MMR from today's Lancet (31 Oct 2003)

[janinlondon]

From today's Lancet:

Separating inflammation from speculation in autism
Sir--The report by Michael Kidd and colleagues (Sept 6, p 832)1 of measles-associated encephalitis in children with renal transplants emphasises the grave risks posed to immunosuppressed children by low uptake of the measles mumps and rubella (MMR) vaccine. Calculations of outbreak size indicate that low MMR uptake has left the UK on the edge of major measles outbreaks.2 Uptake as low as 61%1 makes almost certain the return of endemicity.2 Additionally, the near elimination of congenital rubella syndrome by MMR will surely reverse.
I write as an author of an Early report for The Lancet3 and a paediatric gastroenterologist for many autistic children. Although subsequent studies4 have lent support to and extended the gastrointestinal findings associated with autism noted in this report, the same is not true for any link with MMR; many epidemiological studies have been undertaken, the results of which indicate no causal relation. No other vaccine has ever been studied in such depth, and the evidence for its overall safety is comprehensive. The response by all consultant paediatricians in the Early report3 was to support MMR vaccination without reservation,5 although this fact went largely unreported. The points made by us in this letter remain valid.
This department has continued to assess children with autism on straightforward clinical grounds, since large numbers show improvement in abdominal pain and sleep disturbance if constipation, gastritis, or colonic inflammation are recognised and treated.5 However, not all children with autism show such response, a finding that needs further study. That any reports that characterise gut inflammation in autistic children are reported in the media as supporting the idea that MMR is causative is deeply frustrating, since it is simply not so. I and my colleagues have seen similar intestinal changes in children with no history of regression, in unvaccinated children, and in children whose first autistic symptoms clearly predated MMR administration. Several genes implicated in autism are expressed in the intestine and immune systems, and it is possible that subtle abnormality in these systems is an unrecognised component of autistic-spectrum disorders. This area remains one of legitimate interest, but should be clearly separated from the MMR issue.
MMR immunisation, which should be an easy decision, has become a worrying issue for many British parents. Although this situation reflects in part a broader mistrust of official pronouncements, and has been fuelled by media campaigning, it is founded on the misinformed perception that there is ongoing scientific uncertainty. There is now unequivocal evidence that MMR is not a risk factor for autism--this statement is not spin or medical conspiracy, but reflects an unprecedented volume of medical study on a worldwide basis. By any rational standards of risk/benefit calculation, it is an illogical and potentially dangerous mistake for parents to be prepared to take their children in a car on the motorway or in an aeroplane on holiday, but not to protect them with the MMR vaccine. An unprotected child is not only at personal danger, but represents a potential hazard to others, including unborn children. Unless vaccine uptake improves rapidly, major measles epidemics are likely in the UK this winter.2
Simon Murch

Centre for Paediatric Gastroenterology, Royal Free and University College Medical School, Royal Free Campus, London NW3 2PF, UK (e-mail:[email protected])
1 Kidd IM, Booth CJ, Rigden SPA, Tong CYW, MacMahon EME. Measles-associated encephalitis in children with renal transplants: a predictable effect of waning herd immunity. Lancet 2003; 362: 832-832. [Text]
2 Jansen VA, Stollenwerk N, Jensen HJ, Ramsay ME, Edmunds WJ, Rhodes CJ. Measles outbreaks in a population with declining vaccine uptake. Science 2003; 301: 804.
3 Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637-41. [Text]
4 Horvath K, Perman JA. Autistic disorder and gastrointestinal disease. Curr Opin Pediatr 2002; 14: 583-87. [PubMed]
5 Murch S, Thomson M, Walker-Smith J. Autism, inflammatory bowel disease, and MMR vaccine. Lancet 1998; 351: 908.

Wow, that seems really comprehensive. My 2 are due their boosters next week and I feel much happier after reading it, thanks janinlondon

WOW! Simon Murch is greatly admired (and fancied ) by me and many other parents of children with ASD and/or gut problems. Many of my friends with ASD children who regressed are far more suspicious of the early childhood jabs than the MMR and possibly other, unknown, environmental factors, but it makes very interesting reading. Thanks for posting it.

Hurrah! Thanks for taking the time to record this article. My ds is due to have his first MMR jab very soon. Although I have no doubts about giving it to him (and neither does dh who is a doctor) its reassuring to read articles like this.

He was being interviewed on the Today program this morning. He was asked whether he had been forced into making a statement (or words to that effect, implying that he had to say this to save his career) and he took it very well, completely dismissed it and came over as very calm and sensible.

