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November 3, 2001        News Morgue Search  www.feat.org/search/news.asp

PUBLIC HEALTH

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The Vaccine Controversy: Update

[This is a fairly good updated summary of where the controversy stands

today.  By Sandy Kleffman in The Contra Costa Times.  See accompanying

article in next newsletter post.]

http://www.contracostatimes.com/news/topstory/vaccines_20011104.htm

It’s a sight all too familiar to parents.

The jab. Then the tiny face scrunches up. Tears trickle down the

cheeks. The bawling begins.

For decades, parents have eagerly heeded their doctor’s advice and taken their children for immunizations, confident that any momentary discomfort would be offset by important health benefits.

No one disputes that vaccinations are one of the marvels of modern medicine.

Vaccines have saved the lives of millions of children worldwide, wiped out smallpox and polio, and made deadly diseases such as diphtheria and measles   rare.

Yet today, a chorus of doubt has arisen from parents of autistic children who suspect that vaccines also triggered their child’s disorder.

Most medical experts reject this idea. They note that several recent studies found no evidence of a link between vaccinations and autism.

These experts worry that parents will stop immunizing their children, leading to a flare-up of deadly diseases because of unproven accusations.

Yet the issue refuses to die.

The controversy has led to plummeting vaccination rates in England, a

class-action lawsuit in California and 10 other states, and multimillion-dollar, government-financed studies to address lingering questions.

The allegations come at a time when children receive more vaccinations than ever before.

A typical child today will get 24 doses of 12 vaccines by the age of 6, a dramatic increase from two decades ago.

A 2-month-old may get five shots during one visit to the doctor’s office.

Critics wonder whether this is more than these little bodies can handle.

Much of the controversy centers around thimerosal, a preservative containing mercury that’s been found in several vaccines until the U.S. Food and Drug Administration asked manufacturers in 1999 to voluntarily phase it out.

The action came after FDA scientists concluded that children who receive the entire recommended series of immunizations may ingest more mercury during their first six months than is considered safe by the U.S.  Environmental Protection Agency.

Today, all vaccines on the recommended schedule for American children age 6 and younger are manufactured thimerosal-free.

Yet critics complain that an unknown quantity of older vaccines containing thimerosal remains on doctors’ shelves.

The national Centers for Disease Control and Prevention has not complied with a request by Rep. Dan Burton, R-Ind., and others to recall these vaccines. It did, however, set up a committee to explore the issue.

For critics, the debate takes on added urgency because of the mystery surrounding an apparent explosion in the numbers of autistic children in California, other states, and countries such as England and Scotland.

The latest California statistics reveal the increase continues unabated.

In the past three months alone—from July through September -- 705 additional autistic children registered to receive services through the state Department of Developmental Services’ regional centers.

That marks the largest quarterly increase for autism in California history.

It brings the total number of full-blown autism cases to 16,146. This doesn’t include autism spectrum disorders such as Asperger’s syndrome or pervasive developmental disorders.

No one knows what causes autism, and there is no cure.

It’s is a severe developmental disorder that undermines a child’s

ability to connect with the world.

Autistic children often find it difficult to make eye contact and communicate with others. Many engage in ritualistic behavior such as hand-flapping and following routines.

Between 1987 and 1999, the number of autistic children in California skyrocketed 273 percent, while the state’s overall population rose just 21 percent.

In 1999, the number of autistic children in the state shot up 19 percent. Last year, it rose 16 percent.

This year, the state is on pace to see another 19 percent jump.

Some autism experts believe there is no cause for concern. They note

that the definition of autism has expanded in recent years and that some parents may push for the designation to receive services.

They add that doctors are now more familiar with the disorder and thus more willing to make a diagnosis.

But as the numbers continue to soar with no end in sight, scientists in the United States and England scurry for answers.

Most researchers believe there is a genetic component to autism.

But others wonder whether there could be an environmental factor that

triggers autism in genetically vulnerable children. That could involve vaccines or something entirely different.

“On any given day, kids are exposed to thousands of chemicals and various products,” noted Robert Byrd, section chief of general pediatrics at UC Davis.

David Amaral, a neuroscientist and research director of the UC Davis M.I.N.D. Institute, is among those searching for answers.

“We know that there is a genetic susceptibility to autism, but many genes, perhaps 10 to 20, appear to be involved,” Amaral said in a written statement.

