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.

These are the World Health Organisation’s key facts on measles – 

• 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.’ 

WHO on mumps – 

‘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.)

WHO on rubella (or German measles) –  

‘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.

I Think We Need to Talk

‘Ooh, don’t talk to him like that. He won’t understand.’

That’s the kind of comment my husband used to get when he took our then-baby son out. Why old women felt free to berate him on how he looked after our baby, I don’t know. They didn’t assail me with quite so much advice. Perhaps they assumed a father needs more advice than does a mother. They would spend a lot of time telling him that Oscar (I’m sorry. That’s not his name, but I can’t think of another, and I went with that last time) was going to catch his death of cold. He was born in a blazing hot June, and spent a lot of time naked with a muslin cloth shading him from the sun, but no matter how hot the sun my husband would be told by old ladies in coats and hats that he needed more clothes on. When Oscar was a little older the old women moved on to ‘you don’t want to use long words like that with him,’ whenever my husband spoke to him. That slotted in with the ‘where’s your shoes?’ and ‘shouldn’t you have a hair cut?’ and ‘you don’t want to play with dolls!’ that came at regular intervals as he grew older.

Thankfully our habit of using long words – our general habit of talking to our children as if they can understand what we’re saying no matter what their age – has just been vindicated. Gwen Dewar reports here on a study that shows a correlation between the amount of words that babies hear spoken to them and their academic performance later in life. Unsurprisingly, those children who are exposed to more speech – more interaction, more attention, one would assume – perform better at reading and have a better vocabulary. Another study cited in the article showed that ‘use of sophisticated vocabulary during free play predicted kids’ reading comprehension scores.’

This will perhaps be why at five my eldest son was using phrases like ‘vis a vis’ (correctly, too.) He was very slow to speak – he barely spoke at all until he was two, instead creating a range of signs and sounds for things. But he cracked it, and is now far more eloquent than a lot of his peers. For a long time I was worried that he wasn’t picking up reading that fast, but now, at seven, he can devour a Roald Dahl book in a couple of hours and stay awake until 11 p.m. reading. So I’m glad that we always used long words with him. I’m glad we said ‘thank you’ and not ‘ta,’ and spoke of ‘trains’ and ‘sheep’ rather than ‘choo-choos’ and ‘baa-lambs.’ I’m glad we have books in every room, including the bathroom, and I’m glad he picks them up and looks at them. I’m glad I didn’t dumb my language down, and still don’t. Instead, I explain words if he asks me to, and trust him to understand or at least learn to understand me if he doesn’t. I tell him the origins of words, what languages they come from, how words in other languages are similar.

That leads me on to bilingualism, which is another factor in my children’s lives. Bilingualism is heavily pushed around here by a government which, thank God, recognises the benefits of learning multiple languages at a young age. The second language here is Welsh, which may not lead on to a great prospect of communicating in other countries (Patagonia, maybe?), but does at least open minds to different words in different languages, to different grammar and syntax, and to different ways of expressing ideas.

This is a favourite at bedtime for Ben.
He's too young to tell me to read it in English.

I can’t claim to be a fluent Welsh speaker. I was taught it up to the age of fifteen and deeply resented it. Now, of course, I regret not paying more attention – but I can at least read books in Welsh to my children and they have a bilingual education at school. So they’re exposed to two languages at a very young age, to all of the Celtic and Latin-origin words that Welsh contains as well as all the variously sourced words in English. Since they know that ‘eglwys’ means ‘church’ it won’t be a great stretch to them to learn that the French for church is ‘église’, or the Spanish, ‘iglesia.’ Their brains will be used to stretching for other words with other meaning. What a wonderful thing it is for a child to be trusted to be capable of learning, and to be given education for their minds to take hold of. But still people keep perpetuating the attitude of, ‘oh, you don’t want to teach them more than one language. It’ll confuse them.’ I know people who have been told this by ‘well-meaning’ friends, and have actually listened, and denied their children the joy of bilingualism.

We can put these kind of suggestions in the basket along with, ‘I think it’s time you visited a barber, young man,’ and ‘wouldn’t you rather play with cars?’, and ‘ooh, look at your bare feet! You’ll catch your death!’

