Raluca Nuta, Jordan Crone, Tara Martin and Biljana Jelisic Vaccines and Autism The Great controversy Raluca Nuta, Jordan Crone, Tara Martin and Biljana Jelisic

The Study That Started It All Andrew Wakefield and his colleagues conducted a study in 1998 that sparked this great controversy

The Study That Started It All 12 children under investigation All 12 presenting with regressive symptoms All 12 presenting with intestinal abnormalities 8 of 12 children anecdotally started regressing shortly after receiving the MMR vaccination (parental and doctor report) Is the MMR vaccine associated with autism? This article was retracted in 2010

Theories Linking Vaccinations and Autism Gut Disorder Thimerosal Mitochondrial Dysfunction Genetic

What Does the Research Say? Overall, scientific research has failed to validate a causal link between vaccinations and autism

What Does the Research Say? Uno et al., 2012 Study conducted in Japan compared a group of subjects with ASD and a control group (no ASD), born between 1984 and 1992 By looking at their medical records, it was determined that the control group had been vaccinated at the same rate as the ASD group (24.1% vs. 24.9% for MMR) Conclusion: no causal link between vaccinations and autism

What Does the Research Say? Dales, Hammer, & Smith, 2001 Retrospective analysis of MMR immunization rates in children born between 1980 and 1994 (California) Autism rates increased by 373% during that time period (WOW!!!) Immunization rates increased by only 14% Conclusion: no causal link between MMR and autism

What Does the Research Say? Fombonne & Chakrabarti, 2001 Compared 3 groups: ASD group pre-MMR vaccination (n=98) ASD group post-MMR vaccination (n=68) PDD group post-MMR vaccination (n=95) Found that age of parental concern was the same between the two MMR groups and one non-MMR group Rate of developmental regression was the same between the groups, as well as the age of onset of symptoms Conclusion: no causal link between MMR and autism

Now What? Food For Thought “The sample size was not large enough to absolutely exclude that… vaccinations increased the risk of ASD onset.” (Uno et al., 2012) “… in a child with a strong genetic susceptibility to autism it might be that the addition of just one further risk factor, conceivably the MMR, could precipitate brain changes leading to the onset of an ASD.” (Boucher, 2009)

Now What? Food For Thought As we know, there is an environmental component to the causality of autism – it is not 100% genetics Vaccines may sometimes be the ‘straw that broke the camel’s back’ in terms of environmental factors However, there no way of detecting autism at birth, so how are we to know which children will react adversely and which children will not? Is the risk of autism worth outbreaks of diseases such as measles? More research into biological markers of autism may shed light on this issue

Now What? Food For Thought

Effects of Non-Vaccination All it takes is for someone to be exposed to one of these illnesses in another country, and they can unknowingly carry it back to Canada, or the United States and expose hundreds of people to it. “Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination” (Sugarman et al., 2010)

Effects of Non-Vaccination 2 measles outbreaks: 2008 San Diego, an unvaccinated boy was unknowingly exposed during a trip to Switzerland. 839 people were exposed as a result 48 children too young to be vaccinated had to be quarantined, at a cost of $775 per child One child was hospitalized, 11 were infected. 1745 man hours were spent on investigation and containment efforts Total cost to the public sector of $124,517

Effects of Non-Vaccination 2 measles outbreaks: 2004 Iowa, an unvaccinated college student was exposed in India, and returned home before his infectious period was over More than 1000 people were potentially exposed Only 59% of school aged children were fully vaccinated 2525 man hours were spent on it, at a cost of $124,452 Though only 2 other people were infected, the majority of the costs were spent on the prevention of further spread of the virus

Possible Dangers of Non-Vaccination Rubella is of particular danger to pregnant women, who have a 90% chance of passing the virus on to the fetus, which can cause congenital defects and miscarriage. Mumps causes fever and aches, but can also result in sterility, encephalitis, and meningitis. Measles causes high fever and rash, and complications can result in blindness, encephalitis, pneumonia, and death. Pregnant women may suffer severe complications and miscarry.

Why Are Parents Swayed to Believe That Vaccines Cause Autism? 1980’s: the belief that vaccines cause autism emerged 21st century: the belief became widespread This happened despite scientific evidence Internet, print media, celebrities, and peers perpetuate the beliefs

3 Predominant Reasons Why Parents Choose Not to Vaccinate 1. Incidence of death to childhood diseases is very minimal in developed countries (1 in 1,000) 2. Incidence of autism is reported to be as high as 1 in 58 (for males) and 1 in 100 overall 3. Increase of autism diagnosis is correlated with the increase in vaccinations (Bearman, 2010)

Why Do These Beliefs Continue? Provide answers Pins blame on something Doubt

Impact of the Media and Powerful Spokespeople Despite an unchanging, scientific consensus that no link exists between vaccines and autism, the following influencing bodies continue to draw attention to the loose debate: The media, journalists (Dixon and Clarke, 2013) Researchers, for example Andrew Wakefield (Brumback, 2013) Celebrities, such as Jenny McCarthy (Kirkland, 2012)

Impact of the Media and Powerful Spokespeople Brumback (2013) takes notice within the vaccine-autism debate: “on one side are the alternative medicine advocates and the Hollywood celebrities, while on the other side are university physicians and scientists and public health officials from the CDC and FDA” (p. 544) Which side is, realistically, more likely to convince families with a child with ASD towards their (‘for’ or ‘against’) stance?

