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.

Thanks for that Jimjams (my Google search brought up all sorts of junk, all about type 2).

Also thanks for your other posts, you've been a real eye-opener for me and made me question a lot of what I used to take for granted.

Sorry you're having an even tougher time than your usual, take care.

with all things medical nothing is 100% safe. there are people who react to paracetamol, some who if they catch flu can lead to larger problems etc. we all know that something simple can turn into something more. the same goees with jabs. we have to weigh up the pro's and cons of everything, we make choices in our everyday life that can affect our lives in the slightest way, nothing should be taken lightly.

Ks, my dd hasn't had the second MMR. The concerns about it came up between her first and second shots and although I didn't have the raft of info that we have here, it just felt right to decline it. Both my boys have had mumps and rubella, neither of which were considered as dangerous then as they seem to be now. I am concerned about my dds' losing their MMR-conferred immunity to rubella as they get to child bearing age, I must admit. Measles is slightly different as it can be more serious but I feel that modern methods of nursing would probably prevent many of the tragic deaths from complications, such as Robin describes. My own nanna died at 64, about 40yrs ago, of diabetes, something that is easily controlled by a daily tablet now!

None of my children, on medical advice, has had the Whooping Cough vaccine as there is a family history of fits. I well recall that controversy, back in the 70's, when the govt of the day denied that the vaccine had anything to do with the problems that ensued for some children. It seems to be well accepted now that it did indeed cause difficulties, although I think the type of vaccine has been changed to a safer one.

Jimjams, I'm sorry you're feeling low. If it's any consolation, I think your contributions have been hugely helpful to people trying to work their way through the vacc mire. Best wishes.

My dd had the separate vaccinations at 13 months, 15 months and 18 months. We recently had a letter from the clinic to book her boosters. She is 2.6. I presumed that we would wait until she was at least 3.6 to do so. Does anyone know what age the boosters start from? Also, does she need to have separate boosters, or could she have the MMR as she is older? What is the procedure for testing immunity? So many questions!!

I was one of those babies in the 1970's who didn't have the whooping cough vaccine (or any of the others, I think) because of the brain damage scare. I caught whooping cough as a baby. I eventually started to get the jabs at 7 years. Coincidentally ds1 had a bad reaction to the pertussis jab, turned grey and stopped breathing. After talking it over with our HV we had ds2 immunised and there were no problems. Even children with similar genes can react differently.

Just wanted to add that I honestly don't think jimjams discourages people from vaccinating. She is often asked for her opinion, and is never dogmatic, or ever advises people not to vaccinate even her opinion has been sought directly. She and I have quite different viewpoints on a lot of the MMR research, but she's always scrupulously fair-minded.

I would be sorry if you stopped posting on this topic jimjams, but I would also completely understand why you just might not have the strength left to do so.

Coppertop, I was a whooping cough baby too. I was 3 months old. I stopped breathing and was put into an o2 tent for ages..... I am so luckily to be alive... which is why my kids all have the jabs

I fully agree with tamum. I have never seen a thread where she has advised against the MMR. She answers questions fairly, lets people know where the research is to be found, and leaves them to make their own choices. Yay, Jimjams!

Can I second Tamum's comments? Jimjams and I are poles apart when it comes to MMR, but she only ever presents her opinions or research data and leaves others to make up their minds with the information provided. In the past I have done some searches for information for her, and I know that she analyses the information presented very carefully (as the good scientist she is). We have come to different conclusions, but I admire the rigor of her analysis.

I have to say something here, MMR was introduced in 1988, there was a peak of Autism cases in 1995, 7 years!! AFTER the jabs were brought in, and when many many parents vaccinated their children at the time, (I was given the MMR at the age of 10) Surely IF the two were linked the peak of autistic cases would have been between 1988-90. Sorry but tell me I'm wrong??!!

Jimjams - Sorry that you feel that way ATM. I too have found your posts to be very fair and informative. You are a HUGE source of info here and I myself have picked your brains a few times. {{{HUGS{}}}}

Well you're all very sweet. It means a lot actually so thanks. I'm itching to say something- especially to mieow's post (see its an addiction), but I really can't do it at the moment. Sounds a bit melodramatic I know, but easiest way to explain it- been feeling more and more like this for a while. (I think the book I mentioned below- Calling the Shots- by Mary Alexander- has finished me off.)

Anyway I think we need ot get ds2 a bed. So I'm off to bed browse- far less emotional

BTW I'm planning to go to this next year

www.internationalsymposium.co.uk/index.htm

Anyone want to come?

Jimjams I don't believe that you are telling people not no vaccated, far from it, you are very well informed, the same way I am about CP, but I just find the whole arugement of MMR and Austim very weary, I have been told by a grandmother of an austic boy that Austim is genitic but she still blames the MMR profusely.... sorry but how can it be both? And am I right in thinking that your son was already showing sights of austim and he didn't have the MMR?
I am not picking on you

You can have a genetic predsposition to something. Most gene expression has an environmental inputas well. This was Tamum's earlier point about why it makes sense to study the gentic of autism. There maybe a subset of children whose genetic makeup makes them less able to cope with MMR/thimerosil/antibiotics/whatever other enviromental effect. Think of weight- your body size is determined partly by the genes you have inherited but also by how much you eat and exercise (environmental factors).

My son didn't have the MMR. I don't think his baby jabs did him any favours, but he also was infected with the herpes virus at 11 months with eczema herpeticum. I found some photos of him today at 8 months- he was playing peekaboo behind a curtain - it's a series of three photos. i showed them to my friend with an autistic dd - and she said something along the line of "oh f*". Video evidence also seems to suggest that this was the final trigger for him. There were also other factors that may have affected him but I don't really want to go into those.

