Vaccines and autism
Perhaps the biggest concern related to vaccines that we as pediatricians see parents express is the perception that vaccines cause autism. The clinical features of autism tend to appear in children in the second year of life, when kids get a significant number of vaccines, including the MMR (measles, mumps, rubella) vaccine. A paper published in The Lancet by Andrew Wakefield, a British researcher, in 1998 linked the MMR vaccine with autism. This created a firestorm of controversy that has frightened many people and continues to cause a fear of vaccines. However, subsequent research using various epidemiologic and double-blind, placebo-controlled studies have indicated that neither the vaccine nor thimerosol (a preservative used to prevent contamination of vaccines) was related to autism.
“In 2004, after an investigation by The Sunday Times, the interpretation section of the study, which identified a general association in time between the vaccine and autism, was formally retracted by ten of Wakefield's twelve coauthors. The Centers for Disease Control and Prevention, the Institute of Medicine of the National Academy of Sciences, the UK National Health Service and the Cochrane Library review have all concluded that there is no evidence of a link between the MMR vaccine and autism.”
“In 2007 Wakefield became the subject of a General Medical Council disciplinary hearing over allegations that his research had received funding related to litigation against MMR-vaccine manufacturers, and had concealed this fact from the editors of The Lancet. It was later revealed that Wakefield received £435,643 [about $780,000] plus expenses for consulting work related to the lawsuit. This funding came from the UK legal aid fund, a fund intended to provide legal services to the poor. In 2009 The Sunday Times reported that Wakefield had manipulated patient data and misreported results in his 1998 paper, creating the appearance of a link with autism. In 2010, Wakefield was found by the GMC to have acted "irresponsibly", and The Lancet fully retracted the original paper.”
(Wikipedia search “MMR vaccine” 4/4/10)
One of the reasons autism is such a complicated disorder is that we still do not know the cause of it. There are likely multiple genetic and environmental components that play a role in a child’s development of autism. Recent data indicate that 1 in 110 children is diagnosed with autism (Autism Speaks website 4/4/10). The diagnosis seems to be becoming more and more common. Part of this increase is related to the more modern way of classifying patients with the social impairment seen in autism as autistic rather than labeling them as mentally retarded, which would have been done in years past. The other factor is that we as health care providers are better able to identify children with autistic spectrum disorders. Fortunately, pediatricians have screening tools used at the 18 and 24 month well child exams to evaluate patients for autism. If the child fails the screen, then the child can be evaluated by our in-house developmental specialist and subsequently referred to a county agency for further testing and therapies if necessary. What we have found is that the earlier children are identified with autism, or a related pervasive developmental disorder, and the sooner interventions are started, the greater the chance the child has in learning skills to allow him or her to be more successful at home and at school.