Autism and the MMR Vaccine

Developed by Matthew Rowe

Department of Biological Sciences
Sam Houston State University
Huntsville, TX 77341-2116
 Let’s Meet the Characters

Anne – the mother

Worked two jobs as a single mother
Anne Now attending nursing school

Carly and Ian

Carly
Older sister
Works as a graphic artist
Son is autisic
 Kristen and Alissa

Kristen
Sales manager
14-month old daughter Alissa
 The signs of autism begin before a child is 3

*Vaccine ideally given to children between 12 to 13 months of age.

Second dose before they start school

For unknown reasons, 5x as many boys as girls develop autism.

 Measles, Mumps and Rubella are caused by viruses.
So, what is a virus?

Viruses are microscopic, infectious agents (much smaller than a

bacterium) which consist of a protein coat (a capsid) which encloses
either a RNA or DNA genome. They act like parasites, though they
are not quite living organisms because they cannot replicate/multiply
on their own. But, when they invade the cells of the body, they use
the machinery (DNA) of the host cells to replicate.
 What’s in a vaccine?

A vaccine is a substance consisting of dead or nearly bacteria

or viruses which act to stimulate the immune system to stop
specific bacteria and viruses from replicating.
Adjuvants (such as aluminum) - added to enhance the immune
system response

Antibiotics - to prevent contamination during the manufacturing

process

Preservatives (such as thimersol (ethyl mercury – only in flu

vaccines) and stabilizers (such as gelatin and monosodium
glutamate)
 Back to the case…

Carly had stumbled onto an

episode of “Larry King Live”
while channel surfing.

Photo by Chad McNeeley/Wikipedia

 Jenny McCarthy Jim Carey

MMR vaccine replaced the old, simple measles vaccine in 1988

During the 11 years following it’s introduction, autism rates increased
by 273%

Rates are still increasing – as of 2014, 1 in every 59 kids in the U.S.

develops some form of ASD.” 78% increase in just one decade.

Boys outnumber girls by 5 to 1.

Prevalence of autism in the United States 1970-2018

$268 Billion
 And, there was a study…

Dr. Andrew Wakefield and

colleagues - British medical
journal Lancet in 1998.

Concluded there was evidence

that vaccine might cause
autism
 Table 1: Neuropscyhiatric diagnosis and interval post MMR
vaccination.a
Child Behavioural Exposure identified Interval from
And here are the diagnosis by parents or
doctor
exposure to symptoms

1 Autism MMR 1 week

data from the 2 Autism MMR 2 weeks

scientist in Great 3 Autism MMR 48 h

4 Autism? Disintegrative MMR Dramatic deterioration

Britain referenced disorder? immediately after MMR
booster at 4.5 years

by Carly. 5 Disintegrative disorder None-but MMR at 16

months
Self-injurious behavior
started at 18 months

6 Autism MMR 1 week

7 Autism MMR 24 h
It was published 8 Post-vaccinial MMR 2 weeks
encephalitis?
in Lancet – a 9 Austistic spectrum Recurrent otitis 1 week (MMR 2 months
disorder media previously)
highly respected 10 Post-viral enchphalitis? Measles (previously 24 h
vaccinated with
medical journal MMR)

11 Autism MMR 1 week

12 Autism None-but MMR at 15 Developmental

months deterioration noted at
16 months
aTaken from Table 2 in Wakefield et al. (1998) Ileal-lymphoid-nodular hyperplasia,
non-specific colitis, and pervasive developmental disorder in children. Lancet
351:637-641
 So ….
What should Kristen do?

And how long does she

have to decide?
1 month (vaccinate at 15 months – Alissa is 14 months old
 How do you think
the public reacted to
Wakefield et al.’s
findings?
There was a drastic decrease in
vaccination, world-wide
 Should Wakefield’s study
have sparked a world-wide
anti-vaccine reaction?
 As shown in the graph, the measles rate had dropped dramatically as a
result of the MMR vaccine. In fact, it had gone to zero in 2000 (i.e.. it had
been eradicated in the U.S. – but then, the anti-vaccination (anti-vax)
efforts started in the U.S., and around the world, due to Wakefield’s study...

