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Autism: A Recent
Serious Rise in Finland
F. Edward Yazbak, MD, FAAP
K. Yazbak, BA, MA
Note: The information on this
website is not a substitute for
diagnosis and treatment by a qualified, licensed professional.
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There have been several published and frequently quoted studies from
Finland concerning the safety and efficacy of the combined measles, mumps
and rubella vaccines (MMR). Some of these studies were joint efforts by
the Departments of Pediatrics and Public Health at the University of
Helsinki, the National Public Health Institute and the National Research
and Development Center for Welfare and Health. The studies were often
supported by grants from the vaccine manufacturer.
The two first studies, by Peltola et al, were published in The Lancet
in 1986, four years into a large and extensive National Vaccination
Program. Both were of limited scope and interest. (1,2)
The next publication whose main author was also Professor Peltola of
the Department of Pediatrics appeared in the New England Medical Journal
in 1994. It was comprehensive and detailed: The elimination of indigenous
measles, mumps, and rubella from Finland by a 12-year, two-dose
vaccination program. (3)
It essentially stated that over a period of 12 years, 1.5 million of
the 5 million people in Finland were vaccinated, that coverage exceeded 95
percent, and that the program using two doses of combined live-virus
vaccine had eliminated indigenous measles, mumps, and rubella from
Finland. The study also stressed that no deaths or persistent serious
problems were directly attributable to vaccination and that the most
frequent complication requiring hospitalization was acute thrombocytopenic
purpura, which occurred at a rate of 3.3 per 100,000 vaccinated persons.
Autism and irritable bowel disease (IBD) were never mentioned.
A subsequent report "Explosive School-based Measles Outbreak. Intense
Exposure May Have Resulted in High Risk, Even among Revaccinees" (4) by
Mikko Paunio (Department of Public Health, Helsinki University), Professor
Peltola and others was published in the American Journal of Epidemiology
in 1998. It has received less attention, and has rarely, if ever, been
mentioned during the present, and intense, MMR debate. It essentially
stated
· "That high levels of measles vaccination coverage have not always
prevented outbreaks"
· "That those infected later at home had high measles risk, even if they
were revaccinees"
· "That when siblings shared a bedroom with a measles case, a 78 percent
risk (seven out of nine children) was observed among vaccinees"
· "That vaccinees had approximately 2 days' shorter incubation time than
unvaccinated persons" and
· "That vaccinated and unvaccinated students were equally able to infect
their siblings".
The study concluded that protection against measles might not be
achievable, even among revaccinees, when children are confronted with
intense exposure to measles virus.
In February 1998, Andrew Wakefield published in The Lancet his
well-known study (5), which described specific gut changes in autism and
raised for the first time, the possibility of a link between MMR
vaccination and late-onset or regressive autism. Dr. Wakefield drew no
conclusions but simply called for more research.
In a prompt response, Peltola and Associates contributed a research
letter to The Lancet, which was published in May 1998 (6). Since then all
vaccine authorities have been assuring everyone that MMR vaccination has
not been associated with autism and IBD in 3 million vaccinees followed up
for 14 years.
This Peltola letter and a study from the UK by Brent Taylor et al (7) have
become the main arguments used by Wakefield's opponents to neutralize his
on-going research and findings.
The "damage control" nature of the research letter from Finland is
clearly apparent in its very own title: No evidence for measles, mumps,
and rubella vaccine-associated inflammatory bowel disease or autism in a
14-year prospective study.
This obviously is misleading. The study terminated in 1996, two full
years before Wakefield published his original findings and when he was
specifically questioned, Professor Peltola stated that the study had not
been designed to identify autism as a complication.
In the letter, Professor Peltola reported that about three million
doses of the combined live-virus vaccine [MMR or Virivac Merck, West
Point, PA, USA] had been administered in Finland between 1982 and 1996. He
also listed the adverse events reported shortly after vaccination and
their follow-up. The study, which was supported by a grant from Merck, did
not investigate or report complications, which started weeks or months
after vaccination. Again, Autism and IBD were not suspected to be, in any
way related to MMR vaccination before 1998, and had not once been
mentioned in the original 1994 publication.
In the same issue of The Lancet (Volume 351, Number 9112, 02 May 1998)
Andrew Wakefield responded to Peltola and refuted each of his statements.
