FEAT DAILY NEWSLETTER
Sacramento, California http://www.feat.org
November 26, 2001
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·
Autism Fact Sheets Now Available from Nat Inst of Child
Health. . .
·
Autism and the MMR Vaccine, Autism Research At The
NICHD
Autism Fact Sheets Now Available from National Inst of
Child Health. . .
and Human Development
[From a NICHD communiqué.]
A series of fact sheets describing the latest research
findings on autism is now available from the National Institute of Child Health
and Human Development (NICHD).
“We have a strong responsibility to tell the public about
the results of our intensive research programs,” said Duane Alexander, M.D.,
Director of the NICHD and co-chair of NIH’s Autism Coordinating Committee. “These fact sheets will make NICHD’s autism
research much more accessible to those who need it.”
At least one in 500 people are affected by some form of
autism, a neurodevelopmental disorder that affects early brain development,
resulting in communication problems, difficulty with normal social
interactions, and a tendency to repeat specific patterns of behavior. Because these symptoms and behaviors can
vary greatly among patients, doctors consider autism to be a “spectrum”
disorder—a group of disorders with similar features. Although there is no cure for autism yet, educational,
behavioral, and drug treatments have been designed to ease specific symptoms of
the condition.
Current research findings suggest that autism has a strong
hereditary component. Scientists suspect the disorder is the result of a
complex interaction between several different genes involved with brain
signaling and development. Unidentified
environmental factors are also likely to play a role.
NICHD is currently supporting a range of research to
better understand autism, its causes and potential treatments. Other institutes at the National Institutes
of Health are also supporting autism research.
These include: the National Institute on Deafness and Other
Communication Disorders, the National Institute of Mental Health, the National
Institute of Neurological Disorders and Stroke, and the National Institute of Environmental
Health Sciences.
“As research progresses, we want to keep the public
informed of the latest autism information,” said Laurence Stanford, Ph.D., a
program officer with NICHD’s Mental Retardation and Developmental Disabilities
Branch. “Because this material is being
released as a series of smaller fact sheets rather than one large one, it can
be readily updated as this fast-changing field moves forward.”
There are six autism-related fact sheets available:
·
Autism Facts—presents a general overview of what autism
is, behaviors that might indicate that a child has autism, and available treatments.
·
Autism Questions and Answers for Health Care
Professionals—provides answers to questions commonly asked
by health care professionals about autism, including prevalence, causes,
symptoms, diagnostic tools, and treatment options.
·
Autism and Genes—provides a summary of current
scientific research into the genetic bases of autism.
·
Autism and the MMR Vaccine—describes the scientific
evidence surrounding the purported link between autism and vaccines as well as current
research efforts directed at shedding light on this question.
·
Rett Syndrome—provides an introduction to a disorder
caused by a single genetic mutation; this syndrome causes autism-like symptoms
in girls.
·
The NICHD/NIDCD Network on the Neurobiology and
Genetics of Autism: the Collaborative Programs of Excellence in Autism
(CPEAs)--describes the largest single, autism-specific research effort to date
and provides contact information for each of the 10 research sites involved.
These fact sheets are available from the NICHD autism page
at http://www.nichd.nih.gov/autism/
or may be ordered free of charge from the NICHD Clearinghouse: Address:
PO Box 3006, Rockville, MD 20847 Phone:
1-800-370-2943 Fax:
301-984-1473 Email: NICHDClearinghouse@mail.nih.gov
Comments on the publications may be addressed to the NICHD Clearinghouse, listed
above. E-mail correspondence to the
Clearinghouse should list the word “Autism” in the subject line.
Editor’s Note:
These fact sheets will be reproduced in the FEAT
Newsletter over the next two weeks. The
first document, “Autism and the MMR Vaccine” follows below.
>>> PROFESSORS, TEACHERS, TRAINERS
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Students Now Available
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Autism and the MMR Vaccine
Autism Research At The NICHD
http://www.nichd.nih.gov/publications/pubs/autism/mmr/sub2.htm
·
Why do people think that vaccines can cause autism?
Some parents and families of children with autism believe
that the Measles/ Mumps/ Rubella (MMR) vaccine caused their children’s autism.
These parents report that their children were “normal” until they received the
MMR vaccine. Then, after getting the vaccine, their children started showing symptoms
of autism. Because the symptoms of autism begin to occur around the same time
as the child’s MMR vaccination, parents and families see the vaccine as the
cause of the autism. However, just because the events happen around the same
time does not mean that one caused the other. Although children receive many
other vaccines in addition to the MMR vaccine, these other vaccines have not
been identified as possible causes of autism.