“However, there is also substantial suspicion that a ‘second hit’ is necessary for children to develop full-blown autism,” he added. “There has been some suggestion that an environmental toxin such as mercury could push a child’s developing nervous system over the edge into autism.”

Parents of autistic children complain that they often face an uphill battle to get experts to take their concerns seriously.

“The truth is that I don’t know if a vaccine caused my son harm,” said Karen Eves, a Clayton mother whose 5-year-old son, Niall, has autism.

“But I don’t feel satisfied by the studies, and I’ve really lost a lot of faith with the medical community in how they’ve handled this,” she said.

Another parent, Granite Bay resident Rick Rollens, wonders how the state can afford to pay for services for the rapidly expanding autistic population.

Rollens, a co-founder of the M.I.N.D. Institute, estimates the state spends at least $1 million for a lifetime of care for each autistic child.

“The state is going to get tagged with billions of dollars’ worth of care costs for these children,” he said.

Parents of autistic children zero in on vaccines for two reasons:

either their toddler had a severe reaction to the shots, or their seemingly healthy and happy baby began to regress shortly after an immunization.

Many parents of autistic children share such suspicions, despite what experts say.

When a national group called Unlocking Autism collected 3,500 photos of children for a rally last year to raise awareness about the disorder, it asked participating parents to fill out a questionnaire.

Nearly 47 percent said they suspected or were convinced that vaccines triggered their child’s autism.

Rep. Burton believes vaccines sparked the autism of his grandson, Christian.

The boy appeared to develop normally until he received four shots in one day at the age of 14 months.

“That night, Christian had a slight fever and he slept for long periods of time,” Burton told colleagues on the House Government Reform Committee as they held a hearing on the issue last year.

“When he was awake, he would scream a horrible, high-pitched scream,” Burton said. “He would scream for hours. He began dragging his head on the furniture and banging it repeatedly.”

During the next few months, the family watched helplessly as Christian slid into autism.

Health care experts say it may simply be a coincidence that some parents notice the first signs of autism about the time shots occur.

Children typically get the measles-mumps-rubella (MMR) shot at age 12 to 15 months, for example.

And parents often notice the first signs of autism at 18 to 19 months.

Several recent studies found no evidence of a link.

One of the first people to broach the idea was Andrew Wakefield, a

gastroenterologist at the Royal Free Hospital in London.

Wakefield noticed that 12 autistic children developed an unusual inflammation in their intestines and appeared to regress shortly after receiving the MMR vaccine.

He sparked an uproar in 1998 when his opinions appeared in The Lancet, a respected British medical journal.

Since then, many of Wakefield’s colleagues have disputed his claims. A study by a separate group at the Royal Free Hospital found no association between autism and the MMR vaccine.

Yet Wakefield continues his research. The British public health department, meanwhile, launched a campaign to convince parents that vaccines are safe after immunization rates plunged because of the controversy.

In California, a recent study led by epidemiologist Loring Dales of the state Department of Health Services looked for a correlation between MMR immunization rates and the rise in autism. It found none.

Researchers assumed that if the two were linked, they would see similar curves on a graph when comparing autism cases to MMR vaccination rates.

Instead, autism rates rose sharply, while the MMR rates climbed only modestly.

 

 

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Earlier this year, the U.S. Institute of Medicine of the National Academy of Sciences, a group set up to advise the federal government on scientific matters, concluded there is no evidence of a link between MMR and autism.

The Institute of Medicine released a second report last month on thimerosal, however, that called for additional studies.

The committee concluded that it is “biologically plausible” that vaccines containing thimerosal could cause neurodevelopmental disorders in children.

But it said there is no evidence this has occurred; neither is there adequate evidence to rule out the idea. The committee noted that there have been no published, controlled studies that directly address this question.

It called for additional research because many other nations continue to use vaccines with thimerosal.

The committee also noted that an unknown quantity of such vaccines remains on doctors’ shelves in the United States. It recommended that these supplies not be used when alternatives are available.

Thimerosal, a compound that is 49.6 percent mercury by weight, has been used as a preservative in some vaccines and other pharmaceutical products since the 1930s.

Its purpose is to help prevent fungal and bacterial contamination in multidose vials of vaccines.

