Friday, January 30, 2015

A Critical Review of the Mumps, Measles and Rubella Vaccine Controversy about Autism

In 1998, Andrew Wakefield published a research paper in the medical journal The Lancet, which claimed a connection between taking the Mumps, Measles, Rubella (MMR) vaccine and later complications including Autism in a subpopulation of vaccinated children.  No other studies of the vaccine could find a causal connection between the MMR vaccine and Autism. I will examine the essential facts to reveal if the controversy is settled within the scientific community and to reveal the origin of the controversy.  If this article is not clear, accurate and defensible from a rigorous scientific point of view, I will most certainly take it down and apologize to the public. As of now, I foresee no such problem arising.

Mumps, measles and rubella are childhood diseases that pose a significant health threat to young children whose immune systems have not developed prior immunity.  Mumps is an acute viral illness that is caused by the paramyxovirus.  The general course of the disease lasts between 2 and 10 days and includes symptoms of fever, muscle pain, lack of appetite, fatigue, and headache.  In epidemiological studies of mumps before the immunization era, hearing loss resulted in 4 percent of men who contracted the disease and was causative for 10 percent of all meningitis cases, at a rate of about 1 in 1000 cases of mumps.  The severity of meningitis may lead to hearing loss, brain damage and learning disabilities. 

Measles is another respiratory disease caused by the viral family of paramyxovirus.  Measles includes a rash, fever, loss of appetite, and affects the lymph glands.  Complications include ear inflammation, pneumonia, encephalitis, seizures and death.  Encephalitis complications are fairly rare at 2 cases per 100,000 cases of measles with the same additional complications as the mumps version of paramyxovirus infection. 

Rubella is a togaviral infection with low grade fever, fatigue, a mild rash, and mild respiratory infection, and commonly no symptoms at all occur.  Complications include arthritis in up to 70% of women who had contracted Rubella.  Encephalitis occurs in 1 in 3000 cases and has a significant mortality associated with this form in women.  In pregnant women, fetal development can be altered causing congenital defects.  Up to 85 percent of fetuses who contract the virus develop congenital defects.

The three viruses have significant public health affects warranting methods of public control of the disease.  But, is there a relationship between the MMR vaccination and Autism?  Has there been any scientific basis that properly addressed the effectiveness of the MMR vaccine and if Thimerosal, an antiseptic and antifungal agent used to preserve the vaccine is a causative agent in Autism in a subpopulation of recipients of the vaccine?

Any research should show a domain of thought that is consistently objective, be defensible, be cogent and accurate, and should not be meant to deceive or selfishly rationalize the MMR vaccine for personal vanity.  That is too often the case in many articles that vilify science is due to the vanity of the person who holds out against scientific rigor. The two main views in the public realm of the MMR is either pro benefit to public health with no causal affect to Autism or pro-causal to the Autism spectrum.

The Center for Disease Control states “the MMR vaccine is not responsible for recent increase in the number of children with Autism.”  “Because signs of Autism appear around the same time children receive the MMR vaccine, some parents may worry that the vaccine causes Autism.”  They mention several studies, both large scale and small, on Thimerosal that show no connection to Autism.  None of the studies involved the manufacture of Thimerosal and were funded independently.  The largest study was conducted by the Danish Ministry of Health tracking 300,000 MMR vaccinated children and found no statistical relationship to Autism.  The CDC made a substantial effort to show that there was no relationship to Autism and that the vaccine has a substantial affect in reducing or eliminating
widespread infection in the population.  I found no language supporting the use of use of Thimerosal as anything other than a safe antifungal and antiseptic agent.  The CDC point of view is defensible in that it uses a panel of physicians and researchers that have arrived at consensus to determine public health policy (I formed this opinion from prior work experience and study) and there was no indication that they deviated from their typically robust procedures for this article.  They specifically addressed the concerns about Autism by suggesting that the research reports were rigorous, replicated, and sufficient to address the public’s concern.  It did not appear that the article wanted to rationalize the pro vaccine point of view.