But what do all these comments by various strangers about how we bring up our children say about our society? About our attitude to parenting? About the alteration in society from close-knit communities to ever-varying masses of people who move in and out of contact like jellyfish caught in the tide? I think that might be my next topic for this blog.

The Law of Vomit

Children vomit.

That’s one of the first laws of parenting. If you have a child, at some point it will vomit. When we had our first son, we moved from almost constant possetting (muslin cloths under his head at all times) to the law of If we go away overnight, he will be sick. We went to my cousin’s wedding – he was sick in the car and projectile vomited all over the hotel room. We went to my great uncle’s funeral – he was sick in the car. We went to America – he projectile vomited all over the hotel room we stayed in on our return through Heathrow – so much so that we left money for the cleaning staff, because we were so ashamed of the piles of vomit-covered linen left in the bath. We went on holiday to south Wales, this time with son number two in tow. They both projectile vomited all over the holiday cottage bedroom. This was the occasion of my nephew’s second birthday, and he was where they caught the sick bug from. I still remember my astonishment at my sister’s worry when my nephew was physically sick. But children are sick all the time! I thought. Not so with him. Aside from the usual babyhood possetting (spitting up, if you’re American), this was the first time he’d ever been sick. But you see, even he followed the law. If you have a child, at some point it will vomit.

Easter, then, must be prime vomiting territory. We should have realised, when we decided to take our three children out for a pleasant drive around Snowdonia, hoping to wow them with sights of the snowy and beautiful mountains. We’ve had an unusual Easter that started with snow even down at the coast, so we wanted to make the most of it. It’s all too easy when your backyard is this beautiful to go day by day thinking, Another day we’ll go and see all the beautiful things. And it was beautiful. Snowdon was snowy. The roads were banked up with huge unmelted piles of snow at the sides. The lakes were chill and expansive and wet, as you’d expect.

But as we come out of the mountains and start to turn back towards civilisation, the five-year-old son (let’s call him George – it’s his favourite name since being exposed to the Famous Five) wakes up from an uncharacteristic slumber to say, ‘Daddy, don’t do that. I feel ill.’

‘What kind of ill?’ (My voice gets an edge – that urgent, are we going to need to stop the car? edge.)

‘I’m going to be yick.’

‘Oh dear. Well, hang on, darling. We’ll try to find somewhere to stop.’

This is swiftly followed a kind of flood of what appears to be entirely liquid chocolate and an emergency pull-over into a bus stop. You can only imagine the wailing as we try to strip a chocolate-vomit-covered five-year-old in very chilly conditions, get a new top on him (thank god we brought an extra one), and explain to him why he can’t keep his vomit-covered trousers on. No, not his boots either. Nor the coat. Not anything covered in vomit.

My husband attempts to clean the car and carseat as best he can with terry-towelling nappies and water while I try to calm the child. At one point he’s lying face-down on the pavement screaming, because we won’t let him wear sick-covered clothes. Drivers passing must assume this is a normal occurrence for a five-year-old, since no one stops to ask why we’re abusing our half-naked child by making him lie on the ground in near-freezing temperatures.

Ten minutes later we’re back in the car, deciding whether to go the quick way back home, or back through the mountains. The wailing has stopped. George is warm under a jumper that’s spread over his knees. It seems that the sickness was just a case of too much chocolate. He’s already asking for sweets, ‘if we yop at a petrol yation.’

Back through the mountains we drive, choosing the alternative route so as to take in the majestic sight of Tryfan, a 3,000 ft high pile of cragged stone, and the part-frozen lake at its base. We ooh and aah and crane our necks backwards to take it all in. We travel on into the widening mountain valley. The two-and-a-half-year-old (let’s call him Benjamin) calls out, ‘Water bottle! Water bottle!’

I have a bad feeling about this. And I’m right. Before I can give him any water a chocolate slick explodes over the car, spattering Ben and his seven-year-old brother (Oscar?) in something resembling a terrible bog-snorkling accident.