These parents’ beliefs and observations were reinforced by
a small study of bowel disease and autism, published by Wakefield and his
colleagues in 1998 (Wakefield et al 1998). The study’s authors suggested that
there was a link between the MMR vaccine and autism. This study did not include
scientific testing to find out if there was a link. The authors relied on the
reports of parents and families of the 12 children with autism involved in the
study to make their suggestion. The study did not provide scientific proof that
there was any link.
Since this study was published in 1998, a number of other
studies have also been published that suggested a link between the MMR vaccine
and autism (Singh et al 1998; Horvath et al 1999; O’Leary et al 2000;
Wakefield et al 2000; Kawashima et al 2000), but none of
these provide scientific proof of such a link.
To date there is no definite, scientific proof that any
vaccine or combination of vaccines can cause autism. It’s important to know
that vaccines actually help the immune system to defend the body.
·
How do vaccines help the immune system defend the body?
The immune system has cells, sometimes called memory
cells, that remember diseases. If these cells meet a disease, they keep track
of what it looks like so they can recognize it later. When the memory cells
meet up with the disease again, they recognize it and know they need to get rid
of it. They call in the other parts of the immune system to get rid of the disease.
In some cases, memory cells can recognize a disease without ever having to meet
up with it, which is called “natural” immunity. In other cases, the cells need
some help to become familiar with a disease.
That help comes in the form of a vaccine. The vaccine
takes a form of the disease that doesn’t make you sick and introduces it to the
memory cells so they know what to look for later. If the memory cells ever bump
into the disease again, they know to call in other cells in the immune system
to protect the body and get rid of the disease. The memory cells of a child keep
track of diseases well into adulthood, preventing such diseases by getting rid
of them quickly. In this way, vaccines help the immune system by making it
easier to remember diseases.
·
Why do many doctors and scientists believe that the MMR
vaccine does not cause autism?
In 2000, the Institute of Medicine (IOM) at the National
Academy of Sciences, at the request of the Centers for Disease Control and
Prevention (CDC) and the NIH, conducted a review of all the evidence related to
the MMR vaccine and autism. This independent panel examined completed studies, on-going
studies, published medical and scientific papers, and expert testimony to
assess whether or not there was a link between autism and the MMR vaccine. The
IOM concluded that the evidence reviewed did not support an association between
autism and the MMR vaccine. This and other conclusions from the IOM review were
released in April 2001 (Immunization Safety Review Committee 2001).
Also in 2000, the American Academy of Pediatrics (AAP), a
professional organization for pediatricians with over 55,000 members, held a
conference on the MMR vaccine and autism. Parents, scientists, and
practitioners presented information on this topic to a multidisciplinary panel
of experts. Based on its review, the
AAP also found that the available evidence did not support the theory that the
MMR vaccine caused autism or related disorders. The AAP policy statement appeared in the May issue of Pediatrics
(Halsey et al 2001).
In 1999, Taylor and colleagues published a study
(Taylor et al 1999)
that argued against
the suggested link between autism and the MMR vaccine
suggested in the Wakefield study. Taylor’s study looked at all the known cases
of ASD in children living in certain districts of London who were born in 1979,
or later. Researchers then matched the ASD patients with an independent registry
of vaccinations. The results of this study showed that:
The number of ASD cases had increased steadily since 1979,
but there was no sharp increase in the number of cases after doctors started
using the MMR vaccine in 1988.
Children showed symptoms of ASD and were diagnosed with
ASD at the same ages, regardless of whether they were vaccinated before or
after 18 months of age. This finding is important because if the MMR vaccine
caused ASD, the children who were vaccinated earlier would show symptoms
earlier.
By age two, vaccination coverage (the number of children
who received vaccines) among children with ASD was nearly the same as
vaccination coverage for children the same age who did not have ASD throughout
the region. If the MMR vaccine and ASD autism were linked, then a greater
number of children who had been vaccinated throughout the region would have
ASD.
The first signs of autistic behavior or first diagnosis of
ASD was not more likely to occur in time periods following the MMR vaccine than
in other time periods.
Also in 1999, the United Kingdom’s Committee on Safety of
Medicine examined hundreds of reports collected by lawyers of patients with
autism and similar disorders that families said they developed after receiving
the MMR or MR vaccine. After a systematic, standardized review of the case information,
the Committee found that the information did not support any link between
vaccines and autism. Based on the evidence, the Committee concluded that there
was no cause for concern about the safety of MMR or MR vaccines (Medicines
Commission Agency 1999).
A study, done in Sweden in 1998, also showed no evidence
of association between the MMR vaccine and autism. The study compared the number
of autism cases in children from two Swedish towns before 1982, when local
doctors first started using the MMR vaccine, and after 1982. The results showed
no difference in the rate of autism between the two groups of children in
either town (Gillberg & Heijbel 1998).
