August 26 2001

FOCUS

Kathryn Sinnott blamed herself for her son's autism until she checked medical records. Now she wants people to be aware of the possible risks of vaccines. By Paul Colgan

Injection of fear

Jamie Sinnott would not stop screaming. It had been a hectic day for his mother, Kathryn. She was trying to help her parents pack in time to catch a flight to America, as well as keep Jamie's older brother and sister under control.

It was February 1978 and Jamie was four months old. Days before, the infant's grandfather, a doctor, had given him a routine injection for diptheria, tetanus and whooping cough.

For months afterwards, Jamie cried incessantly. Only lying in a dark, silent room would soothe him and he no longer appeared to recognise his mother. In May that year, doctors suggested that Jamie might be autistic.

The trauma of the child's grandparents leaving their Cork home, they speculated, might have ruptured the smooth curve of his development. It was a suggestion that haunted the young mother for years, leading her to blame herself for his psychological condition.

"From that day, when my parents left, I thought I had fumbled the emotional football," said Kathryn. "You associate the beginning of your child's autism with some life event from the time."

In the years that followed, the young boy had further injections to protect him from other diseases. But he suffered persistent bowel problems, and his autism made him introverted, hampering his language and social skills. Jamie later developed epilepsy and contracted whooping cough.

His health problems seemed to coincide with the vaccinations. Sinnott, however, had no reason to question the safety of the injections, and trusted the opinion of the medical staff that administered them - her father, after all, was a family doctor.

Then in 1994, Jamie was suddenly "flattened" with flu just 24 hours after getting vaccinated against that virus. Sinnott began to think immunisations were doing more harm than good. Her suspicions drove her to check the family's medical records, and she found the coincidences applied to her other eight children as well.

"Everyone has big events happening in their life all the time. You just fix on the one from around the onset of the autism, and blame that," said Sinnott. "It's only when you go back and start checking the records that you find it was right around the time that you had brought your child to the doctor for their jabs."

Until last week, the public mostly knew Kathryn Sinnott as the mother who, on her son's behalf, fought - and lost - a titanic court battle against the state. She wanted the government to provide free primary schooling for Jamie, despite the fact that he was over 18 years old.

Last Tuesday, the public met Kathryn Sinnott the activist, who believes hundreds of children are at risk of developing autism every day from a tiny pin-prick designed to protect them against diseases of the industrial age.

Sinnott is in contact with the parents of hundreds of other autistic children with similar stories. Usually, the story goes like this: a healthy, happy baby has the vaccination for measles, mumps and rubella (MMR) at 15 months. Within weeks, he or she starts to withdraw into their shell, losing interest in the world around them. A few months later, they are diagnosed with autism.

At their press conference, Sinnott and concerned parents' groups highlighted what they claimed was a "raging autism epidemic" in the republic. Some children, they suggested, might not be able to handle the impact of the large number of childhood vaccines they receive. They argued that the sudden surge in cases of the debilitating psychological condition has occurred in parallel with the "herd vaccination" of Ireland's young. Was it not unreasonable to think the two trends were linked?

They were reacting to a report from a Dail committee which found, after a two-year investigation, no evidence of a link between vaccines and autism. It urged the government to continue to try to inoculate 95% of the population against basic illnesses.

The parents had told the committee of their concerns during its investigation. Medical experts supported their case. Why would a group of politicians dismiss their argument so bluntly?

The number of Irish people diagnosed with autism has increased dramatically over the past decade. A survey carried out during 1993 and 1994 in the east of the country found that about five people in every 10,000 suffered from the disorder. A survey to be published later this year by the Irish Society for Autism will show that this ratio has increased to 15 in 10,000.

"We believe that could well be an underestimate," said Pat Matthews, executive director of the society. "It could be as high as 20 in 10,000."

But higher numbers have been reported, some as high as 1 in 1,000. Research by the Hope project, a Cork-based support group founded by Sinnott, said that, in one part of Cork, there were 33 cases in a sample of 13,000: about one case for every 390 people. Similarly stark figures have been reported in America.

Autism was only identified as recently as 1943 by Leo Kanner, an American psychiatrist. He used it to describe withdrawn, self-obsessed children with developmental problems. At first, only severe autism would have been recognised by researchers trying to find out how common the condition was in the population.

But extensive research in the area over the past 20 years has broadened the definition of the affliction. Public awareness of the condition means parents are more likely to have their children thoroughly checked if they show signs of unusual behaviour.

Brian Houlihan, a consultant child psychiatrist at the Mater and Temple Street children's hospital, said that while more children were being brought to him for examination, "a dramatic increase in the severe end of the spectrum - which leads to significant delay in the core triad of language, socialisation and behaviour - has not yet been demonstrated".

