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.

I am hoping to make both days Dinny. The second day looks very ASD orientated, but I am also very interested in hearing Neustaedter on day 1- he's written a very interesting book- the vaccine guide.

Can I put in a quick plea?

This is one of those topics that people are never going to agree on.

Mumsnet is here for us all to discuss issues and learn as a result. This is one of the core of issues that people feel very stongly about. Mumsnet would be a poorer place if there were topics that were 'out of bounds', but there has to come a point when we all just have to agree to differ.

We all come to Mumsnet with a wide range of life experiences and as adults we have to respect that these will colour and inform our decisions. It is wise to remeber this before posting on 'hot' subjects.

I hope this is taken in the spirit of conciliation that prompted it.

Jimjams, I've sent Tech my e-mail, can you drop me a line??

sorry did I get a bit heated. It's just that "symptoms of autism only show at 18 months and the parents just didn't notice" makes me see red. The symptoms are there far earlier with hindsight (both Davros and I reckon we could have spotted autism in our baies). As if a parent could mistake a regression that coincides with simultaneous raging fever, pain, and often seizures.

Sorry Jimjams, not getting at anyone. You seem to have more than the usual amount of stress to cope with at the moment. I felt that all posters need to remember that people come to this discussion from differing stand points. For most of us the vaccination debate comes and goes. For you it is a bigger issue that impinges of your everday life. And all credit to you for still managing to debate this issue without blowing a fuse. I don't think I could if I were in your position.

The vaccination debate does indeed come and go, but I think these informed, passionate debates give food for thought to the many mumsnetters like myself who read but don't often join in. For those of us considering vaccinations, its hard enough to think of the questions to ask, let alone the answers,and postings and links such as those from Jimjams and Pupuce are a great source of information that isn't easy to get hold of.
These discussions have certainly made me think twice before just trotting off to doctors, which I think is the aim, rather than blindly accepting or rejecting vaccination due to mistrust and fear.
Thank you Jimjams, Pupuce, et al, and hope things bet brighter for you soon, Jimjams.

I can't see any harm in these topics coming up every now and then and continuing to be debated, even without any ultimate agreement. New people are always joining MN and may well find this of interest and the picture does change, e.g. Simon Murch's letter to The Lancet which started off this latest thread. I would not have known about that or have been able to tell many of my friends about it if I hadn't seen it here so quickly. We'd have heard about it eventually but this letter is hot news.

And more from Dr Wakefield in The Observer today.

Mieow, what is multifactoral predisposition cp?

My kids have a weaker brain than normal and it gets damaged easier, which is why they both are affected. We went to a Geniticist who said that a bunch of genes from me and a bunch of genes from DH didn't mix and caused a weakness, therefore they have Multifactorial predisposition CP, and why we have decided not to have anymore kids

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Isn't a fever a side effect of the MMR anyway?

If I ever heard of a doctor that saw signs of autism before the parents, especially before age 2, I'd eat my hat!!! I've NEVER heard of it happening. Its not usually the parents in denial but the doctors who then have to be persuaded, chivvied and even begged to acknowledge a child's autism at that age and older.

I'm stunned you think I could have so much influence that someone may decide not to vaccinate because of something I have said. If I was that influential I would spend more time writing to the poeple who make policy decisions. What I do on here is point people in the direction of alternative literature so that they can read a point of view that differs from the dept of health's line and then make up thier own mind. I know a number of families that have chosen not to vaccinate one or more of their children (including several on here). They fall into two camps. Some have always believed in as little intervention as possible. For example my best friend decided when she had her first child 7 years ago that her children would only even be given tetanus. I well remember thinking she was mad. The others I know all have children who may have suffered vaccine damage- or would have had they been given them (there is another mumsnetter who falls into this camp- read the circumcision thread for her story- a good example of trusting a mother's instict over a GP's knowledge -and it was the consultant immunlogist who said thank god she hadn't vaccinated if I remember correctly). Ceetainly I have never changed anyone's mind over whether to vaccinate or not- I don't aim to. But if someone knows that it is worth asking for Infanrix rather than a thimeorsal containing dtp then great. They're vaccinated and they've done it in as safe a way possible. If that "saves" one family on here from the pangs of watching typically developing children and realising that you have lost for ever what others have got then great.

I'm would be absolutely stunned if drs were able to spot autism before parents. Most drs wouldn't recognise autism a child turned up with "i am autistic" written on their head. I first suspected autism at 17 months, we didn't get diagnosed until ds1 was over 3. The only strange thing about my story is that we were diagnosed early.

