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The Monashian Insider
Transcript of The Monashian Insider
Questions & Answers
Too Much, Too Soon?
Monday, 15 September, 2014
Vol XCIII, No. 311
Does MMR Vaccine Cause Autism?
Case study published in 1998 - fully retracted from
THE MONASHIAN INSIDER
WHO: A preparation of biological nature which typically contains a substance mimicking the microorganism responsible for a specific disease.
Direct and indirect protection of a vaccination program
No perfect vaccine efficacy, but elimination of disease is possible.
Widespread success in disease prevention
Eradication of smallpox in the 1970s
However, controversy & misinformation persist
Lack of control subjects
Potential coincidental association
Discrepancies within the medical records
Common Sources of Misinformation
1. Book authors:
"Evidence of harm about thimerosal & autism" by David Kirby
Exposure to both sides of the story
3. News broadcast:
Wakefield’s ‘Science by press conference’ in 1998 even before paper was published
Facebook, Twitter and blogs
Role in spreading information
Provides a platform for dissemination of misinformation
Low prevalence nowadays
Eg. Mumps, Polio, Measles
Low chance (unlikely)
Mild and treatable
Large-scale epidemiological studies & reviews conducted:
Utilizing reliable database such as past medical and vaccination records in various countries with similar vaccination schedules and constituents.
1. Chatterjee A, editor. The controversy that will not go away: vaccines and autism. New York: Springer; 2013.
2. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41. PubMed PMID: 9500320.
3. Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2009 Feb 15;48(4):456-61. PubMed PMID: 19128068. Pubmed Central PMCID: 2908388.
4. Flaherty DK. The vaccine-autism connection: a public health crisis caused by unethical medical practices and fraudulent science. The Annals of pharmacotherapy. 2011 Oct;45(10):1302-4. PubMed PMID: 21917556.
5. Murch SH, Anthony A, Casson DH, Malik M, Berelowitz M, Dhillon AP, et al. Retraction of an interpretation. Lancet. 2004 Mar 6;363(9411):750. PubMed PMID: 15016483.
6. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella vaccination and autism. The New England journal of medicine. 2002 Nov 7;347(19):1477-82. PubMed PMID: 12421889.
7. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 Jun 17;32(29):3623-9. PubMed PMID: 24814559.
8. Smith PJ, Humiston SG, Marcuse EK, Zhao Z, Dorell CG, Howes C, et al. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the Health Belief Model. Public health reports. 2011 Jul-Aug;126 Suppl 2:135-46. PubMed PMID: 21812176. Pubmed Central PMCID: 3113438.
Kennedy A, Lavail K, Nowak G, Basket M, Landry S. Confidence about vaccines in the United States: understanding parents' perceptions. Health affairs. 2011 Jun;30(6):1151-9. PubMed PMID: 21653969.
10. Myers MG PD. Misinformation about vaccines. USA: Elsevier Saunders; 2009.
11. Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, de Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC public health. 2013;13:1183. PubMed PMID: 24341406. Pubmed Central PMCID: 3878652.
12. A C, editor. The media’s role in vaccine misinformation. New York: Springer; 2013.
13. Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet. 2011 Aug 6;378(9790):526-35. PubMed PMID: 21664679.
14. Dixon GN CC. Heightening uncertainty around certain science: media coverage, false balance, and the autism-veccine controversy. . Science Communication. 2013;35(3):358-82.
15. Dixon G, Clarke C. The effect of falsely balanced reporting of the autism-vaccine controversy on vaccine safety perceptions and behavioral intentions. Health education research. 2013 Apr;28(2):352-9. PubMed PMID: 23193194.
16. Organization WH. Vaccines 2014 [updated 2014; cited 2014 August 20]. Available from: http://www.who.int/topics/vaccines/en/.
17. Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. The Cochrane database of systematic reviews. 2012;3:CD001478. PubMed PMID: 22419280.
18. Shim E, Galvani AP. Distinguishing vaccine efficacy and effectiveness. Vaccine. 2012 Oct 19;30(47):6700-5. PubMed PMID: 22944629. Pubmed Central PMCID: 3798059.
19. Maldonado YA. Current controversies in vaccination: vaccine safety. JAMA : the journal of the American Medical Association. 2002 Dec 25;288(24):3155-8. PubMed PMID: 12495396.
20. Ejima K, Omori R, Aihara K, Nishiura H. Real-time investigation of measles epidemics with estimate of vaccine efficacy. International journal of biological sciences. 2012;8(5):620-9. PubMed PMID: 22553462. Pubmed Central PMCID: 3341603.
Evidence consistently showed no association between MMR vaccine and autism.
Through the Public's Eyes
Too Many Antigens
Immunization schedule too packed
"Stresses" / weakens the immune response
Healthcare & Government
USA government – remove thimerosal from vaccine
E.g. General Practice Research Database in UK - a validated electronic medical record, >3 million person-years of observation
Large statistical power allows detection of even rare associations - but no link found
8 children showed symptoms of autism within 1 month post-measles, mumps, rubella (MMR) vaccination.
A new variant/ phenotype of autism was characterized.
Extracted from Addressing the vaccine confidence gap. Lancet. 2011 Aug
Eg. Green Our Vaccines - led by celebrities
1. Exposure to environmental micoorganisms.
Built-in capacity, up to 100 billion of different antigens.
2. Combination vaccines have comparable effectiveness to individual vaccines.
Comparable level of vaccine-specific antibodies
Similar safety profile!
No link between MMR: Autism
Childhood vaccinations are safe
Public perception is greatly influenced by controversies and misinformation
Leads to possible disease outbreaks!