The Media: An Inadvertent Supporter of the Autism-Vaccine Debate What is the harm? Journalists “report this controversy by presenting claims both for and against a link in a relatively ‘balanced’ fashion” This can be considered ‘falsely balanced reporting’ since information on which argument is supported by scientific consensus is not available to readers As a result, the following issues arise: Public uncertainty increases Decrease in vaccine uptake Is this ethical conduct as it influences health action/inaction? (Dixon and Clarke, 2013)

Jenny McCarthy Celebrity mom, McCarthy, in her third autism-related book, Healing and Preventing Autism: A Complete Guide (2009) asserts: “Since I began this journey, I have spoken to nearly 100,000 moms face-to-face and have received letters and e-mails from around the world ... That’s my mission now. To make sure ALL of our children are going to be okay” (p. 3).

Jenny McCarthy Concerns around McCarthy’s advocacy: The Toronto Public Health department disagrees with her stance on the vaccine-autism debate. Additionally, they pleaded with The View to refuse her a platform which would “further confuse” parents (CTV, 2013, July 23). The National Globe (2013, July 16) argues: “…McCarthy fueled parental fears. She built a movement around the flawed theory.”

So… Brumback (2013) takes notice within the vaccine-autism debate: “on one side are the alternative medicine advocates and the Hollywood celebrities, while on the other side are university physicians and scientists and public health officials from the CDC and FDA” (p. 544) Which side is, realistically, more likely to convince families with a child with ASD towards their (‘for’ or ‘against’) stance?

QUESTIONS?

References Bearman, P. (2010). Just-so Stories: Vaccines, Autism, and the Single-bullet Disorder. Social Psychology Quarterly, 73(2), 112-115. Boucher, J. M. (2009). The Autistic Spectrum: Characteristics, Causes and Practical Issues. USA: Sage Publications. Brink, S. (2013, July 16). One Thing We Know About Autism: Vaccines Aren't to Blame. National Globe. Retrieved from http://news.nationalgeographic.com/news/2013/07/130716-autism-vaccines-mccarthy-view-medicine-science/?rptregcta=reg_free_np&rptregcampaign=20131016_rw_membership_r1p_intl_dr_w#close-modal. Brumback, R. (2013). Book Review: Vaccine: The Debate in Modern America. Journal of Child Neurology, 28(4), 544-545. Dales, L., Hammer, S. J., & Smith, N. J. (2001). Time trends in autism and in MMR immunization coverage in California. Journal of the American Medical Association, 285, 1183–1185. Dayan, Gustavo, et al. (2005). The Cost of Containing One Case of Measles: The Economic Impact on the Public Health Infrastructure- Iowa, 2004. Pediatrics 116.1, e1-e4. Dixon, G. and Clarke, C. (2013). The Effect of Falsely Balanced Reporting of the Autism-Vaccine Controversy on Vaccine Safety Perceptions and Behavioral Intentions. Health Education Research, 28(2), 352-359. Fombonne, E., & Chakrabarti, S.(2001). No evidence for a new variant of measles-mumps-rubella-induced autism. Pediatrics, 108(4), E58. Kaufman, S.R. (2010). Regarding the Rise in Autism: Vaccine Safety Doubt, Conditions of Inquiry, and the Shape of Freedom. Journal of the Society for Psychological Anthropology, 38(1), 8-32. Kirkland, A. (2012). The Legitimacy of Vaccine Critics: What is Left after the Autism Hypothesis? Journal of Health Politics, Policy and Law, 37(1), 69-97.

References McCarthy, J. And Kartzinel, J. (2009).Healing and Preventing Autism: A Complete Guide. New York: Dutton. Miller, L., & Reynolds, J. (2009). Autism and Vaccination—The Current Evidence. Journal for Specialists in Pediatric Nursing, 14(3), 166-172. Poling, J. S., et. al. (2006). Developmental Regression and Mitochondrial Dysfunction in a Child With Autism. Journal of Child Neurology, 21(2), 170-172. Public Health Agency of Canada “Measles”. 2013. retrieved from: http://www.phac- aspc.gc.ca/im/vpd-mev/measles-rougeole-eng.php Public Heath Agency of Canada. “Rubella”. 2012. Retrieved from http://www.phac- aspc.gc.ca/im/vpd-mev/rubella-eng.php Public Health Agency of Canada. “Mumps”. 2012. Retrieved from http://www.phac- aspc.gc.ca/im/vpd-mev/mumps-eng.php Sugarman, David, et al. (2010). Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated. Pediatrics. 125.4, 747-755. Uno, Y. et. al. (2012). The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: The first case–control study in Asia. Vaccine, 30, 4292-4298. Wakefield, A. J. et. al. (1998). Ileal-lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103), 637-641. Warren, R.P. et. al. (1991). Increased frequency of the null allele at the complement C4b locus in autism. Clinical & Experimental Immunology, 83, 438-440. N/A. (2013, July 23). Experts worry Jenny McCarthy will spread anti-vaccine message on The View. CTV News. Retrieved from www.ctvnews.ca/health/health-headlines/experts-worry-jenny-mccarthy-will-spread-anti-vaccine-message-on-the-view-1.1380763.