MMR at three? Or should I wait until booster age?

[SoBroken]

To cut a long story short, DS has had all his vaccinations except the MMR. After seeing mothers talk very passionately about the effects it had on their children, DH and I decided we didn't want to do it, and would get single jabs instead.

However, he lost his job and things have been very tight financially. We have never had a spare £300 to actually get it done.

Looking at DS starting nursery after xmas and I'm a bit worried about him catching measles or something while there.

The private clinic where they do the separate jabs told us there is no need to get separate boosters at five, as by then, the danger of autism has passed.

I just want to know at what age this passes? Should i go and get the MMR done now, or should I wait until he's five? Our financial situation is still too tight to get the separate jabs at the moment, at least while DH builds his business up a bit.

How do you respond to this for example? I expect to say "correlation does not equal causation" " coincidence" and "emotional response". Possibly "lies" or "propaganda".

"I had been hitting my head against the wall with my GP and consultants at Worcester and Birmingham Hospitals after our son became ill at 10pm on the night he had the MMR in 1995-6. His character had changed overnight fluctuating between manic periods of hyperactivity to sitting propped up in corners or walls staring vacantly. He also became obsessive about lines - lines of cars, toys, chairs, etc. Previously he had been a normal little chap and, as he was my third child and l have worked with an autistic adult, l do feel l am experienced to reach that conclusion.

He also developed terrible bowel troubles often having to use the toilet during mealtimes, excreting the food he had just eaten.

The medical diagnose at this time "Parenting Issues"

My call to you was a long shot, and l just thank you so much for taking the time to speak to me. Fuelled with the information you gave me regarding diet and your reassurance that l was not mad, l felt l had the tools to help Matthew. And have been ever since.

We had a referral to the Royal Free and we also removed all dairy and wheat products from Matt's diet.We also signed up to be part of your research but only received one visit to collect blood samples. So where are now? Well quite simply always in your debt.

Matt is a strong, fit intelligent young man. Often short on words until he hits a subject that captivates him and then his thirst for knowledge is quite powerful. Not too strong with his literacy but has incredible Three D perception and is extremely talented with construction using his hands. He has opted to do a Diploma in Engineering rather than GCSEs . His report is outstanding stating he his a very able. committed learner and very lovely character."

This is just one, and you might say that it's a coincidence if there was just one or two or ten, but there are thousands of examples of temporal correlation. Then you've got the epidemiology of autism, which has exploded to one in around 150 from one in five or ten thousand. Then you've got ten years of flawed epidemiology, then you've got a definitive "no link" paper which turns out to be flawed as well, so there's quite a lot of reason to think there could be something in all of this.

Go ahead and sneer.

Hey I've just seen this -

"Less than 15mins before posting the Madsen paper quote you suggested that epidemiological methodology used to with regards to MMR vaccination and autism is often flawed. "

What's with the timing thing? What's that about?

It's not just me suggesting it, it's Madsen saying it. There were lots of studies before 2002 - he doesn't seem to discriminate, he seems to be talking about all of them. Lots of them have been quoted here as proof that there's no link, you might even have done it yourself.

Bleurgh. Why am I even wasting my time. Cue the sneering.

I'd like to take your posts in order if that's OK.

You said of the Madsen Study that:

"The Madsen paper is flawed because of the difference between age of vaccination and age of austism diagnosis. If the average age of vaccination is 18 months and the average age of diagnosis is around 4.5 (the dates are in the study, I haven't read it this time) then at the end of the study there will be a three year gap.

That means that all children under the age of around four and a half who've been vaccinated will be counted as non-autistic because they havene't been diagnosed yet, and that obtains even if they're showing signs of autims, because all that counts for the study is the diagnosis."

They followed the children for a lot longer than 3 years.

They were followed up to 9yrs post MMR vaccination.
To make sure they weren't getting a confounder from different lengths of follow-up they checked for any change to relative risk at different time intervals.

Does that make sense?

As for:

"I can't believe you dismiss it as a "rhetorical flourish"

I'm glad you can't believe it.
Because I don't do that.

I said:

"Even without any possibility of "rhetorical flourish", in the sentence you quoted, ......"

Perhaps I could have been misunderstood.

What I think (and meant) is this:

I don't think this was written as a rhetorical flourish.
I can't know that it wasn't as I didn't write it.
Let assume that there is none.

Which is what I did with the rest of my post.

The reason why I brought it up is because t's not uncommon for research papers to be critical of what has gone before.
Your study is unnecessary if perfect information has already been obtained on a subject.
And it's pretty human to have a higher opinion of your own work than others.

I don't think the person who wrote that is lying.

I don't know obviously but I don't think so and am more than happy to assume that it's not for the duration of this discussion.

The letter as it was written is not propaganda.
However it is being used as such.

But I think you want me to say that I know the person who wrote the letter is wrong.
But I don't and indeed can't know that.

But the author can't know they're right either.

The author and their partner have absolute certainty.
I don't.

They could be the only parents of a child who has been made autistic by vaccines.
They could be one family of many.

You can't tell from that letter.