Measles cases reported in the United States, 1944-2007, represented as thousands of cases per year vs.
year, with an inset 1983-2007 as cases vs. year. 1983 was chosen for the beginning of the inset graph as
it represents the minimum reported cases until 1993, after the booster vaccine was added to the
recommendations schedule. Data are from the US Centers for Disease Control.
 United Kingdom (U.K) Data

92% vac. rate 80% in 2004

1,348 in 2008
56 cases in 1998

1st fatality in 2006 13 yr old

Both who died could not
receive vaccination due to
congenital illness that
affected their immune sys.

In the U.K., when the vaccine rate dropped (blue line), the measles rate
(red bars) rose dramatically.
 Why did so many kids develop the measles?

There was a loss of “herd immunity” when parents

stopped vaccinating their kids

So what is herd immunity?

Herd Immunity describes a type of immunity that occurs when the vaccination of a
portion of the population (or herd) provides protection to unprotected individuals..
Herd immunity theory proposes that, in diseases passed from person to person, it is
more difficult to maintain a chain of infection when large numbers of a population
are immune. *Ro is The average number of other individuals each infected individual will infect in a
population that has no immunity to the disease

Estimated Herd Immunity thresholds for vaccine preventable diseases[2]

Herd immunity
Disease Transmission R0
threshold
Diphtheria Saliva 6-7 85%
Measles Airborne 12-18 83 - 94%

Mumps Airborne droplet 4-7 75 - 86%

Pertussis Airborne droplet 12-17 92 - 94%

Polio Fecal-oral route 5-7 80 - 86%

Rubella Airborne droplet 5-7 80 - 85%

Smallpox Social contact 6-7 83 - 85%

R0 = # each unvaccinated person will infect

Herd immunity is critical to children (or adults) who can’t be immunized because
they are immune-compromised – such as children on chemotherapy.

2015 – major
measles
outbreak in
US and even
bigger in
2019

Rhett Krawitt has been battling leukemia for 4.5 years. He can’t be immunized.
Lives in Marin County, Calif., has one of the highest rates (6.45%) of "personal
belief exemptions" in the state.

Going to school can literally threaten his life.

In 2000 - CDC declared measles to be eliminated from the U.S

But - the U.S. response to Wakefield’s study was similar to UK’s

642

And so was the result

Of the 222 cases in 2011, 65% had not been vaccinated and
21% did not know their vaccination status

50 patients had not been vaccinated because of a philosophic,

religious, or personal objection (which is permitted under law).

Since the 2011 outbreak of 222 cases in the U.S., the number
of cases has gone up dramatically to 1,282 cases in 2019

413,308 cases world-wide

between Jan. and Nov. of 2019

In 2018, more than 140,000 died

from the measles
You
are
here

August 2018
 Why are the measles and other diseases back?
The Ant-vaccine movement lead to more exemptions
 “Mumps Outbreak Hits NY, NJ”
Headline News, November 12th, 2009
Mumps can
cause
infertility in
males

Rubella – 179
miscarriages cases in
in pregnant
women & BDs U.S.
traced to
Measles one boy
respiratory,
viral, highly
contagious
(90%);
encephalitis,
corneal
scarring
The anti-vaccination sentiment
didn’t involve only the MMR
vaccine.

Anti-vaxers have argued

against essentially all
vaccinations – and there are real
and dangerous consequences.
One of these is the rise of Pertussis (whooping cough) –
which, like the measles, is potentially deadly

https://www.youtube.com/watch?v=S3oZr
MGDMMw

In CA in 2010 alone:
 7,824 cases
 10 deaths
Pertussis outbreaks are on the rise in certain
areas.
Alright, work with the other members of you team
on these questions: (10 min)

1. Using FiLCHeRS, consider whether the results presented by

Wakefield et al. (1998) merited the dramatic public response.
Was it a good study? Did it have any flaws?