Suddenly there’s a stream of holiday bikers behind us and not a stopping place in sight. Eventually we manage to pull up in a gateway half-filled with a heap of some kind of tarmac sweepings, and try to sort out the chocolate-covered two-and-a-half-year-old. Luckily (again) we have a spare top, but again there’s great dismay at the fact he can’t wear his vomit-covered trousers or boots. Most of the nappies we brought are so soiled from Incident No. 1 that we can’t use them to wipe up after Incident No. 2. I wrap Ben in my coat to keep him warm while my husband (who, by the way, has something of a vomit-phobia) tries to clean up the lake in the carseat.

The journey home isn’t one we try to take at a leisurely pace. Of course there are the obligatory tourists driving along the B-roads as if they expect avalanches and crocodiles around every corner, but eventually we make it, and the carseat covers get a much needed wash, along with almost every item of fabric that was in the car. My husband cleans out the car itself with dettol and water, then sloshes the waste water into the field, unaware that there’s a nesting goose directly in the line of fire. So it’s a bad day for the goose as well as for us.

But was it a bad day? There’s something rather fun in these kind of emergency situations. I mean, once you factor out the distress caused to the children. Being caught on the hop, having to manage to calm down children and keep them warm and clean up unexpected pools of sticky vomit and get them home safely. It certainly made it a memorable day. We all got home safe and well, the children perked up marvellously once they were clean and dry, and the washing machine got to prove its worth.

Lessons learned? Not much I didn’t already know. Always take a change of clothes when you take children in the car. (We don’t – we were just lucky, this time.) Travel with extra water. (Well, I try to.) Travel with towels. (Do terry-towelling nappies count?) Don’t let the children eat too much chocolate before travelling. (Is it ever possible to regulate a child’s chocolate intake at Easter?) If you ever plan a car trip, always expect vomit. (I try not to expect vomit, to be honest. I like to think positively.)

I hope we’ll get to go on holiday later in the year. If we do, remind me to refer back to this blog post, and plan accordingly.

The Tantrum Monster

The other day I was sitting in Café Nero with my husband, enjoying a cappuccino (skinny, decaff, just to be extra boring.) While we drink and talk it’s fun to people-spot, especially since Café Nero is reassuringly cosmopolitan for a small coffee outlet in North Wales. Opposite me was a person whose t-shirt said, ‘Animal Free Ride’ on a large green circle over her left breast, talking away in Polish, I believe, to the rest of her group. Listening to them gave me a pleasant feeling of being abroad, because all the other conversations were such a babble that I couldn’t make out individual words. It’s nice to go out for coffee with my husband. It’s nice to feel free and sophisticated and relax a little on his days off.

Except for the two and a half year old. The emotionally fragile two and a half year old...

The realities of two and a half year olds is that you are never away from them. Offers of babysitting tend to pale away in proportion to how stroppy he is being at that point in time. The ‘of course you can go out, we’ll look after him,’ quickly turns into, ‘well, maybe when he’s not quite so volatile. Maybe when he’s happier being apart from you.’ So a relaxed coffee with the husband turns into a tag-along blowing raspberries in the back of the car, into a high incidence of very sticky hands, into a silent prayer of today, let him be happy.

So far that day he had had tantrums over being sleepy, waking up, wanting to be carried, wanting to be put down, and a sausage roll. In Café Nero it was time for him to have a tantrum over his straw. The carton comes supplied with a proportionally short straw, but he put a long straw into his carton. (‘Did you get him that straw?’ I ask my husband. ‘I thought you did,’ he answers. Then we realise he’s just acquired a stray straw off the floor, and is sucking away at it.) But the straw is too long for the carton. He tries to shove it further through the hole. Apple juice sprays everywhere. He won’t accept the other straw. He won’t let us trim the long one down. He just wants it to be shorter – to spontaneously shorten itself because he’s furious with it.

Having a two year old is like having your own personal drunk or drug addict. They’re volatile, fall over easily, are irrational, take delight in strange food combinations, concentrate intensely on one unimportant detail, and can’t focus on what is important. Their speech is slurred, their co-ordination is clumsy, and they’re wildly unpredictable and liable to fall asleep at a moment’s notice. They often smell of pee. The only difference is that they don’t smell of alcohol – and that they’re like this all the time.