In the same way you can't know that smoking is safe from one life-long smoker living to 85.

A personal account is a starting point for the scientific method.
It can't be the end of it.

I hope you don't mind me splitting my response to your 10:24 post into two parts but I felt you raised a point we hadn't discussed before.

That of the increased rates of autism diagnosis.
From around 4 per 10,000 in the 1960s to 15-20 per 10,000 now.
This is part of around 30-60 per 10,000 children with some form of pervasive developmental disorder.

I don't think anyone is denying the number of diagnoses is increasing.
I certainly am not.

The question is why, and there are two sub-groups of thought that I'm aware of.

1. The true incidence of autism is rising due to a change in environmental factors.

2. That part, or indeed all of the rise is an artifact due to us being better at looking for autism (surveillance) and a broadening of what we define as autism.

These would look the same with regards the headline number of diagnosis but would look different when looked at from different ways.

In the 1990s the diagnosis of autism was changed to Autism Spectrum Disorder.
This broadened the symptom range which qualified for diagnosis, as well as folding in Aspergers into ASD.
Broader definitions, more people fit into it.

One way of seeing if this might have been the case was tried by Rutter in 2005.
He looked at studies from before the 1990s which included enough information on which a diagnosis could be made using the current definition.
When doing this he found that historical rates, when assessed using modern definition were very similar to current rates.

Taylor in 2006 did a similar but independent analysis and concluded:

"The recorded prevalence of autism has increased considerably in recent years. This reflects greater recognition, with changes in diagnostic practice associated with more trained diagnosticians; broadening of diagnostic criteria to include a spectrum of disorder; a greater willingness by parents and educationalists to accept the label (in part because of entitlement to services); and better recording systems, among other factors".

You could also assess a population of adults using the modern criteria and see if they have a similar rate to children. Which is what this study did. They found higher rates in these adults than historical rates would have suggested.

If the numbers of children being called autistic is rising but the number of actual cases of autism is stable maybe children are being moved into the autism box from another box.
This study looked at adults who had been diagnosed with a developmental language disorder as children. They reassessed them using current definitions and found a little over a quarter would shift groups and be diagnosed with autism today.

There is also some evidence social interaction drive autism diagnosis. This study found the strongest risk factor of a child being diagnosed with autism is to be socially close to a child who has already been diagnosed.
This has been interpreted as parents recognising behaviors and signs that both children share and pushing for a diagnosis down that route.

It's also worth noting that rates of autism could be increasing from social demographics, especially paternal age.
Numerous studies find that as dads get older, rates of autism go up.

To sum up, I don't know whether there is any new environmental factor leading to increased autism rates.
But the evidence would suggest if there is, it's a very small part of the puzzle.

I didn't mean anything by my comment on the timing.
I just wanted to make it easy to track which post I was referring to.

I apologise if you thought it was a veiled insult.
As you can see I use the post times now to help us keep track.

I don't know why you are on this thread?
If you have said so, I must have missed it.

But you mention sneering and I want to comment on that.

There has been less than civil discourse used on both sides in this debate, both on this thread and others.

You have accused me of ignorance of many aspects of this issue.
You have said I am intellectually dishonest.
You have accused me of close-mindedness bordering on fundamentalism.

All I have done to you is suggest you may be wrong.
And tried to explain why I think that.

I think I have been polite when doing so.
Tone is always tricky on the internet but I have been ready to apologise when I seem to have inadvertently caused offense.

I would appreciate it if you extended me the same courtesy.

Maybe you aren't that closed minded - thanks for the acknowledgement that they could be the parents of a child made autistic by vaccines. That's quite uncommon from a pro-vaccinist.

It's good that you accept there could be a link - that's what most people who question vaccines think, that's why they want caution, single vaccines, more research.

Acknowledgement of a possible link is an important first step.

OP seems to have disappeared...
3yo IS Booster age, btw, DS (exactly 3.5yo) has just been called for his preschool booster. He won't start school for another year, but he's due anyway, by their accounting.

I had MMR as an adult and haven't "regressed", btw (happily scratches spare head ).

all personal testimony welcome

Ragged Just to remind that the second MMR is not a booster. It's the same as the first one, designed to pick up those children left unprotected by the first shot. (Approx 5% - 10% if I remember rightly).

So, to sum up, where are we on epidemiology? Can it ever be used to prove a causal link between any two events?

DBennett using epidemiological studies only, can it be conclusively proved that smoking can cause lung cancer? You mentioned smoking in one of your earlier posts (that's the only reason I mention it here).

Looking at Blueberties quoted case earlier, what proof would you need, DBennett that the MMR caused that child's problems? For my sake, let's assume that the parents are correct in this case. What proof would you need? What would satisfy you?

@Tabitha8

It depends on what you mean by prove.

If you mean to the level of mathematical proof, no.

But to all practical purposes, yes I think it's fair to say that epidemiology can prove a causal link.
I also think it's fair to say that epidemiology is better at refuting supposed causal links.

One of the guides people use in these cases is the Bradford-Hill criteria. These are a series of pointers which help when questioning causality.
Not all of the are for epidemiology but it prominently used in that field.

