FEAT DAILY NEWSLETTER      Sacramento, California http://www.feat.org

“Healing Autism: No Finer a Cause on the Planet” ________________________________________________________________

March 5, 2002         Autism Database Search  www.feat.org/search/news.asp

PUBLIC HEALTH

·        Once Upon A Time. . .

·        Sense: the National Deafblind and Rubella Association on MMR

RESEARCH

·        Desperation of Those Who Care for the Severly Autistic

·        Special Educators’ Emotional Reactions

·        The Specificity of Deficit in ADHD

·        Magnesium and Tourette’s

·        Maternal Infection, Fetal Brain Develop. & Mental Illness

CARE

·        Courses on Mental Illness Offered, Colorado

Once Upon A Time. . .

Once upon a time there was a little girl called Gabby. Gabby was carefree and happy and had lots of friends. But one day she caught a nasty virus from her best friend Thomas. The virus was called Rubella (German

measles) and made her poorly. Worst of all though, before Gabby became poorly, she passed Rubella on to Mrs Wilson, her best friend Sarah’s pregnant mum.

What a palaver! Mrs Wilson then passed Rubella on to her unborn baby and when little Jake was born he was deaf and blind.

Everyone was very sad. Especially Mrs Wilson who knew that if Thomas’s parents had given him the MMR jab when he was little then Mrs Wilson’s baby would be just as happy and healthy as most of the other babies. Apparently someone had told Thomas’s mum that MMR was dangerous. So she got worried and put it off. What a tragedy! Because MMR is the safest way to protect everyone from Rubella.

And there’s a moral to this story: once you know the facts, it’s easy to act.

The end.

Sense: the National Deafblind and Rubella Association on MMR Briefing paper.

http://www.sense.org.uk/news/Sense%20MMR%20briefing.pdf

Sense Campaigns and Policy Team February 2002

[Contact details for further information. Sense Campaigns and Policy Team 11-13 Clifton Terrace, Finsbury Park, London, N4 3SR tel 020 7272 7774

text: 020 7272 9648 fax: 020 7272 6012 email: campaigns@sense.org.uk ]

Sense, the National Deafblind and Rubella Association Briefing Paper: MMR -the issues Detailed Information

INTRODUCTION

This paper presents background information about the scientific arguments in relation to MMR vaccination.

Sense represents both a large number of people with rubella damage and the parents of rubella damaged children. Falling MMR immunisation rates cause us all a great deal of concern. Rubella, measles and mumps can all have devastating consequences but they are all preventable. MMR is the most effective way to prevent this devastation.

The lack of public confidence in the overwhelming scientific evidence that MMR is an effective method of protecting children and the wider population is saddening and misguided. People with problems caused by these preventable diseases and their parents have not forgotten the damage caused by rubella, mumps and measles epidemics.

The answer is not to replace the triple vaccination with three separate vaccinations as some have suggested. Widespread use of single antigen vaccines will simply lead to children being at risk of exposure to measles, mumps and rubella for a much longer period of time and increase the numbers of susceptible children amongst whom outbreaks could grow. This in turn will lead to widespread disease in the community and more children being born with deafness, blindness and other impairments because of rubella infection during pregnancy. There will also be an increase in the numbers of children who develop a sensory impairment and other problems during childhood as a result of a measles or mumps infection.

PUBLIC HEALTH

What will happen if MMR vaccine rates fall?

If MMR rates fall, we can expect to see outbreaks of all three diseases. Outbreaks of rubella would result in children being born with congenital rubella. Congenital rubella causes deafness, blindness, heart defects and other abnormalities. People severely affected by congenital rubella require intensive neonatal care and continued medical, education and social support throughout their lives. In a measles outbreak, some children would die, many more would be hospitalised, and some would be left with permanent damage. The most vulnerable would be infants who are too young to be immunised and children with depressed immune systems (such as children with leukaemia) who can’t be immunised. An outbreak of mumps would result in an increase in numbers of children affected with mumps meningitis, possibly resulting in deaths as well as an increase in incidence of sensorineural deafness (affecting language development and requiring specialised learning support).

If single antigen vaccines were introduced, we would expect to see a similar public health impact due to the decrease in herd immunity. Increased morbidity and mortality rates would have widespread effects on individual families and the community.