2. What additional data would you like to have to determine

whether or not there is a causal link between the MMR
vaccine and autism?

How would you design a study…

Table 1: Neuropscyhiatric diagnosis and interval post MMR
vaccination.a
Child Behavioural Exposure identified Interval from
diagnosis by parents or exposure to symptoms
doctor
1 Autism MMR 1 week

2 Autism MMR 2 weeks

3 Autism MMR 48 h

4 Autism? Disintegrative MMR Dramatic deterioration

disorder? immediately after MMR
booster at 4.5 years

5 Disintegrative disorder None-but MMR at 16 Self-injurious behavior

months started at 18 months

6 Autism MMR 1 week

7 Autism MMR 24 h

8 Post-vaccinial MMR 2 weeks

encephalitis?

9 Austistic spectrum Recurrent otitis 1 week (MMR 2 months

disorder media previously)

10 Post-viral enchphalitis? Measles (previously 24 h

vaccinated with
MMR)

11 Autism MMR 1 week

12 Autism None-but MMR at 15 Developmental

months deterioration noted at
16 months
aTaken from Table 2 in Wakefield et al. (1998) Ileal-lymphoid-nodular hyperplasia,
non-specific colitis, and pervasive developmental disorder in children. Lancet
351:637-641
 Problem: There were only 12 subjects in Wakefield’s study.

Problem: The age at which children start showing signs of autism is the
same age at which they receive the MMR vaccine.

Just because one event occurs after another doesn’t mean

the first event caused the second!!
Problem: There was no comparison of the rates of autism among kids
that did not get the MMR vaccine versus those who did receive the MMR
vaccine!!!

Was vaccinated # of Autism cases More

Not vaccinated # of Autism cases

If vaccines cause autism, what would you find regarding

the number of cases of autism among vaccinated children?

So, has anyone done studies with comparison groups?

Yes indeed!
And they were really big studies.
 Madsen, K.M. et al. 2002. A population-based study of measles, mumps, rubella
vaccination and autism. The New England Journal of Medicine 347: 1477-1482.

Retrospective cohort study of ALL children (537,303) born

in Denmark 1991-1998
Of these, 96,648 were not vaccinated by their parents
Children were followed on average for 4 years, generating
2,129,864 person-years of observation.
No increase in autism among vaccinated kids
Risk was actually lower for vaccinated kids!
 Honda, H. et al. 2005. No effect of MMR withdrawal on the
incidence of autism: a total population study. Journal of Child
Psychology and Psychiatry 46: 572-579

ALL children (31,426) born in Kohoku Ward in Japan 1988-1996

were followed from birth through age 7.
NO MMR vaccines were given from 1992-1996 because of
concerns over the preservative in it.

Kanagawa
Prefecture

The children weren’t vaccinated

because of a problem with an
ingredient in the vaccine.
What would the hypothesis be if
someone thought that the MMR
vaccine was causing ASD – and
the vaccine were no longer given?
 The Results of the Honda, et al. study

ASD

Vertical blue bars = rate of use of MMR vaccine

Shaded area and red line = incidence of autism
Is this what we would expect if the hypothesis regarding MMR
vaccinations and autism were correct?
 Gerber, J.S. and P.A. Offit. 2009. Vaccines and autism: a tale of
shifting hypotheses. Clinical Infectious Diseases 48: 456-461.

This was a review of 14 studies conducted across the

globe, examined several million children

There was no connection between the vaccine

and autism rates.

As the authors stated:

“These studies… have effectively dismissed the
notion that vaccines cause autism.”
In short, after testing millions of children…

There is absolutely NO link between

vaccines and autism
Autism Speaks used to support the idea that the MMR vaccine
causes autism… But…

In 2015, the Chief Science Officer for Autism Speaks said, “Over
the last two decades, extensive research has asked whether
there is any link between childhood vaccinations and autism...
The results of this research are clear: Vaccines do not cause
autism. We urge that all children be fully vaccinated.”
 Why might we be seeing such a drastic rise in autism?

