MMR or via a single jab or even naturally I would guess). I haven't read anything on either side that has conclusively moved forwards from that point in the last - is it10 now? years.

And actually I'm not sure that in it's current form the research is going to move forwards. I'd personally push for improvements in the yellow card system. If a child ends up in HDU or ICU out of the blue in the days/even weeks following MMR then that should be recorded as a potential adverse reaction and followed up. The parents shouldn't be met with a blanket refusal to even consider that the 2 might be linked.

I think that sort of change would a) potentially generate some interesting research - especially if the children could be followed up longitudinally - expensive - but what a great data set and b) would actually do a lot to restore public confidence (although the dept of health have informed me that public confidence doesn't need restoring).

I know not all cases linked to MMR have resulted in hospital admittance (did the girl in the mitochondrial disorder case?? not sure) but if MMR is triggering something dramatic in limited cases (and I personally know of 2 cases who followed this pattern and now have autism ) then it would start to answer those questions. It would be a chance to get in and find out as much as possible about the child before the potential adverse reaction as well.

I'm off Twig DS1 at respite, ds2 and ds3 at granny's why am I here????

(Am curious about the Bustin evidence though so if anyone has a copy that they have downloaded and it hasn't crashed their computer would love to see it).

Prof Bustin's conclusive testimony which also effectively de railed the UK case is available at

ftp://autism.uscfc.uscourts.gov/autism/cedillo.html

It's day 8 the file downloaded okay to my computer and is not that big, at least not by pdf standards

I don't want to get bogged down in discussion and there are loads of far more appropriate sites to do that anyway, but as far as I am concerned the whole thing is no more than a tragic urban myth. Although as LeoneD says, it is very sad that people feel guilty about it.

Hmm I used to use that technique many moons ago and I'm not sure it's quite 'conclusive' evidence that destroys any MMR/autism link. I really don't. The criticism of the paper is neither here nor there as journals can lay down restrictions on what can be reported (because of space) - listened to a rant about that from a researcher at a conference last week. The access to the raw data is certainly more problematic and it is fairly clear the work needs to be done again. I don't think that's all that unusual for research involving these techniques though. Certainly the people I know working in ancient DNA (an absolute nightmare- and again problematic as you;re working with such tiny amounts of material) were always facing questions about contamination. It is the bane of PCR. They're just not usually held up to public scrutiny in courts - and the research ambles on until a clear(er) picture emerges. The criticism of the poster seems a bit considering the authors themselves said it wasn't anything conclusive. And I think (but don't fully understand why) there were certain assumptions made about measles virus presence in blood that the autism link brigade would dispute.

I don't think many people do feel guilty about it. That's something that Dr Fitzpatrick seems to have latched onto. The people I know who definitely link MMR with their child's regression saw very extreme reactions. I think they're more pissed off that that has never been properly investigated or in some cases recognised (although in others paeds etc have been supportive) rather than guilty for doing what they thought was best. I come across the same feelings in people whose children have had any sort of vaccine damage problem (even when not autism related) and in most cases they're just concerned and confused about what to do with younger siblings. But find it impossible to get answers to their questions because the information is so one-sided. If you're told that something can't possibly happen, but you believe you've observed exactly that to happen and no-one has ever investigated than you tend to lose confidence.

Incidentally when the legal aid was withdrawn Mercksent letters to parents promising not to seek legal costs if they, in turn promised by the end of the month never to sue Merck anywhere in the world The trial judge apparently said that was out of order.

The High Court appeal on funding was heard by Mr Justice Davis - younger brother of Sir Crispin Davis who sits on the board of GSK. Apparently the possibility of a conflict of interest didn't occur to him Remind me why is Wakefield in front of the GMC?

The LSC did originally change their mind and say that families asserting their children were suffering things like seizures, arthritis and encephalitis but not autism could get legal aid. But they withdraw that a couple of years later.

It's not really whiter than white is it? Which it needs to be if this is to be laid to rest.

Sadly, the sample he used for the research was very biased, ie 98% of uk children at that time were vaccinated and therefore all the children who later developed autistic traits had had the vaccine beacuse nearly all children had it. That theory is like saying all the children who got autism were human as there was no control sample ie uk children who weren't vaccinated and developed autistm. Also 'case series' is a very low standard of research. A case is just a case and is not generalisable to the rest of the population unless you complete a randomised control trial (all those that have been done show no link at all).

The problem is that this paper should never have been published as it was not good enough without further study (which would have fouhd different results). If it had never been published, this debate would never have happened. I peer reviewed the paper when it was first published with a group of eminent psychiatists (experts in Autism) when i was a lowly research student. They were all astounded at its poor quality and all requested the raw data to look at. Funnily enough, they never got it - i wonder why??? There is a lot of very poor research out there, every day the paper's are full of it - this 'study' is just one of those and should be consigned to history as a case study not robust science.

Sorry for the rant but we are now beginning to see the return of once fatal illnesses such as measles because of this study.....where will it end?

eh?

The sample used were parent who presented to him with abowel problems who believed that the problems had started post MMR. The MMR element wasn't co-incidental.

Why are psychiatrists experts in autism. Neither my son nor any of his peers have ever been referred to a psychiatrist - although several have been to bowel and gut specialists.
Not really sure what you are talking about....

And I had connected my sons regression with the MMR before I knew anything about Wakefield. So I think the discussion - which arose because of persistent parental reporting would have happened any way.

loulou I think you've completely misunderstood the paper. It doesn't remotely resemble your understanding of it. It described a novel gut disorder found in some children with autism. It also made the point that it was not enough for causation. It was a gut paper about novel gut disease with a mention that the parents linked the regression to the MMR. The paper was about guts rather than Psychiatry. The paper said the finding of a new gut disease was not enough to show causation from the MMR.

Wakefield's theory has always been that a subgroup of children with autism have regressed following MMR. He's never put a figure on that but other people now say about 7% of children with autism are triggered by the MMR. Wakefield has never suggested that MMR is triggering autism in every case. He is concerned about a subgroup of children who have severe gut disease and autism.

The papers supposedly recounting Wakefield's work have looked at whether MMR is responsible for the rise in autism, but that's not part of the hypothesis either.

According to the current understanding of this theory 93% of children who develop autism do so independent of the MMR. The remaining 7% with gut disease and a marked regression following MMR are the children that this paper refers to. The other 93% are not relevant.

God I'd love to see a Psychiatrist take a poke at my son They wouldn't know what had hit them (actually I have -not in professional role- and she suggested faith healing )