What are the different uptake rates of the MMR vaccine across Europe and how have these affected herd immunity and the threat of an epidemic? Data relating to uptake rates is difficult to compare as immunisation schedules are not harmonised across Europe nor is there a centralised data collection system.

For example, where private medicine is common, the reporting system may be based on how much vaccine is imported or distributed. Other countries estimate the prevalence of vaccine coverage through the analysis of ad hoc surveys of representative samples.

We are aware of recent disease outbreaks where immunisation rates have fallen or are low. A measles outbreak in the Republic of Ireland last year resulted in 111 hospital admissions and 3 deaths. MMR uptake was less than 80%.

Outbreaks also occur in well immunised populations, particularly amongst pockets of low uptake. In the April 1999 -January 2000 measles outbreak in the Netherlands, 2961 cases were reported and there were 68 hospitalisations and 3 deaths. During 1997 -1999, the Netherlands had reported overall MMR uptake rate amongst children to be 95 -96%. The areas where the measles outbreaks occurred were related to communities of non-immunised individuals belonging to a particular religious group. MMR coverage in the corresponding geographical areas ranged from 53% to 90%.

Amish communities in the United States also eschew vaccination and experience a disproportionately large number of cases of whooping cough, measles, and congenital rubella.  In contrast, Finland, which has had a two-dose MMR policy in place since 1982 and has uptake rates of over 98%, is the first country in the world to be documented free of indigenous measles, mumps and rubella.

What is the impact of MMR on the incidence of rubella? Prior to the isolation of the rubella virus and the development of a vaccine, rubella epidemics occurred within a country at six to nine yearly intervals with pandemics frequently spreading through several countries occurring at approximately ten to thirty year intervals, peaking and abating over three to five years. The most severe recent pandemic occurred between 1963 and 1968 when many thousands of children were born with multiple impairments as a direct result of their mothers contracting rubella during pregnancy.

Rubella immunisation for school girls and non-immune women of child bearing age began in 1970. This strategy had little impact upon the circulation of rubella virus in the community and congenital rubella continued to occur. Rubella was a common childhood disease and prior to the introduction of MMR, non-immune women were known to contract rubella infections from children, their own included.

Rubella was included in the MMR infant immunisation schedule in 1988. The MMR immunisation programme has led to an enormous reduction in the notifications of measles, mumps and rubella 7 along with a marked decrease in the incidence of congenital rubella births. Since the introduction of the MMR vaccine in 1988 the numbers of children affected by congenital rubella, the number of terminations due to rubella disease or contact in pregnancy and the incidence of rubella in the population at large, have all dropped dramatically.

Congenital rubella births registered with NCRSP and rubella associated terminations notified to ONS (1971-2000) 71-75 76-80 81-85 86-90 91-95 96-00 Congenital rubella births 241 206 201 113 21 17 Terminations due to rubella disease / contact 3709 2002 759 268 43 17 1. Births are reported to NCRSP from England, Scotland & Wales. Another 77 individuals born before 1971 are

registered with the NCRSP 2. Terminations data are from the Office of National Statistics, for England & Wales only

What is the scientific basis for the recommended time period between vaccines? The first MMR immunisation (given at 12 -15 months of age) is scheduled to coincide with a decrease in maternal antibody protection and an increase in susceptibility to disease. To increase protection against measles, mumps and rubella and to prohibit the build-up of susceptible groups of children amongst whom outbreaks would be likely, a second dose of MMR is recommended prior to school entry. Modelling work was done in Britain prior to the introduction of the second dose to determine at what age it would be most effective in limiting outbreaks of measles, mumps and rubella. The 2-dose strategy has succeeded in eliminating indigenous cases of measles, mumps and rubella from Finland, where uptake is over 95%.

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SINGLE ANTIGEN VACCINES

Would a choice of single vaccines increase or decrease the full uptake of the MMR vaccines, and what would the effect be on group immunity?

The use of single antigen vaccines would require six visits to a GP and take from 3 -5 years depending on the time span left between administration of each vaccine. The proportion of children protected at any one time against all three diseases would be reduced.

This would mean more children going unprotected, increasing the risk of infection to themselves and to other children. 13 Such a decrease in herd immunity would lead to outbreaks of rubella, measles and mumps.

Higher uptake is more likely to be sustained when fewer visits are required. The use of single antigen vaccines would necessitate six visits and would lead to patchy coverage across the country. This would lead to a decrease in herd immunity against rubella, measles and mumps and outbreaks of all three diseases would occur.