Neither has any link been proven between autistic disorders and the MMR, the most controversial of the vaccines. Spurred by concerns from consumers, the Institute of Medicine in America last year appointed a group of 15 independent experts to review all the available research on the connection between autism and the MMR. There was, they decided, no cause for concern. The World Health Organisation (WHO) concurs, advising the vaccination of 95% of the population.

What concerns some parents about the MMR is that it is a potent biological cocktail containing traces of three diseases which is injected into 15-month-old babies. By coincidence, the first signs of autism usually appear between 18 and 24 months old, not long after the injection is administered.

The research that arouses the most alarm is that of Andrew Wakefield, of the Royal Free hospital in London. With help from Professor John O'Leary, an Irish pathologist, he sought to show that autistic children had problems in their gut linked to the measles virus. The virus and the bowel problems, he suggested, could be linked to MMR injections, and the bowel problems then stopped vital nutrients reaching the brain.

Though Wakefield's methodology has been heavily criticised by some researchers, there are other studies that show there may be medical, not just psychological, symptoms of autism. About 5% of autistic children have rare chromosome abnormalities, and their brain tissue seems to be physically slow to develop.

Like Sinnott, Wakefield and O'Leary are keen to point out that they are not anti-vaccine. They both urge parents to inject their children, but believe it could be done more safely - perhaps by giving the jabs one at a time.

Some parents feel they are not given enough information when they take their children to be vaccinated. "I feel doctors have a lot to answer for," said Maurice Gueret, a Dublin GP. "There is no time for a proper consultation - it would be five to 10 minutes on average. And sometimes the vaccines are given by a nurse in the office."

But the cause of those who want blanket vaccination of the public has already been heavily damaged by the research of Wakefield and others. The suggestion of a link between autism and a vaccine is enough to make parents hesitant.

Without injections, children die. The Irish have been slow to achieve high levels of protection against measles - last year, an outbreak saw 1,600 children fall ill, and three die from related diseases.

Doctors and politicians had hoped to eradicate measles, rubella and mumps - as they have got rid of diptheria and typhoid. But that only works if most of the population is immunised. Their efforts, as the Dail report noted, have probably saved more lives than any other public health measure - apart from the provision of clean water. Politicians say that, in the absence of a proven link between vaccines and autism, it is their duty to pursue vaccination to protect public heath. But should they not have been more vigilant about the possible link to the rise in autism?

No, says John Clements, a medical officer at the vaccines department at the WHO in Geneva, because there is no evidence that autism is linked to vaccines. "We are monitoring vaccine-preventable diseases in areas where we are giving vaccines. But are we monitoring the emergence of six-toed children in the same places? No. There is a limit to what you can monitor."

The case of Cecelia Young, a Dublin mother, is not unusual. Adam, her son, was given the MMR jab in November 1995 when he was 15 months old. About 72 hours later he developed a high temperature, and started screaming and blacking out.

Eventually, he settled down but five months later, his behaviour started to change. He became quiet and sullen, and started to lose his speech.

In January 1997, Young's sister, who taught autistic children in Australia, suggested during a phone conversation that Adam might have the disorder. His mother hung up.

Adam lost all of his speech, keeping only "Mammy", "Daddy,", and "coke". He was diagnosed as severely autistic, and also had attention deficit hyperactivity disorder (ADHD).

Unlike many parents, however, Young refused to be beaten by the condition.

Having educated herself and consulted doctors in London, she put her son on a gluten-free diet. The results were astonishing. His progress so far has been so rapid, that Young believes his condition might actually be reversed.

"You can trust him now," she said. "He will get up in the morning and get something for himself, and sit down and watch television. Before we started him on this treatment, he used to run away. He could have been playing with knives or anything." Young is now involved with the Irish branch of Allergy Induced Autism, a group that lobbies for awareness of autism that appears to be linked to vaccinations.

The entire issue will soon take centre stage in the Irish courts. Lavelle Coleman, a Dublin-based law firm, has agreed to represent more than 100 families who want to sue vaccine manufacturers - and the government - for, they believe, poisoning their children.

The overwhelming conclusion of doctors and biologists is that vaccination is safe, that it is, in fact, vital to a child's health. However, the WHO is investigating the possibility that mercury-based preservatives used in vaccines could be a factor in illnesses, including autism, arising from immunisations.

But saying the MMR vaccine causes autism is a bit like saying a car crash can be caused by someone wearing a brown jacket nearby, Clements says.

"It's highly unlikely, but it might be the case. Anyone can have a good idea about what causes an event, and they are welcome to make their hypothesis and test it.

"But it becomes a lot more perilous in medicine when you hypothesise, and then start making national policy decisions based on good ideas."

Kathryn Sinnott thinks it might have been better never to have had her children vaccinated. "Who knows what I would have done, if I knew what I know now?" she said. "Jamie might have never become autistic."

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