Remember as well that no-one is saying that autism is caused only by MMR- that would be ludicrous. the best guesstimate is that about 10% of autistic cases have MMR as a trigger (or a final trigger in a series of hits) that means that 90% have other causes. Some of these will be pre-natal, some peri-natal some post-natal.

Anyway enough. I have to stop now- sorry.

yeah u are sis, admit u're being mean

i too find the mmr debate very weary now, as it has been more or less going on since b4 i had kids, and in the last 2years it has been headline news, it is not something u can avoid, but there is only so much info i can take in b4 i go 'NO MORE!!' i know there are so people on here who dont know much about the issue and are trying to find out for themselves, and i'm not saying they should ask questions, but sometimes i feel we are covering the same ground and going round in circles. i wish there was more substansiale (sp) research into the mmr/autism debate, and something mroe concrete that peoples can look towards.
i heard last week that there is now a possible link between autism and antibiotics, i'll see if i can find the article in a bit, but at the same time when i read it i think 'here we go'. the media have got us in every way possible, we are scared, confused parents who have no idea which way we should go in protecting our kids.

that should read 'i'm not saying they shouldnt ask questions' oops

Jimjams, thanks for earlier link re International Symposium 2004 - I am very interested in going. Are you planning to go both days?

Also just wanted to say I am thinking of you in what sounds a hard time for you. You have helped me, and many others, in so many ways...please let me know if I can do anything at all to help. Much love, Dinny X

Oh I know you can have a genitic predisposition. My children have multifactoral predisposition cerebral palsy....

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What I don't understand is why those fed up of MMR threads still look at them

RobinW - seems to me that everyone on here finds Jimjams posts interesting even if they don't agree with her... and no one seems to say that she suggests to NOT vaccinate to anyone.....

Jimjams' points make perfect sense to me. I have a child with ASD and I don't think MMR had anything to do with it but I can appreciate the possibility that it could be partly to blame for some autism. I very much believe in the genetic factors, having 2 other (recognised) autistic people in my family and having heard some years ago about twin studies. There are so many questions about environmental factors in all sorts of conditions/illnesses which everyone would love to see analysed and firm conclusions made but this may never happen. Therefore we have to make up our own minds based on our circumstances and feelings.

RobinW You wrote: " I can understand the parents of some autistic children would rather blame MMR than think its genetic".

I am sorry but this is stunningly arrogant.

The parents who blame the MMR are generally not loons who are desperately searching for a cause for their child's autism. They tell a totally different story than the "average" parent of an autistic child. For example my friend's little boy was perfectly normal (and she knows all about SN as her eldest child has DS). He had the MMR, and within days developed an extremely high fever. He had constant diarrhoea, woke up screaming in pain constantly, and stopped talking and interacting pretty much immediately. This is so so so different from the story that mother's usually tell. Read the book Calling the SHots for another look at vaccination side effects (and that book is very much in favour of vaccination as a policy). It shows how links are dismissed without investigation, and how the mother is dismissed as a lunatic. Mother's know their children best, and can seperate a total change in behaviour and toileting that occurs within days form a gradual regression that may take place over months. I've written on here before how ds1 stopped talking a month after receiving his measles jab, but that was a slow regression which probably began before his jab (his eating habits certainly changed dramatically before the jab). Mother's of autistic chidren are generally pretty strong (we have to be tbh otherwise you couldn't ever go out, and you certainly couldn't fight for the things your child needed). Certainly my friend with the MR damaged child is probably one of the ablest and strongest women I know. Single mum with a DS and autistic child- she has to be, and she certainly doesn't need to cast around for people to blame (she seems to accept the DS without having to blame something, or prefer to believe something else). I trust her to know what happened to her own child.

I get fed up with MMR as well. I wish they would just put the bloody thing under an independent enquiry. Leave no stone unturned etc. I wish I could get fed up with the causes of autism. I wish that autism was someone else's concern, I wish I didn't have to worry about vaccine damage, I wish I was with 99% of the population who can march down to the surgery and get the latest jabs as I did with ds1.

I do think everyone knows the risks of not vaccinating- that's fairly easy to quantify. Or at least its fairly easy to work ut the worst case scenario. For starters it wakes me up cold at night (less often these days, but fairly regularly when I was still deciding what to do with ds2, and before I had finsihed reading everything -and I read both sides- upstairs next to the loo there's a dept of h leaflet about the DTP) You say I rarely talk about the benefits. Do a search under varivax and you will find that I recently suggested to someone that it might be worth enquiring whether her child needed varivax. A vaccine I would totally oppose for mass immunisation. I've written before that my problem is with mas immunisation without any attempt to categorise "at risk" groups. They could do this now with a quick family history questionnaire. Had they doen that with us I suspect that DS1 would have been recommended for all vaccinations except pertussis, but to receive them more slowly and more spread out than usual.

I actually have absolutely no interest in the decision someone makes. At the moment though the majority of people hand over the decision of whether to vaccinate or not to the State. They spend more time deciding which school they want their child to go to than whether or not to vaccinate (and imagine the outcry if the govt said that they had to send their child to the local failing school, rather than the private one "for the good of society".) That is not a criticism - its exactly what I did with ds1. For the majority of people I suspect vaccination is the most sensible option, or at least the one that they will be able to live with most easily, but I do think people owe it to their children to find out as much as possible before vaccinating so that they really understand what it is they are doing. And also so that they understand that problems from vacination don't always happen to someone else.