Is it administrative convenience or best clinical practice to administer three vaccines in one visit?

Good clinical practice is to reduce the number of invasive procedures because every invasive procedure carries a risk, however small that risk may be. In the case of MMR immunisation, invasive procedures are limited to two. That is, one immunisation is given at age 12 -15 months and one given prior to school entry. Use of single antigen vaccines would increase the number of invasive procedures to six and thus carry additional risks.

It is not best clinical practice to leave children exposed to these diseases. Use of single vaccines would leave children (and pregnant women) exposed to measles, mumps and rubella. It is a good use of resources to prevent outbreaks of these diseases. In addition, it may be convenient and less traumatic for the child if the three vaccines are administered in a single visit.

Which countries allow single vaccination? No countries in which MMR vaccine is available use single antigen vaccines to protect against measles, mumps and rubella. Due to the different types of medical systems around the world and the lack of centralised data collection, we are unclear as to which particular countries import or produce single antigen vaccines in addition to MMR. However, data on the World Health Organisation’s MMR Immunisation Schedule (2000) web-site identifies European countries which recommend immunisations against measles and mumps. Most of these are from the former Soviet Union and since its break-up, outbreaks and deaths from infectious diseases have increased.

In Japan, only measles and rubella vaccines are routinely available. Mumps vaccine is optional. MMR was withdrawn in 1993 because the Urabe mumps strain it contained was associated with mumps meningitis. This vaccine had already been withdrawn from use in the UK in September 1992 following a higher than expected incidence of aseptic mumps virus meningitis.

Japan manufactures its own vaccine products and plans to reintroduce once the manufacturing process of a new mumps component is addressed. Between 1992 and 1997, there were 79 measles deaths in Japan. In the same period in the UK there was only one death from acute measles infections.

VACCINE SAFETY AND EFFECTIVENESS

Was the MMR vaccine adequately tested?

MMR has been in use in the USA since 1972 and in Scandinavia since 1982. It had therefore been extensively tried and tested prior to introduction in the UK in 1988. In addition, the safety of MMR vaccines has been reviewed repeatedly by the UK Government’s independent expert committees, that is the Committee on the Safety of Medicines (CSM) and the Joint Committee on Vaccination and Immunisation (JCVI). CSM is responsible for advising on the licensing and safety of human medicines. JCVI is responsible for advising on vaccination policy.

The CSM review of the licensing of the MMR vaccines found that licensing followed normal procedure and was based on the provision of satisfactory data regarding safety and efficacy in adequate numbers of children.

Furthermore, around 30 studies had been carried out on combined measles, mumps and rubella vaccines prior to the introduction of MMR in the UK in 1988. In particular, the rigorous Finnish double blind placebo controlled trial among twins reported a low incidence of side-effects. Earlier studies of MMR combined with other vaccines including DTP and polio did not raise concerns about safety. Studies in the UK since the introduction of MMR continue to confirm its safety and effectiveness.

Is there any benefit in deferring the MMR vaccine until the immune system is better developed?

No. The first MMR immunisation (given at 12 -15 months of age) is scheduled to coincide with a decrease in maternal antibody protection and an increase in susceptibility to disease.

The immune system is continually developing. During early infancy, maternal immunity offers extra protection to the child. This means that if a mother has had measles or has been immunised against it, her baby will usually be protected from it. This is possibly also true for mumps and rubella. Although it offers good protection against many forms of gastroenteritis and respiratory illnesses, breastfeeding offers little, if any, protection against measles, mumps and rubella.

Maternal immunity wanes over the first year and morbidity and mortality from measles infections are high in children under one year of age. Deferring MMR immunisation would increase the numbers of children susceptible to measles, mumps and rubella.

We are not aware of any evidence that vaccines in current use impair the development of the child’s immune system or that MMR impairs the development of a generalised immune response. A recent review of the available evidence says that the hypothesis that multiple vaccines overwhelm, weaken, or “use up” the immune system is not supported by any evidence. [Notations and references available at: http://www.sense.org.uk/news/Sense%20MMR%20briefing.pdf ]

For the latest information on Rubella and immunisation please visit Sense at http://pull.xmr3.com/p/2213-34ED/32822668/http-www.sense.org.uk-rememberrubella.html  as soon as you can.

