Mumps and the MMR vaccine

thisislondon.com ^

[krodriguesdc]

Mumps and the MMR vaccine

Evening Standard editorial comment

Parents have good reason to be concerned about the possibility of a mumps outbreak in London. The epidemiological history of this infectious disease suggests that mumps is unpleasant but hardly ever fatal to children. In rare cases it causes meningitis or encephalitis; it can also cause infertility in boys. Before there was a vaccine for mumps, it tended to kill no more than five people a year.

Yet it is impossible to be certain that half a century of vaccination against the disease will not have weakened our natural immunity to the extent that a renewed outbreak would produce unusually severe symptoms.

This is why the near quadrupling of mumps cases in the capital to 112 in 2001, and the 30 per cent rise in the last quarter over the previous three months, is particularly worrying, given that clinics across the country have been without supplies of the mumps vaccine for up to six months and do not know when they can expect fresh supplies.

The Government will be blamed for creating this situation, and endangering childrens' lives, by insisting that the triple MMR vaccine be used to inoculate children against measles, mumps and rubella, but it is not directly the fault of the Department of Health. The reason why there is such a shortage of mumps vaccine is that not much of it is being manufactured (none to UK licence specifications) and the logical reason for this is that every country in the developed world except Britain has accepted the overwhelming scientific evidence that MMR does not trigger autism in young children. This is not to say that blame should rest with parents who refuse the triple vaccine.

Ever since Dr Andrew Wakefield produced his own variant findings, which suggested a possible link between MMR and autism and bowel disorders, enough anecdotal evidence has emerged that the MMR vaccination appears to coincide with the onset of autism in young children to convince many parents that they must be connected. Pressure is therefore growing to make it the responsibility of the Government to accelerate the production of mumps vaccine and then provide all three vaccinations separately on the NHS. This will be the first major challenge for the new public health minister David Lammy, and perhaps the toughest he will ever have to face.

[Al B.]

Whatever is causing the rise in autism was well under way pre-MMR. Your own graph shows this unequivocally.

No it wasn't, and the graph demonstrates nothing of a kind.  There was a "catchup campaign" initiated in NW London in 1988 involving non-vaccinated children born in 1986.  These children were inoculated with MMR in 1988, but the autism incidence rates were recorded by birth year, as the graph clearly shows.

Please see a discussion of this very question in a letter printed in the Lancet:

Wakefield, A, "MMR vaccination and autism," Lancet, 354 (Sep 1999): 949-950.

Next, I'll be hearing that the Lancet is a non peer-reviewed journal.  LOL.

[discostu]

Yes it does. In England in 1978 we see 100 autistic kids, in 1986 two years before the vaccine we see 250, and there's a relatively steady steady climb through that whole period. Even if you back up two years because it's graphing by birthdate instead of diagnosis date you still see a 100% increase in autistic kids BEFORE MMR. Same kind of thing going on in the California graph. The rate is CLEARLY increasing in both sample sets before MMR.

[Al B.]

What the hell are you talking about? The number of new cases is the axis on the right and the UK line is for NW London ONLY! Go read the Lancet article where the graph was originally printed before you start spouting non-factual nonsense.

You might also be interested to know that in California, DSM-IV criteria for autism yields an estimated incidence of autism of 105-263 cases in 1998, when in actuality there were 1,685 new cases reported.

Nah, on 2nd thought you're probably not interested.

[TomB]

Concerning the California study:

Follow-up analysis and complete study A follow-up analysis of the data published in 2001 showed that there is no association between autism rates in California and the proportions of young children in this state who have received Measles Mumps Rubella (MMR) vaccine.

There are no recommended childhood vaccines or any other vaccines that are known to cause autism in children.

The complete study by authors Dales L, Hammer SJ, Smith, NJ. Entitled 2001 Time Trends in Autism and in MMR Immunization Coverage in California, published in JAMA 285, 1183-1185.

Facts of the study

* The study looked at the percent of children born in 1980-1994 and enrolled in California kindergartens who received the MMR vaccine, by age when the vaccine was received, and the number of autism cases enrolled in the California Department of Developmental Services regional service center system.

* The number of autism cases in California increased greatly, over 373%, compared to only a small 14% increase in MMR vaccine coverage in children for the same time period.

