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MMR and autism - US conference

 

Britain these past few weeks has seen an unprecedented spate of media-inspired hype over the safety of MMR. Some people give us their views, others present the facts, and a presenter then tells us they can’t make sense of it all. That’s a pity, because there’s a lot of sense to be made. Right now there’s far too much heat and not enough light.

So for some calm reflection and good common sense from doctors, scientists, parents and government, let’s cross the pond to the USA and see how these things might be handled better. In June 2000, sponsored by the Centres for Disease Control and Prevention, the American Academy of Pediatrics convened a conference on “New challenges in childhood immunizations” in Illinois. The conference was attended by representatives from various paediatric committees, parents, practitioners and scientists, with a multidisciplinary panel of experts to review the evidence on what was known about the pathogenesis, epidemiology and genetics of autistic spectrum disorders, and what was known about the supposed link between inflammatory bowel disease, measles and MMR vaccine.

The report [1] can be downloaded from the Pediatrics website, and the URL is given below. It is 23 pages long, but worth every word. It is comprehensive and authoritative, yet humble and sensitive at the same time. Some of the results and conclusions are in Table 1. The paper looks at every aspect of the autism and measles vaccination, and especially the link with MMR. The application of causality criteria is particularly useful, and there is a voluminous reference list.

Table 1: Conclusions

Main results of US conference on MMR and autism
Autism is a complex disorder of uncertain and probably multiple aetiologies.
Abnormal brain development in autism may occur before 30 weeks' gestation.
In utero, rubella is a known cause of autism.
Animal data support the biological plausibility that exposure to unrecognised infectious or environmental agents could cause autistic spectrum disorders.
Increased reporting of autistic spectrum disorders occurred long after the introduction of widespread use of MMR vaccine in the USA in 1971.
Some children with autistic spectrum disorders have gastrointestinal symptoms, but an increased rate has not been established.
Separate administration of measles mumps and rubella vaccines provides no benefit over MMR and would result in delayed or missed immunisations.
Continued scientific efforts need to be directed to the identification of causes of autistic spectrum disorders.

In particular, it calls for more and better research to understand and prevent autistic spectrum disorders and identifies areas for further study, including:

Reading and understanding this paper would greatly benefit healthcare professionals dealing with childhood vaccinations. It’s language is accessible for parents as well. It may not be the easiest of reads for any of us, but all of us can benefit from it. There’s also more on the CDC Internet site at http://www.cdc.gov/nip/vacsafe/concerns/autism/ .

Perhaps the most important lesson from the conference is that it is less about proving the lack of a link between MMR and autism, and more about finding the cause of autism and doing something about it.

References:

  1. NA Halsey et al. Measles-mumps-rubella vaccine and autistic spectrum disorder: a report from the New Challenges in Childhood Immunizations conference convened in Oak Brook, Illinois, June 12-13, 2000. Pediatrics 2000 107. ( http://www.pediatrics.org/cgi/content/full/107/5/e84 )
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