He also highlighted the fact that "In the five year period to 1991, there
was a 300% increase in the numbers of Crohn's Disease in Finland, an
extraordinary observation that remains unexplained (Gastroenterology 1997,
1417; 112:A-732)". In his conclusion, Dr. Wakefield stated that "The
authors have failed to address the issue raised in our study and this ad
hoc retrospective and fundamentally irrelevant report contributes nothing
to the scientific debate surrounding this issue. Neither does it mitigate
the failure to have conducted prospective, long term safety studies of MMR
vaccine."
Two years later, Dr. Wakefield notified the authorities, several months
in advance of his forthcoming publication Measles, Mumps, Rubella Vaccine:
Through a Glass, Darkly (8) to allow them time to prepare for any possible
fall-out. This precipitated the production of yet another Finnish paper
(9), which detailed the more serious adverse events of the same study.
This latest contribution by Dr. Annamari Patja (with Professor Peltola
listed last) was also supported in part by a grant from Merck. Patja
stated that there were only 173 "potentially serious reactions claimed to
have been caused by MMR vaccination" among the 1.8 million individuals who
received some 3 million doses of MMR vaccine. All occurred within four
weeks from vaccination and several of them were followed longitudinally
till 1996. They included one death, 77 neurological, 73 allergic, and 22
miscellaneous reactions. Some 45% of them, according to the authors, were
probably caused or contributed by some other factor. Minor adverse events
among 437 vaccinees were listed casually but were excluded from further
analysis. According to Dr. Patja, "Idiopathic thrombocytopenic purpura was
also excluded because it has been analysed previously", this in spite of
the fact that thrombocytopenic purpura following MMR vaccination was the
most frequent complication requiring hospitalisation. (3)
The references as to the absence of autism and IBD were clearly added on
in rather unrelated paragraphs. The study was promptly and thoroughly
criticized by Welsh in Scotland, Shattock in England and us (10) and is
receiving less attention now.
What has been most intriguing is that neither Patja in December 2000
nor Peltola in May 1998 ever mentioned the incidence of autism in Finland
during the duration of their MMR study or since. One would have certainly
expected that they would have, if indeed they had examined autism and its
relationship to MMR. But they NEVER did.
What is more disturbing is that Dr. Patja appears to have ignored a
recent study from Oulu University (11) which describes an impressive rise
in autism in Northern Finland, similar in magnitude to that in other
Western countries. This study by Kielinen et al was submitted for
publication in November 1999 and was published in the journal of European
Child & Adolescent Psychiatry in 2000. All professionals reporting on the
specific subject of autism, in a country with only 5 million people should
have been aware of its results.
The Kielinen study included all children born between 1979 and 1994 in
the northern Provinces of Oulu and Lapland (which represent 1/8 of the
total population of Finland), and who were therefore 3-18 year old on
December 31, 1996 when the Peltola study ended.
The authors personally reviewed records from all selected cases of autism,
to determine that they fulfilled the present criteria of ICD-10 and
DSM-IV. Their careful review revealed a cumulative incidence of autism in
Northern Finland of 12.2/10,000 an alarming increase when compared to the
previously reported incidence of 4.75/10,000 in 1991. (12)
More concerning is the fact that the increase in younger children, all
born in the second half of the MMR campaign, was even more spectacular.
The cumulative incidence in the 5-7 age group specifically was 20.7/10,000
or more than 1 in 500 children. It certainly is possible but rather
unlikely that such an increase is due to better diagnosis. A label as
ominous as autism is not imposed lightly in a country where each and every
disability becomes immediately the sole responsibility of the State. In
fact, as in the United States, these are probably conservative figures.
The reported increased incidence in the younger age group is of
particular concern as it could indicate an accelerating increase in autism
overall. Equally concerning is the fact that there are no incidence
studies from the rest of Finland where the exact increase in autism
remains a mystery. There is NO REASON to think that it will be less
impressive than in the northern provinces. A similar situation just took
place in the Unites States. In 1999, the California report (13) was the
first detailed documentation of an autism explosion. Since then, alarming
autism rates have been reported in all states. (14,15)
A fortunate aspect of autism in Northern Finland (if one dares put
autism and fortunate in the same sentence) is the fact that almost 50% of
children in the Kielinen study had a tested IQ above 70. This is
remarkable because many tests are based on verbal abilities, which are
less adequate in children with autism and do not represent their real
functional level, as the authors pointed out.