No- fever, persistant bowel changes etc do not indicate a causal effect - but the reactions should be yellow carded. And a total change in bowel habits, behaviour, fever, high pitched screaming and a regression that begins within days of receieiving a vaccine is fairly suspicious. Generally 80% are of these reactions are not yellow carded. In the book mentioned several times- Calling the Shots- the author's 2 year old little girl developed seizures 36 hours after her meningitis C jab, she also came up in a purple rash and blood results tested postive to meningitis. Later her hair fell out, and she had repeated seizures (including ones which lasted 20 minutes). She was told that the positive test result to meningitis must be contamination, and that there was absolutely no possibility that the seizures had been caused by the vaccine, so no they wouldn't yellow card it (a yellow card should be filled out if there is any possibility that something is an adverse reaction). Her mother remains convinced this was an adverse reaction to meningitis C, having read the book I think it is the most likely explanation. If these sorts of reactions were investigated properly, if drs kept an open mind then I would have a lot more confidence in the vaccination programme. If the vaccination programme made more sense (why vaccinate a tiny baby against tetanus for example- I can only think to prevent cord infections, but then it should be given earlier surely). then I would have more confidence in it.

People make up thier own mind on vaccination, its the way it should be- they have to live with the consequences of any decision they make.

Oh I'm glad its not just me who choked when I saw that davros

Anyone who has the Bill Bryson book "ashort history of nearly everything" have a read of the chapter on Clair Patterson. It's interesting.

Anyone here who is rich ( ) I've been sent an invitation to a viewing of "Hear the Silence" a channel 5 film about MMR and autism. The viewing is taking place on Sunday 23 November from 1.30-5pm. Members of the cast and the director etc will be there, together with executves and trustees from the charities mentioned below. Oh and there are drinks I can't go but I'm happy to pass my invitation onto someone if they want to go. You have to be rich though as the suggsted starting donation is 100 pounds a ticket. The proceeds are being split between Visceral (Dr Wakefield's charity - which provides funding for research) and Allergy induced Autism (AiA). The event is sponsered by Zenith North. If you want my invitation just contact me via mumsnet and I'll post it onto you.

whoops - its taking place at The institute of contemporary arts, the mall, London.

I'm not saying this is right... but what I remember hearing, is that a group of autism experts were shown home videos of many children, and then asked to state which children the experts thought, on the videos, displayed signs of autism. And apparently the "experts" overwhelmingly, accurately, picked out children that went on to have autistic diagnoses. But the thing is, all of these autistic children had parents who were claiming that their child had been entirely "normal" at the time the video was made, and that MMR had caused their child's autism.

Now, I don't know if this study truly exists, if it's an urban myth, or if it involved such a small sample size it's not valid. Comments? I wish I could find a reference.

I also wonder when reading these threads what the anti-vax people want "us" to do. Never vaccinate? Campaign for single jabs? Boycott MMR? I know JimJams is "pro-choice", but I feel that much of the anti-MMR raving just leaves parents confused. Parents just want a simple message "This option is the best available". We don't all want to have to agonise and scratch our heads over what can be fairly complicated science trying to figure out what is best for our particular child on this particular issue, on top of all the other difficult decisions we have to make as parents.

But where is the anti MMR raving zebra (except in the Daily Mail which is just generally fairly raving). All the stuff I see tends to finish with "most medics agree parents should vaccinate". This again is why an independent (which would be hard) enquiry is needed.

I think your video stry is a mix up of several. There was a paper published where researchers analysed children at their first birthday parties- and spotted signs of autism. There was another reasearcher who analysed videos of babies at 6 months rolling and was able to find signs of motor problems in the children who went on to develop autism. He was also asked at the DAN (defeat autism now) conference to pick out the Autistic twin from a home video. He answered correctly that both twins were autistic but one was further along the spectrum (and he got that correct as well). These studies were not done on MMR damaged/not MMR damaged children. If the case ever gets to court it could be interesting as the parents are relying heavily on video evidence. Certainly having analysed my own home videos we see a real difference in eye contact, gaze monitering and shared attention before and after the eczema herpeticum (not to mention speech )

Wow! I'm astonished at the belief that doctors somehow diagnose autism without parents ever noticing that their child is 'different'! A visit to some of the Special Needs threads would tell the real story. Parents have to fight hard to be taken seriously. I first raised my concerns about ds1 when he was 14 months old. Apparently he was just shy. At 2yrs he was referred for speech therapy. He got his first session a whole year later. The therapist took our concerns seriously and referred us to a paediatrician but warned us that the waiting period is usually 6 months. Without us pushing for those referrals, we would probably still be hearing how he is just shy/lazy/stubborn/slow/gifted (take your pick - we've heard them all).