Hypotheses to consider:

1) Autism is actually on the rise

2) The diagnosis (or spectrum) is continually more inclusive

Professionals are more aware of autism and better trained
to diagnose it
3) It is over-diagnosed It is the diagnosis “de jour”

*Studies suggest that it actually is on the rise.

 Epilogue: There’s even more to the story:
Wakefield’s “Study” was fraudulent. He lied!!!

Wakefield was paid £435,643 in fees, plus £3,910 expenses (by

Richard Barr, an attorney who was attempting to prove the
connection between MMR and autism).

Why? They were developing an alternative measles vaccine…

Wakefield also lied about conditions of some of the patients, and the
patients were hand-picked to make it look like there was a
connection between the vaccine and autism.
 So, what happened when this deceit came to light?

The General Medical Council of Great Britain found Andrew Wakefield

guilty of unethical and irresponsible behavior in the original Lancet
study (1/28/2010).

Investigatory panel ruled that Wakefield had,

"failed in his duties as a responsible consultant", acted both against

the interests of his patients, and "dishonestly and irresponsibly" .
5 days later, February 2, 2010, the Lancet formally expunged the 1998
paper – finding it “fatally flawed.”

The British Medical Journal said his work was an “elaborate fraud”
 Because of this “elaborate fraud”…

2012 – Britain had 2016 cases of measles as a delayed

consequence of parents not vaccinating their kids
 Consider the implications of this:

The current anti-vaccine movement started largely because

Wakefield lied.

Much, if not most, of the fear and paranoia about vaccines

was generated by this person and then reinforced by mis-
informed individuals.

Children have died because of this.

 Evaluating Risk

Must compare risks of the disease

with that of vaccines
 What are the risks from Measles, Mumps and Rubella?22

Measles Mumps Rubella

Symptoms: Rash, fever Symptoms: fever, headache, Symptoms: Red rash

muscle aches, tiredness, swollen which usually lasts 3 days,
Complications include salivary glands, loss of appetite fever, swollen glands, joint
pneumonia, meningitis and pain
even death Complications include Complications are worse
inflammation of the testicles (and the older a person is.
1/1000-1/2300 infected possible sterility in rare cases), Pregnant women can
people die from the inflammation of the brain and have miscarriages.
infection spinal chord (with possible brain Newborn babies can have
damage) inflammation of the cardiac, cerebral,
20 million cases ovaries and/or breasts ophthalmic and auditory
worldwide, 122,000 deaths defects.
 What about the risk from the MMR vaccine?
Less than 1 in one million people have a
serious allergic reaction to the MMR vaccine.

No healthy person has ever died from it

Severe Problems (which are Very Rare) May Include

Deafness
Permanent brain damage
Long-term seizures, coma, or lowered consciousness

These occur in less than 1 out of a million doses

These are so rare that it is hard to tell whether they are actually
caused by the vaccine. Correlation doesn’t equal causation!
 Other points to consider…
Does “safe” = no harm?
Nothing meets this definition…
Consider that, every year in the United States

350 people are killed in bath-

or shower-related accidents,

200 people are killed when food

lodges in their windpipe,

100 people are struck

and killed by lightning.
Let’s look at another incorrect claim made by those opposed to vaccines.
The claim: Vaccines don’t stop the spread of the disease

A quick reality check shows this is absolutely false…

Doesn’t exist anymore

Almost eliminated

Doesn’t exist anymore

This chart shows the reduction in disease types as a result of vaccinations

 Polio Eradication: Example of Vaccine Success Story

Polio used to
be a scourge
that affected
people from
all over the
world.