You asked about smoking, lets use that as a case study for the Bradford-Hill Criteria:

Strength of association: Large changes in risk are less likely to be random noise.
Former smokers have a 3.5x increased risk of lung cancer. Current smokers upwards of 4x.

Consistency: Do most studies say the same thing.
Studies looking at lung cancer in current smokers form very similar results. Former and passive smokers tend give you more randomness.

Specificity: Are there other things which could cause the disorder in question.
There are a few other known causes of lung cancer, radon gives some studies trouble but generally the differences are straight forward to tease out.

Temporal relationship: obviously cause must precede consequence.
Childhood lung cancer is almost unheard of. There is also a temporal relationship between starting smoking and onset of lung cancer.

Biological gradient: Is there a dose-response relationship?
Smoking has a strikingly strong gradient of risk.
Former smokers 3.5x the risk

I hope you mean "refute" as in "argue against" rather than "disprove"?

I must assume you do.

Since you accept the possibility of a link between autism and vaccines, including MMR, that is.

You cannot at the same time believe the link to be disproved.

The two are self-contradictory.

Interesting that you talk about mathematical proof in connection with epidemiology.

An impossible aspiration: you might achieve an overview of probability and often significant probability, but proof and disproof of absolutes - it would be misleading to suggest this is possible.

To be honest refute doesn't mean anything but disprove.
It's often used wrongly to mean "attempt to refute".
I think this is the mistake you must have made.

The other thing is, what's that thing about Madsen follow up being nine years?

Results
A total of 537,303 children were included in the cohort and followed for a total of 2,129,864 person-years. Follow-up of 5811 children was stopped before December 31, 1999, because of a diagnosis of autistic disorder (in 316 children), other autistic-spectrum disorders (in 422), tuberous sclerosis (in 35), congenital rubella (in 2), or the fragile X or Angelman's syndrome (in 8), and because of death or emigration in the cases of 5028 children, whose data were censored. For children who received MMR vaccine, there were 1,647,504 person-years of follow-up, and for children who did not receive the vaccine, there were 482,360 person-years of follow-up.

and

Statistical Analysis
Follow-up for the diagnosis of autistic disorder or another autistic-spectrum disorder began for all children on the day they reached one year of age and continued until the diagnosis of autism or an associated condition (the fragile X syndrome, Angelman's syndrome, tuberous sclerosis, or congenital rubella), emigration, death, or the end of follow-up, on December 31, 1999, whichever occurred first. The incidence-rate ratios for autistic disorder and other autistic-spectrum disorders in the group of vaccinated children, as compared with the unvaccinated group, were examined in a log-linear Poisson regression model with the use of PROC GENMOD (SAS, version 6.12).30 We treated vaccination as a time-dependent covariate. The children were assigned to the nonvaccinated group until they received the MMR vaccine. From that date, they were followed in the vaccinated group. In additional analyses, the MMR-vaccinated children were grouped according to their age at the time of vaccination, the interval since vaccination, and the calendar period when vaccination was performed.

What you said just isn't true.

the second MMR boosts though, both the measles and the mumps response.

Catherina What do you mean when you say the 2nd MMR boosts? Do you mean it improves immunity? I can't see how that can work. If I'm one of the 90% protected by the first dose, I don't need my immunity "boosting", surely? It should be good enough by that point.

first of all, the MMR contains three compounds, so you may be immune against 1 or 2, but not the other(s), then, indeed, it has been reported that titers increased in people with borderline immunity after a second shot (or measles epidemic, in which these folk did not display symptoms, but a higher titer after an epidemic rolled through the community, nevertheless)

My idea of booster jab is a subsequent jab that either reinforces existing immunity* (by reminding the immune system of the threat) or tries to provoke an immune response in those who didn't get full immunity the first time around. I am confused what other definitions others feel are more accurate, but I don't care anyway to nitpick. It's obvious that OP (still AWOL) meant the jab due at school starting age, and like I said, most 3yo children will start being due that now, not some time after their 5th birthday.

*Good example is the chickenpox virus, no? You keep immunity by repeat exposure thru life, else immunity can actually fade away, leading to higher risk of shingles or a repeat bout of CP. Lifelong immunity for lots of diseases is achieved via "booster" series, eg., Polio or Tetanus.

Hence the option to have a blood test to check immunity prior to having a second dose that is probably not needed.

Sorry, my comment was to Catherina. I took too long typing it!

I've seen government ministers saying the booster is to catch the people who weren't given immunity the first time. I think there's a lot of deliberate confusion because at first it was going to be just one, giving lifelong immunity, then it was two, then some people I've read on here are offered three, and they get earlier and earlier too. First it was 18 months for life, then 13 months, then you need the booster, then you need a booster at three plus a pre-schooler, then you need to check yourself before you go to uni or get pregnant.

The problem for pro-vaccinists is that a lot of them deny waning immunity because that would mean herd immunity hasn't ever worked. And then when they're talking about something else, they say oh yes waning immunity. It's hard to get to the bottom of it.