* If there were a relationship between MMR vaccination and autism, one would expect the shape of the MMR immunization level curve to be very similar to the shape of the autism case number curve. This is not the case, thus the analysis in this study does not support any link between MMR vaccination and autism.

View the proper graph here.

[TomB]

And since you find the Lancet such a good source of information:

Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association

Brent Taylor, Elizabeth Miller, C Paddy Farrington, Maria-Christina Petropoulos, Isabelle Favot-Mayaud, Jun Li, Pauline A Waight

Department of Community Child Health, Royal Free Campus, Royal Free and University College Medical School, University College London, London NW3 2QG, UK (Prof B Taylor FRCPCH, M-C Petropoulos MRCP, I Favot-Mayaud MD, J Li PhD); Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, London (E Miller FRCPath, P A Waight BSc); and Department of Statistics, Open University (C P Farrington PhD)

Correspondence to: Prof Brent Taylor

Summary

Background We undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism.

Methods Children with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method.

Findings We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 [82%] core autism, 52 [31%] atypical autism, 27 [38%] Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0·94 [95% CI 0·60­1·47] and 1·09 [0·79­1·52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0·92 [0·38­2·21] and 1·00 [0·52­1·95]). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder.

Interpretation Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.

Lancet 1999; 353: 2026­2

[TomB]

why bother?

Seeing all the incorrect information you've been posting, I've been wondering the same thing, doc.

"Why bother" indeed.

BTW, congrats on completing a post without any cut-and-paste.

[discostu]

I don't read opinion pieces, I read peer reviewed research. I'm sorry if you can't read the graph. It's clear the rate of autism is climbing steadily before the MMR. It's clear that as with so many psychological symptoms the definition of autism is expanding. Observe this list of "symptoms" of Asperger Syndrome (one of autism's subspecies, only diagnosed since the 80s):
lack of empathy
naive, inappropriate, one sided interaction
little or no ability to form friendships
pedantic, repetitive speech
poor nonverbal communication
intense absorbtion in certain subjects
clumsy and ill coordinated movements and odd postures

Now go over to a WOD or crevo thread and tell me how many FReepers are autistic. When the definition keeps expanding you're bound to get an "epidemic". To blame that epidemic on medicine that didn't even start getting used until after the epidemic has begun is fool hardy. Let's lock down the definition of autism and see what happens to the rate of diagnosis before we cast aspersions on vaccines that have saved thousands, possibly millions, of lives.

[TomB]

Four years later, researchers at Harvard published data from a large study (the Physicians' Health Study) verifying what McCully had been saying since 1969.

So he published a study, and then further, independent research confirmed his findings. Just the way it is supposed to work.

Now, all Wakefield has to do is get someone to reproduce his findings. But while it's been tried, no correlation has been found.

[TomB]

Whoops, looks like you've got another bad article. While it doesn't make anything up, it certainly embellishes Dr. Kilmer's plight:

His work was not met with applause in the scientific community, which coalesced in a herd mentality around the concept of cholesterol.

McCully was denied tenure, and soon left Harvard. In 1995, Meir Stampfer of Harvard recalled for NBC's Tom Brokaw what McCully went through for daring a different idea.

Here is an interview which paints quite a different picture:

"McCully: The immediate reaction when I first started was supportive. I had a number of colleagues who were interested, and the chairman of my department was interested for a period of about five or six years. I was able to publish the basic elements of the theory until about 1975, when the chairman of my department retired. The new chairman informed me that I would have to support my work in some way but no he made no effort to help obtain this support. My laboratory was removed from the department to another part of the hospital. It was made clear to me that I should look elsewhere for support. The Director of the hospital told me that Harvard Medical School believed that I hadn't proven my theory. I left Harvard at the end of December of 1978 and came to Providence VA Medical Center in 1981 where I have worked ever since.

Sounds like he wasn't getting anywhere with his research and was let go (perhaps he didn't get along well with the new chairman?).

Anyway, the real story is much less "sexy" than what you posted.

You really need to quite taking these articles at face value.

[Al B.]

To blame that epidemic on medicine that didn't even start getting used until after the epidemic has begun is fool hardy.