Thanks to vaccination efforts, the number of people infected

has dropped from 350,000 in 1988 to less than 20 in 2017.

It now occurs in
only 3
countries:
Afghanistan,
Nigeria and
Pakistan
Paralytic form is gone
So ….
What should Kristen do?
Consider: Before vaccines, parents in the United States
could expect that every year:
Polio would paralyze 10,000 children.
Rubella (German measles) would cause birth defects and mental
impairment in as many as 20,000 newborns.

Measles would infect about 4 million children, 4,000 would

become mentally impaired (via encephalitis), 450 would die.

Diphtheria would be one of the most common causes of death in

school-aged children.

A bacterium called Haemophilus influenzae type b (Hib) would

cause meningitis in 15,000 children, leaving many with permanent
brain damage.

Pertussis (whooping cough) would kill thousands of infants.

 Epilogue (continued):

Jenny McCarthy Jim Carrey

In spite of all of these facts…

Advocates for the link between vaccines and continue to press
ahead with their public campaign against vaccines.7
What might this be an example of? Dissonance reduction
 Experts vs. Parents and Celebrities Opposed to Vaccinations

Remember the Chickenpox parties that are organized by parents who want their
children to catch the virus naturally rather than getting vaccinated?

Remember the idea of experts vs. non-experts?

Do you think these parents have an in-depth understanding of immunology,

disease transmission, complications of diseases, and the associated risks
posed to their children and others if they do not have their kids vaccinated?
Many preventable diseases are on the rise because of the anti-vaccine
movement and/or due to lack of access to vaccines
 The most prominent members of the anti-
vaccination movements in these countries were:

Members of religious groups that

opposed vaccinations on moral
grounds (most prominent)

Practitioners of homeopathy,
chiropractic, and natural and
alternative medicine.
 To Vaccinate or Not to Vaccinate?
Another On-going Lesson - Whooping Cough.

Pertussis is characterized by intense, paroxysmal coughing that is so violent it

can cause small hemorrhages in the skin, hernias, rectal prolapse, or even
degeneration of the brain due to lack of oxygen. The whoop sound is really
the sound of the person gasping for air between coughs. People can become
malnourished because of the inability to eat. Some have died. It was
responsible for 1.3% of all deaths in England and Wales. Contagious – 70%.
 Vaccine for Whooping Cough was
developed in about 1926 and, eventually,
it was combined with other vaccines to
produce the DTP vaccine (diphtheria,
tetanus, pertussis)

By 1960, whooping cough had almost been eradicated – just as

the measles had been eradicated in the U.S. by 2000.

In Sweden, the number of cases went from about 300 per

100,000 to about one third of that and were continuing to fall.

But, in 1960, a scientist named Strom then began calling into

question the need for the vaccine and claimed that
complications from it were more dangerous than the benefits.

His calculations were shown to be wrong, but he ignored this

fact and continued to claim that adverse neurological reactions
had increased dramatically.
 His claims eventually made it into a TV show in Britain.

Fear of the vaccine spread around the world. Vaccination rates

dropped off in the Britain, Sweden, Russia, Japan, and Australia.

Vaccination rates had been about 81% in Britain before the

warnings against vaccinations. Dropped to 31% in 4 years.

The pertussis rate in Britain increased about 10-fold during these

4 years.

In Sweden, where rates had dropped from 300 per 100,000 to

about 50 per 100,000, now jumped to 3,370 per 100,000 in the
early 1980s.

In the resulting epidemic in Australia, 10,699 cases were

reported and 2 infants died.

Wrong information = wrong decisions

 The Reality
About Vaccines

They work and

are safe
Vaccines are one of the greatest scientific accomplishments in
the history of civilization.

Hundreds of Millions of lives have been improved because they

prevented people from developing diseases, many of which
would have been fatal.
As long as a disease remains in some parts of the world, vaccination
programs must be maintained everywhere, because an infected
individual can travel anywhere in the world within 24 hours.
So ….

What should Kristen do?