Sense, The National Deafblind and Rubella Association was formed over 40 years ago by a group of mothers to provide information and support to the families of Rubella damaged children. Registered Charity no. 289868 http://www.sense.org.uk Sense, 11-13 Clifton Terrace, Finsbury Park, London N4 3SR Tel: 020 7 2727774

* * *

Desperation of Those Who Care for the Severly Autistic

Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorder.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11872104&dopt=Abstract  <- - address ends here.

Hellzen O, Asplund K.  Doctoral Student, Department of Nursing and Health Sciences, Mid-Sweden University, Sundsvall, Sweden, Professor, Department of Nursing, Umea University, Umea, Sweden.

Being in a fragmented and isolated world: interviews with carers working with a person with a severe autistic disorderAim. To illuminate the meaning of being a carer for a person with a severe autistic disorder.

Background.

Carers working with people with severe autism are occasionally exposed to residents’ self-injurious behaviours and violent actions and at time residents appear resistant to all forms of treatment.

Design/method.

A qualitative case study was conducted. Six Swedish carers enrolled nurses (ENs), working on a special ward in a nursing home were interviewed about their lived experiences when caring for an individual with a severe autistic disorder. Narrative interviews were conducted and interpreted using a phenomenological-hermeneutic method inspired by Paul Ricoeur.

Findings.

Two themes were formulated which describe the carers’ reality and their dream of an ideal. This ideal described carers’ experiences of being trapped in a segmented and isolated care reality and their longing to achieve a sense of wholeness.

The findings were interpreted and reflected on in the light of a framework inspired by the German philosopher Karl Jaspers in order to achieve a deeper understanding of the text.

Conclusions.

In their desperation, the carers used their empirical knowledge based on scientific knowledge, which could be understood as a substitute for their vision of a consolating wholeness. This paper shows that searching for a substitute to consolation seems to be an important aspect of the meaning of being a carer for a person with a severe autistic disorder.

PMID: 11872104 [PubMed - in process]

* * *

Special Educators’ Emotional Reactions

“Behavioural knowledge, causal beliefs and self-efficacy as predictors of special educators’ emotional reactions to challenging behaviours.”

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11869385&dopt=Abstract  < Address ends here.

Hastings RP, Brown T.

Centre for Behavioural Research Analysis and Intervention in Developmental Disabilities, Department of Psychology, University of Southampton, Southampton, UK.

Background: Theoretical models and emerging empirical data suggest that the emotional reactions of staff to challenging behaviours may affect their responses to challenging behaviours and their psychological well-being.

However, there have been few studies focusing on factors related to staff emotional reactions.

METHODS: Seventy staff working in educational environments with children with intellectual disability and/or autism completed a self-report questionnaire that measured demographic factors, behavioural causal beliefs, behavioural knowledge, perceived self-efficacy, and emotional reactions to challenging behaviours.

RESULTS: Regression analyses revealed that behavioural causal beliefs were a positive predictor, and self-efficacy and behavioural knowledge were negative predictors of negative emotional reactions to challenging behaviours. Staff with formal qualifications also reported more negative emotional reactions. No other demographic factors emerged as significant predictors.

CONCLUSIONS: The results suggest that behavioural causal beliefs, low self-efficacy and low behavioural knowledge may make staff vulnerable to experiencing negative emotional reactions to challenging behaviours. Researchers and clinicians need to address these issues in staff who work with people with challenging behaviours.

PMID: 11869385 [PubMed - in process]

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* * *

The Specificity of Deficit in ADHD

How specific is a deficit of executive functioning for Attention-Deficit/Hyperactivity Disorder?

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11864714&dopt=Abstract  <- - address ends here.

Sergeant JA, Geurts H, Oosterlaan J.

Klinische Neuropsychologie, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands

A selective review of research in the executive functioning (EF) is given for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), higher functioning autism

(HFA) and Tourette syndrome.

The review is restricted due to changes in the classification of the disorder in recent years and secondly the heterogeneity of EF is restricted to five key areas of concern, inhibition, set shifting, working memory, planning, and fluency.

The review makes clear that there are strong differences between child psychopathological groups and controls on these EFs. However, future research will be needed to identify an EF deficit or profile, which is specific for these disorders.

PMID: 11864714 [PubMed - in process]

* * *

Magnesium and Tourette’s

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11863398&dopt=Abstract  <- - address ends here.