The MMR and chickenpox vaccines have never contained thimerosal.

But before 1999, it could be found in the combined vaccine for

diphtheria, tetanus and pertussis, otherwise known as DTaP, in the hepatitis B vaccine, and in the vaccine for haemophilus influenzae type b, known as Hib.

The FDA looked at the issue in 1998 and 1999 as it compiled a list of drugs and foods that contain mercury, a known neurotoxin. As part of the study, FDA officials asked pharmaceutical companies about the thimerosal content of their vaccines.

Scientists then determined that 6-month-olds who received the full recommended set of immunizations could accumulate doses of mercury that exceeded EPA guidelines for their body weight.

It’s difficult to draw definitive conclusions about thimerosal because it contains a form of mercury known as ethylmercury. There have been only limited studies about the toxicity of ethylmercury, the Institute of Medicine noted.

Some parents of autistic children are furious that federal officials never initiated a recall of vaccines containing thimerosal.

“It just amazes me to think that we’ve allowed vaccine manufacturers to continue to use a product that has never been proven to be safe for children,” Rollens said.

“There’s a terribly strong bias not to disrupt the immunization policy of this country at any cost,” he said.

No one knows what percentage of vaccines on doctors’ shelves contain thimerosal, but “we feel certain it’s a small number,” said CDC spokesperson Charlis Thompson.

GlaxoSmithKline, which previously produced a hepatitis B vaccine with thimerosal, recently announced it would exchange any of its mercury-containing vaccines for mercury-free ones.

The day after the Institute of Medicine issued its report, a coalition of 35 law firms filed class-action lawsuits against pharmaceutical companies in 10 states, including California.

The law firms want the companies to pay for studies analyzing whether there is a link between mercury-containing vaccines and autism. They also want children who received these vaccines to be tested for mercury in their bodies.

“This was a horrible mistake made by the industry and the vaccine establishment,” said Michael Williams, a lead attorney on the suit based in Portland, Ore. “Nobody calculated how much mercury was in there. It’s shocking.”

Williams said companies began putting thimerosal in vaccines merely as a low-cost packaging convenience. It was cheaper to provide multidose bottles than single-dose. Such preservatives aren’t needed in single-dose vials.

Critics argue that additional studies are needed on the cumulative impact of an increasing number of vaccines.

An Institute of Medicine committee will hold a hearing in Seattle on Nov. 12 to address this issue. The committee asked experts to testify about whether the number of vaccines given could overload a baby’s immature immune system, as critics suggest.

“There have been no studies looking at the vaccination schedule itself,” said Eric Hurwitz, assistant professor in the department of epidemiology at UCLA.

“We don’t know what the impact is of giving multiple vaccines simultaneously,” he said.

Others disagree. Bruce Gellin, executive director of the National Network for Immunization Information, said vaccine safety tests have been conducted with the entire immunization schedule in mind.

Gellin stressed that parents will endanger their children if they stop having them vaccinated because of suspicions and incorrect information.

There were fewer than 100 cases of measles in the United States last year, he noted, but that could change if immunization rates plunge.

“Vaccines protect the individual who is vaccinated and they protect the community at large,” he said.

Scientists around the world, meanwhile, have launched studies to unlock the mystery surrounding autism.

Last month, the EPA and the National Institute of Environmental Health Sciences announced $5 million grants to both the M.I.N.D. Institute and the Robert Wood Johnson Medical School at the University of Medicine in New Jersey to explore whether there could be environmental factors that trigger autism.

Byrd, meanwhile, oversees a study sponsored by the M.I.N.D. Institute that will investigate the reasons behind California’s rapid autism increase.  He hopes to have some results by next spring.

Byrd wants to answer one of the biggest questions surrounding the autism debate: Is the increase real, or is it a matter of changing definitions or other factors?

By comparing younger and older autistic children, researchers will investigate whether we are seeing a new type of autism with children who have gastrointestinal problems and develop normally, then regress.

“I hope to shed light so that we better know, with the remaining questions, where to look,” he said.

* * *

 

Reader’s Posts

Teacher wanted for autism self-contained class in south Louisiana.  Prefer

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My 2 yr old son has autism. There’s not much support or info locally, would

like to try to get something started. I’m in Hazel, Kentucky. Murray and

Paducah are closest big cities. I want to get the word out,

 

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