Another study, done in England in 1997, looked at any
possible link between the measles-specific vaccine (one part of the MMR
vaccine) and different problems that result from damage to the nervous system,
such as learning disabilities and behavior problems. These researchers found no
proof that the measles vaccine was in any way linked to long-term damage to the
nervous system (Miller et al 1997).
·
Is there any research going on to find out if the MMR
vaccine is linked to autism?
The NIH is doing a number of things to look into the
claims about MMR vaccines and autism:
The Network on the Neurobiology and Genetics of Autism:
Collaborative Programs of Excellence in Autism (CPEA), funded by the NICHD and
the National Institute on Deafness and Other Communication Disorders (NIDCD), with
additional funding from the CDC, are working together to study autism and the
MMR vaccine. This research will examine people diagnosed with autism who seemed
to develop normally, but then started to show autistic symptoms. This type of situation is called “regression.”
To learn as much as possible about these patients, researchers will compare
them to people who do not have autism, and to people who showed autistic
symptoms since birth, called classic autism. CPEA researchers will compare
vaccination records to see if the onset of autism was associated with receipt
of MMR and other vaccines. Lab tests
will then look for any evidence of persistent infections that could be related
to the MMR vaccine.
The NICHD is also working with other NIH Institutes, the
CDC, the Environmental Protection Agency (EPA), and other federal agencies to
conduct a large, long-term study of the effects of the environment on children’s
health. This study will follow 100,000 children from before birth to age 20, to
track their growth and development, as well as their genetic blueprints and
environmental factors that they encounter. Researchers hope to develop theories
about whether environmental events, like environmental pollutants or vaccines,
can cause abnormal development, such as autism, asthma, or other childhood disorders
that have shown dramatic increase. The study is currently under design.
Another NIH Institute, the National Institute of
Neurological Disorders and Stroke (NINDS) is also conducting a retrospective
case-control study to identify any molecular markers in neonatal blood of
children with autism, with support from the California Department of Health
Services and the Division of Bioengineering and Physical Science (DBEPS) at the
NIH.
In 1998, the NIH, led by the NICHD and the NINDS,
sponsored a conference on ASDs. These and other NIH Institutes formed an expert
panel, which also included 15 professional organizations and three parents’
groups, and began a review of over 2,500 scientific articles to develop a
system for diagnosing ASDs. The panel published its findings in the Journal of
Autism and Developmental Disorders in 1999 (Filipek et al 1999). In 2000, the panel’s
report was adopted as a practice parameter by the American Academy of Neurology
and the Child Neurology Society (Filipek et al 2000). Practice parameter:
screening and diagnosis of autism gives doctors and other health professionals
the first, standardized method for diagnosing autism and ASDs based on
scientific evidence.
In addition, the NIH is in the process of implementing the
autism aspects of the Children’s Health Act of 2000. This Act, which was signed
into law in October 2000, charges the NIH with the, “Expansion, intensification,
and coordination of activities of the NIH with respect to research on autism.”
All of the NIH Institutes that fund autism research are working together to
establish “Centers of Excellence” to focus on autism research. In addition, the
NIH will form a committee with representatives from parents’ groups and other
federal agencies to coordinate autism research activities throughout the
federal government and to enhance efforts to educate doctors and other health
care professionals, and parents, and other child caretakers, about autism.
·
Aren’t the diseases prevented by the MMR vaccine mild,
when compared to the life-long symptoms of autism?
The diseases that the MMR vaccine prevents, measles,
mumps, and rubella (also called German measles), are actually very serious.
Many times, the symptoms and effects of these diseases are just as serious and
life-long as the symptoms of autism. In some cases, these diseases result in
death. If people stop getting vaccines, the number of cases of these diseases
will increase, and with it, the number of deaths and serious health problems.
Measles is a life-threatening disease that spreads quickly
and easily. Before the vaccine was
available in the U. S., nearly everyone who was exposed to measles got the
measles, with nearly three-to-four million cases each year. The symptoms of
measles include a rash, high fever, cough, runny nose, and watery eyes. But, if
not treated, these seemingly mild symptoms can lead to conditions such as
pneumonia, seizures, and water and swelling around the brain. For one-in-500 to
one-in-1,000 people, measles causes death. High levels of immunization in the
U. S. have led to a 99 percent decrease in measles cases since doctors first
started using the vaccine. But in poorer countries of the world, where vaccines
aren’t as common, nearly 900,000 people died from causes related to measles in
1998.