I won't say what descriptions have been applied Simon Much on my autism lists today. Especially from one mother - who has an MMR damaged child (thankfully doing extremely well now- 5 years down the line).

Has he said why children with autistic enterocolitis have mealses virus in their guts (and spinal fluid?). I know that this is does not prove causation- but "interesting" none the less. I'm also interested as to whether he is using the epidemiological studies as "proof" in the above statement. Over and over again it has been explained why these don't show anything either way.

This is why I think the MMR needs investigating further. This is a quote from Paul Shattock who runs the autism research unit:

"There is not just one cause of autism there are many. BUt the MMR is the one that the finger has been pointed at, and I think it has got to be investigated. 10 to 11% of children with autism in the UK have children who swear it was triggered by the MMR. And I believe them.

This is a regressive autism. The kids are developing normally in every way, and the parents have the video evidence to prove it (easy to check btw- I've posted elsewhere about things like pointing). The first thing the parents notice is the behavioural regression which takes an average of 15 days to come out. With the second shot the kids often go down the next day"

This is why the regression following the MMR is so different to that described by other parents of auti children. My son showed a slow regression- he lost words but over months. If you talk to people with MMR damaged children, the screaming, the regression, the violet pain starts very very soon following MMR.

Reading a very moving book at the moment. "Calling the Shots" Not about MMR , but about one mother's journey following and adverse reaction to the meningitis C jab. You can get it from Jessica Kingsley if anyone is interested. here: www.jkp.com/

I also listened to the Today prog on radio 4 this morning and was very interested in Dr wakefield who was interviewed about 5 minutes after Dr Murch, He ( wakefirld) said that he is absolutely sure of autism MMR links and also said Murch is caving into extreme pressure including denied promotions and the threat of his clinic being shut down. He said so many reports from US and UK scientists have found autism and bowel disease links to MMR but that the findings are all sub judice. He said it is an international outrage and there needs to be a Hutton style investigation. He was very convincing and he made me bloody glad we gave our daughter single vaccines.

Anyone who doesn't think that the british govt is very very scared of Wakefield should listen to the radio show on this thread:

www.mumsnet.com/Talk?topicid=138&threadid=11513&stamp=030930145145

Also just heard something interesting on an autism list. Apparently a pot of money was put aside to investigate causes of autism. I remember listening to a Radio 4 interview where Paul Shattock was invited to put in an application (at which stage he almost keeled over). All that money has now gone onto looking at genetic links. Possibly a lot safer? Must be my fault then for daring to reproduce. Don't get me wrong I'm sure there is worth in looking at the genetic links, but gene expression is affected by the environment and its dangerous to ignore one big potential possibility.

This rather amusing article describes very well the problem with focusing purely on genetics.

In our own personal case, ds1's problems are not related to the MMR. With hindsight he was having problems almost from the beginning. Dh also has a lot of autistic traits so in our case it may well be genetic. However we both agree that the amount of anecdotal evidence is so overwhelming that there has to be SOME kind of link between the MMR and autism. It is accepted that some children DO react badly to immunisations, so why is it so impossible to believe that these jabs could affect the brains of some children? Like other parents we weighed up the pro's and cons. We decided in favour of MMR for ds1 but fully understand that the MMR might not be right for all.

And most people say the same as you coppertop- which is why I believe the mothers of the MMR damaged children. Their stories are different than ours.

Leaving aside the whole autism question its interesting to look to the States (where they spend more time arguing about thimerosil than MMR). In the States they have a vaccine damage compensation system which pays out for vaccine damage. It is funded by the drugs companies themseleves- who have to pay a levy per bottle of jab sold. The amount they have to pay depends on the vaccines danger rating. So for the DT they pay 6 cents per bottle, for polio 29 cents (they use killed polio) for MMR $4.44 and for DTP $4.56. A reminder that all vaccines can do damage and that according to the US rating the MMR is the one second most likely to (other jabs come between these figures).

You're right Jimjams - all vaccines have potential side effects. I thought and decided to go ahead with MMR. We live in Spain, and when we went, I asked the nurse if he knew about the fuss in the UK. He replied with a flat "no". Everyone simply does what the doc tells them here.

On the other hand, I think there has been an over-reaction in the UK. When were seperate measles mumps and rubella vaccines vigorously tested in babies? I just wish we could find a balance between the two extremes.