How is that that a sweet request of, ‘Peanut butter?’ can turn into a freshly made sandwich being torn into pieces and thrown on the floor because it wasn’t folded right, the peanut butter wasn’t spread right, he wasn’t allowed to make it himself because sometimes I just don’t have the patience to oversee these things, or because he changed his mind half way through and wanted honey instead? Actually, this article at slate.com answered a lot of those questions. It explains how hard it is for the toddler to understand why you’re suddenly saying no all the time, how they work to their strengths when negotiating the world (using their new-found motor skills in place of their inadequate language skills, for example), and how their frontal lobe is just not developed enough to enable them to plan and reason logically. All this boils down to the fact that when your two year old is screaming and throwing things (when your seven year old gets a black eye because he’s just had a toy hurled at his face), there’s a reason for that behaviour, and to a certain extent you just have to work through it. It doesn’t always help when he’s just upturned a potty full of urine onto the carpet, but knowing that your two year old is living in a bewildering, changing world is a very useful thing.

So, let’s get back to a world where you give the toddler a carton of apple juice and he decides the straw is too long. It’s almost inevitable that there will either be a spillage, or screaming. You can try to explain to him why he shouldn’t squeeze the carton like a marauding monster rampaging through a city, or why you can’t make the straw longer – but you shouldn’t expect to get anywhere, at least, not until a few more months have passed. Perhaps you will get looks of shock and disapproval from other people in the café (perhaps they never had children, or forgot what it was like.) But you shouldn’t feel that your child is the most terribly behaved child in the world. You shouldn’t feel that you oughtn’t to take him out in public, or that you should be able to stop him screaming. You should just grit your teeth and try to enjoy your coffee. After all, how many chances will you get, until your babysitters decide they can actually handle your bundle of joy again?

On Books and Women

Yesterday was World Book Day (leading to a slew of panicked posts on facebook starting with ‘My child’s just told me they have to dress up as a book character!’ and ending with, ‘I’ll send him as a normal boy, then,’ or ‘I’ve spent all night making mouse ears.’)

Today, it’s International Women’s Day, I’m told.

I can understand World Book Day. Not everyone is exposed to that many books. Even now children still manage to slip through school without ever learning to read, and adults get by day by day without society knowing they can’t do much more than spell their own name. You have to admire their resilience. I’d imagine that anyone clever enough to hide their illiteracy would be clever enough to learn to read, given the right encouragement. So promoting books and reading is an excellent thing. As a writer, I certainly believe in anything that encourages a person to pick up a book.

Books have only been around for the last two hundred years or so – and by that I don’t mean all books. I don’t mean the Lindisfarne Gospels or the contents of the British Library or Bibles and prayer books. I mean books. The kind of books that exploded with the advent of the railways, with W. H. Smiths setting up on stations, with Dickens writing books that went out in serialised chunks, where the next exciting instalment was waited for with baited breath by readers on the other side of the Atlantic. Books you can push into your pocket. Books you stack up in the bathroom to read in those private moments. Books in piles by your bed, books teetering out of the bookshelves, because books are cheap, books are easy to get hold of, books are given away free with newspapers and sold for pennies in charity shops, and lent and borrowed and read until the spines cracked, and then replaced because it’s that cheap and easy to do so.

But women, to my understanding, have been around for – well, take your pick. When exactly do you choose the moment that homo sapiens broke away from their relatives? Wikipedia, the fount of all human knowledge, tells me that ‘Archaic Homo sapiens,the forerunner of anatomically modern humans, evolved between 400,000and 250,000 years ago.’ So we’ve been there for a while. And that’s not forgetting that females didn’t pop into existence when homo sapiens decided to branch out and become its own species. Women have been on this earth for as long as men have been on this earth. Every person that has been born has encountered a woman at some point in their life.