You've got me confused with someone else. I'm not blaming the huge increase in autism diagnoses on anything. As a parent who has vaccinated his kids with MMR, I AM, however, interested in getting to the truth of the matter, not just play some silly game of abstract posting.

And I know all about the objectivity of medical journals, peer-reviewed and otherwise. Getting to the truth in medical research these days isn't all that easy.

[discostu]

Except that there have been hundreds of studies that show over and over no possible causal link between the two. The best the anti-MMR crowd can muster are opinion pieces reinterpretting somebody else's study, and graphs that clearly show they're barking up the wrong tree. I'd like to get to the bottom of it too, it's hard to cure something if you can't pin down the cause. But it's clear that the MMR vaccinations are not the source, there have been too many studies done too many ways and there's just no valid science that contradicts them even a little. Those working to cure autism have wasted enough time on MMR research, it's time to find some other possible cause to research.

[TomB]

Not to mention the fact the autism obviously existed long before the MMR vaccine was developed. What caused those cases? And shouldn't they be concerned with the root cause, which MMR cannot possibly be?

[Al B.]

But ........., there have been too many studies done too many ways and there's just no valid science that contradicts them even a little.

LOL! Think I've heard that before from the medical research crowd, just before they've had to eat their words. I'll reserve judgment until I know a little more, if you don't mind.

CDC might be able to end this debate very quickly if they would honor their commitment to Mr. Burton to open up the VSD to independent review. So far, they haven't seen fit to do that.

[discostu]

As I dig deeper into this topic I think it many ways this is similar to ADHD and PTSD and a few others. Over diagnosed. Back when I was growing up we had a name for kids with the symptoms of Asperger, they were called "pain in the ass" (notice there's heavy overlap between those symptoms and the ADHD symptoms too)... actually I shouldn't say "they" I should say "we". Yes I was a pain in the ass kid. Always in trouble, generally obnoxious, sometimes monofocal (I once unspooled the internal antena of a radio trying to figure out how it works), didn't have a lot of friends, I still do the awkward pose thing. This wasn't considered a syndrome that needed expensive treatment and psychotropic medicine. It was considered a character flaw that could be eliminated (or at least focused and controled) with good parenting. And it worked, now I'm in software QA and get paid good money to break things figuring out how the work. It was considered part of the crap shoot of being a parent, sometimes you got a good kid that didn't break stuff and rarely needed to be scolded, sometimes you got a pain in the ass that you had to keep finding new ways to punish and direct. But of course nobody makes money because your kid is a pain in the ass (well maybe Radio Shack), but once your kid has been diagnosed with a syndrome the money train is going full force.

[discostu]

ah my favorite rebutal, the laugh and claim superior knowledge. Whatever. Just check out KR's history, it's his axe and the best he can come up with are op-eds from the 19th century about the general hazzards of vaccines. If you'd rather believe an op-ed written before the Civil War than the hundred of studies done in the last 10 years all I can do is shake my head.

[TomB]

LOL! Think I've heard that before from the medical research crowd, just before they've had to eat their words. I'll reserve judgment until I know a little more, if you don't mind.

So what would you consider evidence that MMR/autism link is bogus?

[krodriguesdc]

BUMP

[krodriguesdc]

Kilmer McCully, M.D. had this to say in an interview as well - is this article bad too?...

here's the link...

"I had discovered a new explanation for our deadliest disease," he said, "I thought I would get a big-shot professorship out of it." Instead, his research was labeled ‘malpractice’ and ‘errant nonsense,’ and he lost his junior faculty position at Massachusetts General. After fifty-one job rejections, the Harvard-trained pathologist took a position at a small VA hospital in Providence, where he borrowed money from better-funded colleagues to continue his research. In the late nineties, a slew of new studies supported McCully’s findings, and homocysteine levels are now routinely screened as a risk factor for heart disease. “

Hmmmm...

[Al B.]

So what would you consider evidence that MMR/autism link is bogus?

An independent review of the CDC VSD data, done by researchers without a vested interest in the results.

[TomB]

An independent review of the CDC VSD data, done by researchers without a vested interest in the results.

Independent research has been published by teams in the UK, Sweden, Finland and others, why isn't that enough?