Vaccinations and Autism – a search of the literature.
Note: Most of
these are letters, commentary or reviews. In
other words, there are lots of opinions, but very little in the way of
original research or hard data. - SM
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Br J Gen Pract 2001 Nov;51(472):904-10 |
Books
Comment in:
· Br J Gen Pract. 2001 Nov;51(472):875-6.
Parents' perspectives on the MMR
immunisation: a focus group study.
Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R.
Division of Primary Health Care, University of Bristol. m.a.evans@bristol.ac.uk
BACKGROUND: The uptake of the combined measles, mumps and rubella immunisation
(MMR) in Britain has fallen since 1998, when a link was hypothesised with the
development of bowel disorders and childhood autism. Despite reassurances about
the safety of MMR, uptake levels remain lower than optimal. We need to
understand what influences parents' decisions on whether to accept MMR or not
so that health professionals can provide a service responsive to their needs.
AIM: To investigate what influences parents' decisions on whether to accept or
refuse the primary MMR immunisation and the impact of the recent controversy
over its safety. DESIGN: Qualitative study using focus group discussions. SETTING:
Forty-eight parents, whose youngest child was between 14 months and three years
old, attended groups at community halls in six localities in Avon and
Gloucestershire. METHODS: Purposive sampling strategy was used to include
parents from a variety of socioeconomic backgrounds. Three groups comprised
parents who had accepted MMR and three groups comprised parents who had refused
MMR. Data analysis used modified grounded theory techniques incorporating the
constant comparative method. RESULTS: All parents felt that the decision about
MMR was difficult and stressful, and experienced unwelcome pressure from health
professionals to comply. Parents were not convinced by Department of Health
reassurances that MMR was the safest and best option for their children and
many had accepted MMR unwillingly. Four key factors influenced parents'
decisions: (a) beliefs about the risks and benefits of MMR compared with
contracting the diseases, (b) information from the media and other sources
about the safety of MMR, (c) confidence and trust in the advice of health
professionals and attitudes towards compliance with this advice, and (d) views
on the importance of individual choice within Government policy on
immunisation. CONCLUSIONS: Parents wanted up-to-date information about the
risks and benefits of MMR to be available in advance of their immunisation
appointment. Many parents did not have confidence in the recommendations of
health professionals because they were aware that GPs needed to reach
immunisation targets. Most parents would, however, welcome more open discussion
about immunisation with health professionals.
PMID: 11761204 [PubMed - indexed for MEDLINE]
Record 2 of 118 in SilverPlatter MEDLINE(R) February
Week 1 (2002/02)
TI: Parents'
perspectives on the MMR immunisation: a focus group study.
AU: Evans,-M;
Stoddart,-H; Condon,-L; Freeman,-E; Grizzell,-M; Mullen,-R
SO:
Br-J-Gen-Pract. 2001 Nov; 51(472): 904-10
JN:
British-journal-of-general-practice,-The-the-journal-of-the-Royal-College-of-General-Practitioners
AN: 21596740
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Pediatr Infect Dis J 2001 Sep;20(9):887-8 |
Vaccines and autism.
DeStefano F.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Publication Types:
· Review
· Review, Tutorial
PMID: 11734770 [PubMed - indexed for MEDLINE]
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Pediatrics 2001 Oct;108(4):E58 |
No evidence for a new variant of
measles-mumps-rubella-induced autism.
Fombonne E, Chakrabarti S.
Institute of Psychiatry, Department of Child and Adolescent Psychiatry, King's
College London, London, United Kingdom.
OBJECTIVE: A link has been postulated between measles-mumps-rubella (MMR)
vaccine and a form of autism that is a combination of developmental regression
and gastrointestinal symptoms that occur shortly after immunization. This
hypothesis has involved 3 separate claims: 1) that there is new phenotype of
autism involving regression and gastrointestinal symptoms, 2) that this new
variant is responsible for the alleged rise of autism rates, and 3) that this
phenotype is associated with biological findings suggestive of the persistence
of measles infection. We tested the first of these claims. If this new
"autistic enterocolitis" syndrome had some validity, then 1 or
several of the following 6 predictions should be supported by empirical data:
1) childhood disintegrative disorder has become more frequent, 2) the mean age
of first parental concern for autistic children who are exposed to MMR is closer
to the mean immunization age than in children who are not exposed to MMR, 3)
regression in the development of children with autism has become more common in
MMR-vaccinated children, 4) the age of onset for autistic children with
regression clusters around the MMR immunization date and is different from that
of autistic children without regression, 5) children with regressive autism
have distinct symptom and severity profiles, and 6) regressive autism is
associated with gastrointestinal symptoms and/or inflammatory bowel disorder.