Suffragettes on Bow Street,1913 (Leonard Bentley, flickr)

So why do we need a special day for women? Wikipedia, again, tells us that, ‘the sex ratio for the entire world population is 101 males to 100females.’ So there we are. I don’t think one extra man to every 100 females makes us exactly a minority. It probably makes for one disappointed man, but not much more than that. I don’t want to be hoist aloft for one day of the year and told that I’m special, that my opinion counts, that I’m worth my place in the world. I want this to be the reality every day, not because I’m female, but because I’m a person. Let’s not have one day a year of lauding women’s rights. Let’s not have feminism or girl power or reminders that we are special. We’re no more special than anyone else. How about 365 days of respecting everyone’s rights?

Of Sleeping, and Not Sleeping

I am a night owl.

That’s not really a fair description. I’m sure most owls don’t spend their nights lying in bed staring at a computer screen. If they did they’d die of starvation. Most owls don’t have unrequited lustings after stars of the screen or obsessions with certain television series. Most owls don’t write novels. (I have to wonder what an owl’s novel would be like, although since my latest novel contains a character who, at times, thinks she’s an owl, perhaps I’ve tried to answer my own question.)

But anyway, here I am. I prefer to go up to bed at around eleven. I prefer not to go to sleep until about two. I could push that later, but owing to the feeling of having some responsibility to be awake in the daylight hours, I don’t. I’m lucky that I have a very accommodating husband. (I’m not going to start referring to my family members as ‘DH,’ ‘DS1,’ ‘DS2,’ etc., which makes them sound like gaming consoles.)

It’s a shame that I’m not trying to write this in that lovely quiet time before two a.m.. Then I wouldn’t be typing one handed while a two year old shoves a Weetabixy spoon into my face and screams at me. But my tendency to stay awake until the small hours is why I find this article so reassuring.  Apparently, ‘more intelligent individuals are more likely to be nocturnal than less intelligent individuals.’ This pleases me. This means that while I’m lying under my quilt staring at my computer screen becoming more and more dejected because I can’t make words flow or think of a plot for a new story, I’m being super intelligent. It means all those infuriating, bouncy, ‘I couldn’t be so lazy’ type morning larks are the dull and brain-dead among us.

Owl, by Jennicatpink on Flickr.
This is roughly how I look if I wake up too early in the morning.

I know this isn’t the most social way to live. I force myself to turn off around two. I wake up somewhere around 11 a.m., if I’m lucky; later, if I’m really lucky. If I’m prised out of bed earlier than that I tend to roam around with my face creased up into an attempt to pretend I’m still asleep and do things on automatic pilot. If I have to walk the children to school I usually haven’t brushed my hair or looked in a mirror or changed out of the t-shirt I slept in. I stay alert just long enough to walk back, before slipping back under a quilt at the earliest opportunity, putting an audiobook into my ears, and going back to find inspiring dreams.

Later in the year, perhaps, when I’m not pushed into a dreary, uncreative mire by the curse of winter, I might use those precious after-midnight hours to write something of worth. Until then I’ll keep on staring vacantly at the computer screen, and writing bad poetry. But at least I have the reassurance of Psychology Today that I’m intelligently unproductive.

Introductions

This is the time to introduce myself. A shiny new blog, a place to jot down idiocy and ramblings and frustrations and ideas. It's hard to do right now because I have a two year old standing behind me on the settee slapping my head with both hands and shouting, 'Lap! Lap!' at me. (He's pretty good on his 's's, but not when he's concentrating on hitting me, it seems.) When he's not shouting 'slap,' he's jumping and shouting, 'Bounce high up!' The cat is drinking the pineapple juice from the child's bowl (who'd have guessed?) and there's soup in the pressure cooker screaming to be turned off. I'm trying to lose weight (ten pounds so far) and soup seems like the way to go.

Perhaps this is as good an introduction as any, since it describes quite a few of my days. What else is there around me? Sunshine. A good spattering of dog hair and rubble on the carpet (a lovely 1960s piece made of inter-meshing fern leaves.) Books. More books. And a certain degree of peace, since the other children are at school. Thank god. I mean, home education seems the way to go, but I think I would go mad if I attempted it myself. I'm an introvert. I crave quiet, not 18 hours a day of arguments.

To prettify this entry and make it look as if my life is not all chaos and dog hair, here are some crocuses I took pictures of yesterday. See you again soon!