Very interesting Jimjams.... thanks for posting

Jimjams, the story about the pot of money is that the MRC put out a call for proposals, and the money was ring-fenced for autism studies. None of the first round of applications was deemed fundable after peer review, it all scored really badly. There was a readvertisment, and the only decent studies proposed were those involving genetics, so that's what got funded. I know it would be possible to dismiss this version of events as part of the conspiracy, but this was nothing to do with the government, and the person who told me that the non-genetic applications were not up to scratch is a major proponent of the MMR damage theory, so not someone with an axe to grind (or with an axe to grind, but in the opposite direction!).

To be honest, it seems to me that if you believe that MMR causes autism then it has to be because certain individuals have a genetic susceptibility; if it was anything else (other than some really weird rare environmental agent) then there would be far more children with MMR-induced autism, surely?

I'm not saying all this to score points, but just to try and say that at least at the level of the scientific community there isn't a huge conspiracy, and maybe some good will come out of the genetic studies. I do hope so.

tamum - it may not be a huge conspiracy but have you ever heard of cul de sac epidemiology ..... ?
It was first introduced in the Lancet in 2000.

Jimjams, have you seen this

Thanks for that pupuce. Interesting as I recently chatted with an OT who said that recent research showed that c-section babies often seemed to have sensory integration problems. And what is at the root of autism? sensory integration dysfunction.... I've only browsed but will have a look when I'm clamer (just back from a very NT Halloween party and I am spinning).

Tamum- I do take your point about a certain genetic type being susceptible. It already seems fairly clear that families with a predisposition to allergies/autoimmunity seem to be at risk from vaccinations (not just for autism for other things as well). Would love to know whether children with a family history of autoimmunity should be given the full whack of vaccinations- especially as this would be directly relevent to my family. As far as MMR damage without a genetic component goes then there has been a suggestion that catching chickenpox very close to receiving the MMR is not particularly helpful. Could be worth looking at in more detail anyway. Another area worth looking at is antibiotics. However for the reasons outlined in the hit and run article below I think we do need to be looking further than just genetics.

Consipracy aside, having seen what happened to Wakefield I can't imagine many scientists with mortgages to pay rushing to show the link between MMR and autism. And whether it is fair or not the conflicts of interest between many bigwigs in academia and the research they are comissioning (and yes I'm talking about links to drugs companies) make many people suspicious of the research that is produced. I agree we need a Hutton style enquiry if confidence in the MMR is to be re-established.

Personally I'd like a bit more dialogue (more joint studies- have thier been any? I've found reviews but not really studies) between researchers in the fields of autism and other autoimmune conditions that are rocketing out of control such as diabetes (type 1) and MS. We can always put the increase in autism down to change in diagnostic criteria (and I am sure it is true in the case of AS) but surely not type 1 diabetes. Mind you it would help if someone started collecting autism figures- not that anyone is paying any attention in California (and their figures don't include AS, or PDD).

My own view is that the MMR isn't a big problem (apart from for the poor sods who've been damaged by it- but not at a population level). Something is though. And I'd love to know what it is.

Pupuce- having read that- I am a classic case (Induction at term, long 18 hour labour, with epidural, then c-section). More research in this area please

Jimjams, as a member of a 'very' diabetic family mostly type 1 but lots of allegedly (I'm more convinced by the diet/sugar/weight combination) age-onset type 2, I'd be grateful of you could give me a link or reference to the increase in type 1 you mentioned. The Diabetes UK site gives the following info but no references:

Mumps or rubella infections are among the possible causes of Type 1 diabetes. Vaccinations against these infections would, therefore, seem beneficial. However, there is a theoretical possibility that the viral antigens (molecules which stimulate an immune response) injected in the course of vaccination, could, in some way, provoke a harmful response by the immune system (in theory, the development of Type 1 diabetes). This, coupled with the fact that the incidence of Type 1 diabetes is rising across Europe, especially in children under five years old, has raised public suspicions about the safety of the MMR vaccination

Whilst these concerns are reasonable, they are not supported by scientific evidence. A study in Sweden has shown that there is no evidence to suggest that a mumps or rubella vaccination increases the risk of developing Type 1 diabetes. In fact the study suggests that the measles vaccination might even be protective. A later study in Finland suggested that the rising incidence of Type 1 diabetes actually slowed when the MMR vaccination was introduced.

In the UK, a study sponsored by Diabetes UK (then, the British Diabetic Association) looked at the dramatic increase in incidence of Type 1 diabetes in children under five years old between 1985 and 1994 (a period spanning the introduction of the MMR vaccination). When the vaccination records of these children were examined, researchers could find no evidence to suggest that children given the MMR vaccine were more likely to develop Type 1 diabetes than those who were not. The researchers also pointed out that the incidence of Type 1 diabetes has been rising steadily across Europe since the 1960s, long before the MMR vaccine was introduced.