There has been widespread press against the MMR vaccination with Thimerosol. They always assert that Thimerosol is the causative agent of Autism.  A repeated claim revolves around the press being influenced by pharmaceutical companies and that there is an invisible force suppressing the truth about Thimerosol.  Yet, any brief look at Google search and thousands of copycat articles are prevalent.  Apparently the invisible hand trying to hide the claims against Thimerosol are everywhere.

The controversy began with former Dr. Andrew Wakefield conducted a very small study of 12 patients, whom he claimed had autism as a result of the MMR vaccine.  But, that paper published in the peer reviewed medical journal The Lancet was delisted at the request of 10 of the papers coauthors due to the studies lack of controls and its spurious linkage of 3 separate diseases as a single disease.  The study used a survey of parents to link autism to the MMR without examination or comparison to a control.  After the publication of the study, the British Medical Association requested Dr. Wakefield to reconduct his tests but with greater controls to see if his original findings could be replicated.  He refused to comply.  After an investigative report into his first study found that the data was fabricated, an investigation into the falsification of the data, Mr. Wakefield was stripped of his credentials after the longest investigational hearing in the practice of medicines history.   He was stripped of his credentials there can be no doubt that the only study linking Autism to the MMR vaccine is a fraud.  Wakefield was given time to conduct better research and he failed to adhere to rigorous controls.  The fact that Mr. Wakefield lost his credentials and after careful consideration his Lancet paper withdrawn due to falsification of the primary data, there can be no doubt that Mr. Wakefield has a major credibility problem and his point of view suspect in regard to the vaccine. 

There are claims that U.S. and Italian courts have ruled that the MMR is linked to Autism and that awards have been made based upon evidence.  These have been false claims with no corroborative evidence provided in those judicial and public opinions.  The most infamous case distortion involved Ryan Majobi.  By my own examination of that case, it was remanded to an omnibus case against the manufacture of Thimerosol.  the ruling was not to support a claim that Thimerosal caused Autism in Ryan, but that the court ruled that Ryan had suffered from encephalopathy, which everyone agrees can result from the inoculation.  The court record states, “Petitioner specifically asserted that Ryan “suffered a Vaccine Table injury, namely encephalopathy as a result of the MMR vaccine.” Found on December 19, 2003.  The disease was not in the MMR vaccine, but was contracted as a result of the needle puncture allowing encephalitis to emerge within the body of Ryan.  It is well known that this is a pathway to Autism, separate from the MMR. 

In fact, the case regarding Thimerosal was sent to a Special Masters of the U.S. Court of Federal Claims.  This court appointed a master of the subject of medical research to review the facts regarding the science around the likelihood of Autism resulting from the preservative.  Ryan Mojabi became a sub petitioner in the Michelle Cedillo v. Secretary of Health and Human Services case under the jurisdiction of the Special Master appointed.  The Cedillo’s alleged the MMR caused Michelle to suffer various medical conditions, including Autism.  The Special Master denied the petition after reviewing the scientific literature presented at trial for the 12,000 litigants and the Federal Court of Appeals upheld his decision.  This refutes the assertion by the thousands of reports repeating the false claim that a U.S. court held in favor of Ryan Mojabi and linking the MMR to Autism. 

For those of you who may not be aware, a Special Masters is an appointed officer, who serve a quasi judicial role to assist the courts’ in complex cases that require expertise beyond the knowledge or ability of the court.  Special Masters can compel evidence to be provided, including of a scientific nature to be provided the master to review and to take expert testimony at the highest order. 
Finally, there are claims of an Italian court ruling against the safety of the MMR vaccine in a single case. 

The problem with this case is in the fact it does not alter scientific opinion.  Nor did it alter the immunization policy of Italy.  One such decision does not alter the substantial judicial opinion supporting MMR vaccination. According to the Italian National Health Service, MMR vaccinations are still required for infants in Italy of 13 -15 months of age. 

I conclude that immunization using Thimerosal is reliable as no reliable evidence could substantiate the claim that Thimerosal is a causative agent of Autism.  If substantive and reliable evidence could be produced against Thimerosal, I would have to rethink this opinion.  To date, no such evidence has been produced by any researcher outside of the defrocked Andrew Wakefield.


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