Thursday, 23 May 2013

Vaccinations, Autism, and the MMR

From Wikimedia Commons. People were just as scared of vaccines in Jenner's time.
The issue of vaccines came up on facebook today – specifically the MMR vaccine and the threat of autism. Before I start I have to add the disclaimer that I have no medical qualifications and most of what I know, or think I know, has been picked up from general knowledge or internet searches. But I’m a firm believer in the benefit of vaccines. When Edward Jenner theorised and tried out the smallpox vaccine in 1796, he started an incredible thing. The BBC estimates that ‘300 million people died from smallpox in the 20th century alone,’ but due to a world-wide drive to eradicate smallpox the illness only exists in labs.

To my mind there’s too much science to support vaccines and not enough to disprove them. They’ve saved too many lives and saved so many life-altering problems. But it’s the MMR I was thinking of specifically. It was research led by Dr. Andrew Wakefield in 1998 that started the panic over the MMR vaccine, leading to a great number of people holding their children back from vaccination. The Lancet officially retracted their publication of this research when it was shown to be rife with misconduct. It seemed to be a case riddled with breaches of ethics and underhand behaviour.

On the other hand, here are some of the risks of the three illnesses you are protected against through the MMR vaccine.

  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
  • In 2011, there were 158 000 measles deaths globally – about 430 deaths every day or 18 deaths every hour.
  • More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
  • Measles vaccination resulted in a 71% drop in measles deaths between 2000 and 2011 worldwide.
  • From Wikimedia Commons. A child with a four-day
    measles rash.
  • In 2011, about 84% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

To quote WHO again, from the source linked above,

‘The most serious complications [of measles] include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. Women infected while pregnant are also at risk of severe complications and the pregnancy may end in miscarriage or preterm delivery.’ 

‘The virus usually causes mild disease in children, but in adults can lead to complications, such as meningitis and orchitis.’

(We all know the word ‘orchid’ means testicle, right? Rarely, mumps can leave males sterile.)

‘Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome (CRS). Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction – many of which require costly therapy, surgeries and other expensive care.’

Wait a minute? A foetus exposed to rubella can develop autism? That’s not something the anti-vaccine people talk about. And to bring it all home, take this from The Telegraph - ‘In the 1960s [mumps] killed about five people a year in the UK, compared to measles fatalities of about 100.’ That’s in a population, then, of about 53 million people. Imagine that. 100 children dying of measles? A year! Imagine your child dying because people were afraid to immunise and these diseases started to spread again? Imagine a hundred pairs of grieving parents, every year. The vaccines don’t always work on everyone, but if enough people are immunised then the ones it didn’t work for shouldn’t be exposed to the illness, and they won't get it either.

From Wikimedia Commons. A single virus particle from the
Measles virus. 
Of course it’s not as simple as that. A friend who is a nurse alerted me to a study by a Dr Singh which took place in 2002 – four years after the initial scare – which again seemed to show a link between the MMR and autism. One of the conclusions of Singh’s article is, ‘Fundamentally, I tend to think that autistic children have a problem of their immune system, which is the “faulty immune regulation.” Hence they have abnormal immune reactions to measles virus and/or MMR vaccine.’ This is linking autism not just to the vaccine, but to measles in general. What are the chances of your child contracting measles if no one is vaccinated? Just recently over a thousand people have contracted measles during an outbreak in Wales. Eight-five of these people required hospital treatment. 

Singh’s study has attracted criticism since publication, questioning methodology and assumptions of causality.   I don’t have the medical credentials to make many comments on this study, and it’s unclear to me what proportion of children receiving the MMR vaccine, in Singh’s opinion, develop autism as a direct result of the vaccine. Autism, it seems, has many and varied causes. On the other hand, the increase in measles since the MMR scare is stark. There have been 1,170 cases of measles in Wales during this recent outbreak alone, in a population of just over three million. In contrast, the British Medical Journal reported (in the link above) that there were 32 cases of measles in England and Wales in the last quarter of 2001 – that’s in a population of about 56 million people.

I don’t have any firm conclusions to take away from this. I’m not a scientist or a doctor. But I think it would behove all of us to educate ourselves over these matters before making snap judgements. I will continue to immunise my children against illnesses because it seems to me to be the best thing to do, not just for my own children, but for the other children and vulnerable people they might come into contact with. Without vaccines, with three children and a one in three death rate after infection, I might have lost one of them to smallpox by now.


  1. I remember the whole vaccine scare...we had to get tests to make sure we didn't have autism spectrum and my parents weren't super convinced. fun times.

    1. I was before all that, luckily. In fact, I think I was before the MMR, because I remember all the girls having the Rubella immunisation and thinking it was so unfair the boys didn't have to have it.