Mumps, which the MMR vaccine also protects against, was a
major cause of deafness in children before doctors started using vaccines to
prevent it. Even though it tends to be
mild in children, mumps is dangerous for adults, with side effects that can
include paralysis, seizures, and fluid in the brain. Before the vaccine for
mumps was available, there were about 212,000 cases of mumps each year in the
U. S. In 1998, there were only 606 cases of mumps in the U. S.
The last disease prevented by the MMR vaccine, rubella, is
harmful to pregnant women and their growing babies. If a pregnant woman gets
rubella, her baby may develop a life-long condition that includes heart
defects, mental retardation, and deafness. In some cases, the baby’s condition
is so severe that the baby dies. In 1964-65, before the vaccine for rubella was
available, 20,000 babies were born to mothers who had rubella. Of those 20,000
born, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded.
Note: Disease statistics cited in this document came from
the National Institute of Allergy and Infectious Diseases at the NIH and the
National Immunization Program at the CDC.
·
Should my child have the MMR vaccine?
Both the CDC and the AAP recommend that children receive
two doses of the MMR vaccine, as long as they have no known health problems
that prevent the vaccine from being effective. The CDC and AAP immunization
schedules recommend that the first dose be given at age 12-to-15 months, while
the second dose should be given at either four-to-six years of age or 11-to-12 years
of age.
Allergies, immune system diseases like HIV, or other
sicknesses can interact with a vaccine to make it less effective. These
interactions can sometimes cause other health problems. If your child is sick,
your doctor may delay the vaccination until your child is healthy. For example,
a child with a fever should not have a vaccination until the fever is gone.
Make sure you give a complete description of your child’s current health and health
history to your child’s doctor at every visit, so he or she can help you make
an informed choice about the timing of your child’s vaccinations.
References: Filipek PA, Accardo PJ, Ashwal S, Baranek GT,
Cook, Jr EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE,
Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW,
Tuchman RF, and Volkmar FR. (1999). The screening and diagnosis of autism
spectrum disorders. Journal of Autism and Developmental Disabilities, 29( 6):
439-484.
Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook, Jr EH,
Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ,
Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW, Tuchman RF, and
Volkmar FR. (2000). Practice parameter: screening and diagnosis of autism;
Report of the Quality Standards Subcommittee of the American Academy of
Neurology and the Child Neurology Society. Neurology, 55: 468-479.
Gillberg C and Heijbel H. (1998). MMR and autism.
Autism, 2: 423-4.
Halsey N, Hyman S, and The Conference Writing Panel.
(2001).
Measles-mumps-rubella vaccine and autistic spectrum
disorders. Pediatrics,
107( 5): e84-107
Horvath K, Papadimitriou JC, Rabsztyn A, Drachenberg C, and
Tildon JT. (1999). Gatrointestinal
abnormalities in children with autistic disorders. J Pediatr, 135( 5): 559-563.
Immunization Safety Review Committee, Board on Health
Promotion and Disease Prevention, Institute of Medicine. (2001). Immunization
safety review: measles-mumps-rubella vaccine and autism. Stratton K, Gable A, Shetty
P, and McCormick M (Eds.). Washington, DC: National Academy Press.
Kawashima H, Mori T, Kashiwaga Y, Takekuma H, Hoshika A,
and Wakefield A. (2000). Detection and sequencing of measles virus from
peripheral mononuclear cells from patients with inflammatory bowel disease and
autism. Dig Dis Sci, 45( 4): 723-729.
Medicines Commission Agency/ Committee on Safety of
Medicines. (1999).
The safety of the MMR vaccine. Curr Probl Curr
Pharmacovigilance, 25: 9-10.
Miller D, Wadsworth J, Diamond J, and Ross E. (1997) Measles
vaccination and neurological events. Lancet, 349: 730-731.
O’Leary JJ, Uhlmann V, and Wakefiled AJ. (2000). Measles
virus and autism. Lancet, 356: 772.
Singh VK, Lin SX, and Yang VC. (1998). Serological
association of measles virus and human herpes virus-6 with brain autoantibodies
in autism. Clin Immunol Immunopathol,
89: 105-108.
Taylor B, Miller E, Farrington CP et al. (1999). Autism
and measles, mumps, rubella vaccine: no epidemiological evidence of for a
causal association. Lancet, 353: 2026-2029.
Wakefield AJ, Murch S, Anthony A, et al. (1998). Ileal
lymphoid nodular hyperplasia, non-specific colitis, and regressive
developmental disorders in children. Lancet, 351: 637-641.
Wakefield AJ, Anthony A, Murch SH, Thompson M, Montgomery
SM, Davies S, O’Leary JJ, Phil D, Berelowitz M, and Walker-Smith JA. (2000). Enterocolitis in children with developmental
disorders. Am J Gastroenterol, 95: 2285-2295.
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