Don't call it raving, then, just call it vehement criticism. What are we parents supposed to do? Wait for an independent inquiry before we decide whether to vaccinate? The government tells us it's "safe", most scientists say "as safe as we can prove anything to be", the anti-MMR brigade goes on about "unknown" risks. Who "should" we believe?

I don't think, btw, you personally should be put in the position of having to explain or justify all this. I'm just saying that I think the frequent debates leave most parents feeling more confused than informed. And I still don't understand what the anti-vax brigade expects most of us to do.

In all honestly, I don't have a set-in-stone opinion about MMR, I've yet to be 100% convinced either way. What I am sure of, is that people have no confidence in the official line. Zebra says But we receive exactly this message from the govt, time and time again, whenever MMR is mentioned. The problem is, many people don't believe them and that is the issue that has to be tackled, with no holds barred.

Hey, Jimjams, how does it feel to be so influential?? (sorry, shouldn't joke, but really.....!!)

I agree with Suedonim (now you're influencing me ). The trouble with the govt line is that we've heard it all before. "beef? totally safe- here photograph me shoving a hamburger into my daughter. Oh whoops changed our minds and now we've just performed a mass experiment on you all so now we'll just track how many of you die".

That's why no-one will ever believe them. The problem is the truth is no-one knows for sure whether or not it does cuase autism in a small subselt of children.

interestingly enough the guy who firts raised the BSE concerns has said publicly that when he first raised his concerns he was treated in a very similar manner to Andrew Wakefield.

Not sure what happened to my sentence construction there.

Also the govt (if it is serious about maintaining high vaccination rates) does have a choice in this case. Single jabs until the case has been closed once and for all in either direction.

They could look at thimeorsil whilst they were at it as well.

Problem is, there is no simple message. Personally I wish that parents who have no real grounds for ocncern WOULD get their kids vaccinated then those of us with concerns wouldn't have to worry so much or feel responsible for everyone else. I'm giving my baby daughter her early jabs, thimerosil-free thanks to Jimjams, and there's a small possibility I may give her MMR or sepaerate jabs, I haven't decided yet but ultimately its up to us, we can't expect the "powers that be" to tell us what to do, just advise.
I went to a conference ages ago where there was a presentation by a group of Italian Drs who showed videos of about 6 kids and we were then all asked to guess which ones were later found to be autistic. I think I was the only parent there with about 60 professionals (not Paeds necessarily but EPs, SLTs etc). No-one got it 100% right and I think I did OK but got one wrong. However, I've never heard of a child being diagnoised autistic who is not............. Some have been known to "lose the label" but that is only after high quality, intensive early intervention and probably with an underlying level of ability that has responded to that intervention. Errr, have I gone off the point? I'll just hit post message!

I think the point about lack of confidence in the govt line is a very good one. To go off on a tangent a little bit: it used to be that everyone listened to those in authority (police, govt, techers) whatever they said. Now they don't and I think that is a good thing. But now everyone whinges about the govt (and all politicos in fact) using "spin" to "present" arguments. Well they have to don't they!!! How else can they persuade us of anything? I do think it's much better than the old way.

Anyway - Jimjams you do obviously know about this more than me, but I really don't like the idea of separate jabs being pushed as a definitely safe alternative to MMR because:

1. How much more extra stress for baby is it? Dd has had all vaccinations so far, but I really dread the appts.

2. Those particular 3 jabs have not been tested as separate jabs in babies. At least, they have not been tested to the extent that MMR has.

On balance, I think the govt is right to stick to MMR (but only just).

Finally Jimjams I have a question (while we're on the subject): is there a good website anywhere which shows which jabs are known to have what side effects? I ask as I am deeply suspicious of the Spanish practice of giving newborns the Hep B jab. They then have a booster at 2 months along with Hib, men C, and the triple one with whooping cough in it: dd was ill after that first lot of jabs and I'm thinking of refusing the hep b for baby no 2 next year. It will be a fight though and i want to find out as much as I can first to see if its worth it.