The MMR vaccination was introduced into the routine childhood vaccination schedule in 1988, and since then, some 10 million immunisations have been administered in the UK. It is widely used in other countries.

In conclusion, there is currently no evidence to suggest that the MMR vaccination increases the risk of developing Type 1 diabetes. There is some evidence to suggest it might be protective.

I hasten to add, I'm not trying to be provocative, I'm genuinely concerned, the article I copied seemed to be sitting on the fence with no scientific basis one way or the other.

I've just booked dd's pre-school booster and also pointed out I'd not had her hib recall jab done yet either, to which the response was 'well which do you want to get done then ?' I asked which should be the priority, only to be told 'that's your decision' Ahh.

Sorry you've misunderstood what I was saying. What I meant is that given there is a huge rise the incidence of auotimmune conditions in general we should be asking ourselves why. I have no idea why this may be but I think we should consider these as a group. Allergic conditions are also increasing. Recent reseach has suggested that asthma may be on the increase due to a lack of trace elements (I have only read the press reports on this- I don't know the details). Interesting stuff. I would just like autoimmune/allergic conditions to be looked at as a whole as well as individually. Something (or many things?) in our environment is making more of us chronically ill.

I have heard of a possible link between type diabetes and hib and hep b vaccination. I haven't heard of an MMR link.

I do think that a family history with a high incidence of autoimmune conditions should equal caution when vaccinating, but that's just my opinion (oh and that of JABS, and various other bodies, but nothing official as such).

Sorry you've misunderstood what I was saying. What I meant is that given there is a huge rise the incidence of auotimmune conditions in general we should be asking ourselves why. I have no idea why this may be but I think we should consider these as a group. Allergic conditions are also increasing. Recent reseach has suggested that asthma may be on the increase due to a lack of trace elements (I have only read the press reports on this- I don't know the details). Interesting stuff. I would just like autoimmune/allergic conditions to be looked at as a whole as well as individually. Something (or many things?) in our environment is making more of us chronically ill.

I have heard of a possible link between type diabetes and hib and hep b vaccination. I haven't heard of an MMR link.

I do think that a family history with a high incidence of autoimmune conditions should equal caution when vaccinating, but that's just my opinion (oh and that of JABS, and various other bodies, but nothing official as such).

Just googled quickly- one paper about the increase in type 1 is here:

www.medforum.nl/idm/worldwide_increase_in____.htm

There is a huge increase in type 2 as well, but that'll be linked ot obesity.

KS, our dd has just had a single measles vacination (17 months) and I plan to gt her immunity tested before any booster. Until she is pre-school age, I will just hope it has worked - where do you draw the line in giving boosters? Who's to say a booster will leave a child immune. Or another booster, etc.....

message withdrawn

robinw- when I am asked directly about giving jabs I do not say don't vaccinate. I wrote this last night www.mumsnet.com/Talk?topicid=1372&threadid=13247&stamp=031031231613

nothing there about not vaccinating, just different suggestions for how to go about doing it.

I come from this angle in this sort of discussion because the government claims that the MMR is defintely safe, and that there is "no scientific evidence" for a link with autism. Neither statement is true. If you read my many posts you will see that I say time and time again it is a case of balancing risks. I've also said that I don't believe MMR to be a big problem. After all only 10% of autism is being put down to MMR. And my child was not MMR affected.

The too clean theory actually ties in with giving too many vaccinations. That's one possible problem with not giving children a chance to fight childhood diseases.

Anyway to be honest I'm retiring from all mumsnet vaccination debate from now on, although I'm happy to point people in the various directions if they want more information. It's one thing arguing the pros and cons of vaccination when you have a perfectly normal child. It's another when you have one who will never live an independent life. I have to be a certain positive state of mind to do it. And at the moment I'm not.

hugs JimJams. Sorry to hear you're not feeling your usual positive self. I haven't got anything to add to the discussion, but I did want to say how helpful I've found your posts and these discussions in the past. I have always made the decision to vaccinate, but your posts have really made me think and to weigh those decisions carefully (particuarly when I was thinking of pushing for a chickenpox vaccination for me - your posts were so helpful then).

So, I can understand why you're bowing out, but please don't bow out forever, you are more valuable than you realise

My love to you and yours.