Generally speaking in the past, only one fifth of children with autism
had IQs of 70 and above. Of late, higher ability and performance are being
reported in increasing numbers and seem to be more prevalent in children
with late-onset autism. If this is truly so, then one must consider a
trigger that may affect the child after a period of normal development. In
Finland the MMR vaccine has to be examined, before it is ruled out.
Absolving it, a priori, when independent longitudinal studies of its
safety are lacking, is reckless.
It is unconceivable that a disease affecting more than 1 in 500
children has received so little attention. Autism is the present and real
epidemic in Finland and Peltola, Patja and their talented associates
should turn their attention to it, instead of spending their time
defending the MMR vaccine. It should be easy to interview parents of
affected children and to ask them if they believe there is an
autism-vaccine connection. The Government of Finland should initiate and
finance studies in which every aspect and every possible cause of autism
are scrutinized. It is unlikely that the vaccine manufacturer will fund or
support such studies.
References
1. Peltola H, Karanko V, Kurki T, et al. Rapid Effect on Endemic
Measles, Mumps and Rubella of Nationwide Vaccination Pro-gramme in
Finland. Lancet 1986; 1:137-9
2. Peltola H, Heinonen OP et al Frequency of True Adverse Reactions to
Measles-Mumps-Rubella vaccine: a double-blind placebo-controlled trial in
twins. Lancet 1986; 1: 939-42
3. Peltola H, Heinonen OP, Valle M, Paunio M, Virtanen M, Karanko V,
Cantell K. The Elimination of Indigenous Measles, Mumps, and Rubella from
Finland by a 12-year, two-dose vaccination program. N Engl J Med 1994;
331: 1397402. )
4. Mikko Paunio, Heikki Peltola, Martti Valle, Irja Davidkin, Martti
Virtanen, and Olli P. Heinonen. Explosive School-based Measles Outbreak.
Intense Exposure May Have Resulted in High Risk, Even among Revaccinees.
Am J Epidemiol 1998;148:1103-10
5. A J Wakefield, S H Murch, A Anthony, J Linnell, D M Casson, M Malik,
M Berelowitz, A P Dhillon, M A Thomson, P Harvey, A Valentine, S E Davies,
J A Walker-Smith. Ileal-lymphoid-nodular hyperplasia, non-specific
colitis, and pervasive developmental disorder in children. Lancet 1998;
351: 637-41
6. Heikki Peltola, Annamari Patja, Pauli Leinikki, Martti Valle, Irja
Davidkin, Mikko Paunio.
No evidence for measles, mumps and rubella vaccine-associated inflammatory
bowel disease or autism in a 14-year prospective study.
Research letters: Lancet: Volume 351, Number 9112, 02 May 1998
7. Taylor B, Miller E, Farrington P, Cetropoulos M, Favout-Mayaud JL,
Waight P. Autism and measles, mumps, and rubella vaccine: no
epidemiological evidence for a causal association. Lancet 1999; 353:
2026-29.
8. Wakefield AJ, Montgomery SM. Measles, Mumps, Rubella Vaccine:
Through a Glass, Darkly. Adverse Drug Reactions and Toxicology Review,.
2000,19 (4) 1-19.
9. Patja A., Davidkin I., Kurki T., Kallio M., Valle M., Peltola H
Serious adverse events after measles-mumps-rubella vaccination during a
fourteen-year prospective follow-up. Paed. Infect. Dis.J. 19 1127-1134
(2000)
10. Yazbak FE, Yazbak K.An Unconvincing Finnish Study.
libnt2.lib.tcu.edu/staff/lruede/Fin2.html
11. Kielinen M, Linna S.-L, Moilanen I. Autism in Northern Finland;
European Child &Adolescent Psychiatry 9:162-167 (2000)
12. Vinni I, Timonen T Behavioral Analytical Point of View. Finnish
Association for mental Retardation, Helsinki (1991)
13. Changes in the population of persons with Autism and Pervasive
Developmental Disorders in California's Developmental Services system :
1987 through 1998. A report to the legislature
www.dds.ca.gov./autismreport.cfm
14. Yazbak FE Autism 99: A National Emergency.
www.garynull.com/Documents/autism_99.htm
15. Yazbak, FE Autism 2000: A Tragedy.
www.garynull.com/Documents/autism_2000.htm
F. Edward Yazbak, MD, FAAP
Kathleen Yazbak, BA, MA
TL Autism Research
E-mail: [email protected]
These personal observations may not represent the views of
organizations to which we belong.
Copyright 2001
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