METHODS: Three samples were used. Epidemiologic data on 96 children (95
immunized with MMR at a median age of 13.5 months) who were born between 1992
and 1995 and had a pervasive developmental disorder diagnosis as reported in a
recent UK survey (post-MMR sample) were compared with data from 2 previous
clinical samples (1 pre-MMR [n = 98] and 1 post-MMR [n = 68]) of autistic
patients. All patients were assessed with the standardized Autism Diagnostic
Interview (ADI), allowing rigorous comparison of age at first parental concerns
and rates of regression across samples. Reliability was excellent on ADI
scores, age of parental concern, and developmental regression. Furthermore,
data on bowel symptoms and disorders were available in the epidemiologic survey
from both pediatric and parental sources, and immunization dates were obtained
from computerized records. RESULTS: The prevalence of childhood disintegrative
disorder was 0.6/10 000 (95% confidence interval: 0.02-3.6/10 000); this very
low rate is consistent with previous estimates and is not suggestive of an
increased frequency of this form of pervasive developmental disorder in samples
of children who are immunized with MMR. There was no difference in the mean age
at first parental concern between the 2 samples exposed to MMR (19.3 and 19.2
months) and the pre-MMR sample (19.5 months). Thus, MMR immunization was not
associated with a shift toward an earlier age for first parental concerns.
Similarly, the rate of developmental regression reported in the post-MMR sample
(15.6%) was not different from that in the pre-MMR sample (18.4%); therefore,
there was no suggestion that regression in the developmental course of autism
had increased in frequency since MMR was introduced. In the epidemiologic
sample, the subset of autistic children with regression had no other
developmental or clinical characteristics, which would have argued for a
specific, etiologically distinct phenotype. Parents of autistic children with
developmental regression detected the first symptoms at a very similar age
(19.8 months) to those of autistic children without regression (19.3 months).
Moreover, the mean intervals from MMR immunization to parental recognition of
autistic symptoms were comparable in autistic children with or without
regression (248 vs 272 days; not significant). In the epidemiologic sample,
gastrointestinal symptoms were reported in 18.8% of children. Constipation was
the most common symptom (9.4%), and no inflammatory bowel disorder was
reported. Furthermore, there was no association between developmental
regression and gastrointestinal symptoms (odds ratio: 0.63; 95% confidence
interval: 0.06-3.2; not significant), and only 2.1% of the sample experienced
both problems, a rate that did not exceed chance expectations. CONCLUSIONS: No
evidence was found to support a distinct syndrome of MMR-induced autism or of
"autistic enterocolitis." These results add to the recent
accumulation of large-scale epidemiologic studies that all failed to support an
association between MMR and autism at population level. When combined, the
current findings do not argue for changes in current immunization programs and
recommendations.
Some
questions: 1) Since these children were born and received MMR prior to anyone
connecting MMR to autism, how did that effect the results? 2) Why are the
cases included in this study treated like the only cases and then this
"sample" used to disprove the notion that there has been an
increase? 3) Why are the assumptions (1-6) being used to disprove
the theory, rather than tested first (separately) to see if they are valid?
4) Isn't the fact that Dr. Wakefield has seen and reported on many
parents of autistic children who do report inflammatory bowel symptoms and the
fact that in this study there is not one such case, compelling evidence that the
sample in this study is seriously flawed?
PMID: 11581466 [PubMed - indexed for MEDLINE]
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CNS Drugs 2001;15(11):831-7 |
Autism and measles-mumps-rubella vaccination:
controversy laid to rest?
DeStefano F, Chen RT.
National Center on Birth Defects and Developmental Disabilities, Atlanta,
Georgia 30341-3724, USA. fdestefano@cdc.gov
It has been suggested that vaccination, particularly with measles-mumps-rubella
(MMR) vaccine, may be related to the development of autism. The main evidence
for a possible association is that the prevalence of autism has been increasing
at the same time that infant vaccination coverage has increased, and that in some
cases there is an apparent temporal association in which autistic
characteristics are first noted shortly after vaccination. Although the
prevalence of autism an