“The central role of magnesium deficiency in Tourette’s syndrome: causal relationships between magnesium deficiency, altered biochemical pathways and symptoms relating to Tourette’s syndrome and several reported comorbid conditions.” Grimaldi BL. Pickerington, Ohio, USA

Prior studies have suggested a common etiology involved in Tourette’s syndrome and several comorbid conditions and symptomatology. Reportedly, current medications used in Tourette’s syndrome have intolerable side-effects or are ineffective for many patients.

After thoroughly researching the literature, I hypothesize that magnesium deficiency may be the central precipitating event and common pathway for the subsequent biochemical effects on substance P, kynurenine, NMDA receptors, and vitamin B6 that may result in the symptomatology of Tourette’s syndrome and several reported comorbid conditions.

These comorbid conditions and symptomatology include allergy, asthma, autism, attention deficit hyperactivity disorder, obsessive compulsive disorder, coprolalia, copropraxia, anxiety, depression, restless leg syndrome, migraine, self-injurious behavior, autoimmunity, rage, bruxism, seizure, heart arrhythmia, heightened sensitivity to sensory stimuli, and an exaggerated startle response. Common possible environmental and genetic factors are discussed, as well as biochemical mechanisms.

Clinical studies to determine the medical efficacy for a comprehensive magnesium treatment option for Tourette’s syndrome need to be conducted to make this relatively safe, low side-effect treatment option available to doctors and their patients. Copyright 2002 Harcourt Publishers Ltd.

PMID: 11863398 [PubMed - in process]

* * *

Maternal Infection, Fetal Brain Development and Mental Illness “Maternal infection: window on neuroimmune interactions in fetal brain development and mental illness.”

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11861174&dopt=Abstract  <- - address ends here.

Patterson PH.

Biology Division, California Institute of Technology, 91125, Pasadena, California, USA

Direct viral infection of the developing brain can have disastrous consequences for the fetus. More subtle and perhaps more insidious are viral infections of the pregnant mother, which can have long-lasting effects such as an increased risk of schizophrenia in the offspring. A recent mouse model has shown that respiratory infection in the pregnant mother leads to marked behavioral and pharmacological abnormalities in the offspring, some of which are relevant for schizophrenia and autism. This effect on fetal brain development might be caused by the maternal antiviral immune response, possibly mediated by cytokines.

PMID: 11861174 [PubMed - in process

* * *

Courses on Mental Illness Offered, Colorado

http://www.rockymountainnews.com/drmn/health_and_fitness/article/0,1299,DRMN_26_1009995,00.html

Two free comprehensive courses on living with people with mental illness will be offered this month by the National Alliance for the Mentally Ill of Denver. One class will focus on adults with disorders; the other will address children with mental illness.

Taught by family members of people with mental illness, the 12-week “Family to Family Education Program” will discuss treatment, research and skills that family members need to cope with mentally ill relatives who are 18 and older.

The class begins March 12 and will run from 6:30 to 9 p.m. near South Colorado Boulevard and East Yale Avenue. Call (303) 692-0262 to register.

“Visions for Tomorrow” is an eight-week course taught by trained parents focusing on children with mental disorders. Information on brain biology and disorders such as attention-deficit disorder, autism, Tourette’s and bipolar will be offered. Other topics will include stigma, the judicial system and advocacy groups.

The class begins March 21 and will run from 6:30 to 8:30 p.m. at Children’s Hospital. Call (303) 860-0271 for more information.

APRIL 21, 2002 - 12 Noon to 5pm

THIRD NATIONAL AUTISM AWARENESS RALLY:

“The Power of ONE! I.D.E.A.”

FREE and OPEN TO THE PUBLIC

FEAT’S “Night of Caring” April 27

Sacramento FEAT is holding its’ 9^th Annual “Night of Caring” Dinner and Auction fundraiser on April 27, 2002.  If you have been helped by the FEAT and the Daily Newsletter and would like to show your appreciation you can by supporting our fundraiser. Make an auction contribution or sponsorship donation.  Please call 916-843-1536 for more information.  Thank you.

FEAT is a tax-exempt non-profit corporation

Lenny Schafer, Editor@feat.org  •  CALENDAR EVENTS@feat.org Michelle Guppy Catherine Johnson PhD  •  Ron Sleith  •  Kay Stammers  •  Edward Decelie

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