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Archive for October, 2009

Dr. Paul Offit

Dr. Paul Offit

The American Academy of Pediatrics (AAP) presented Paul Offit, MD, FAAP, with the President’s Certificate for Outstanding Service at the National Conference and Exhibition of the AAP earlier this week.  The award recognizes an individual’s outstanding service and long-term, personal dedication to the mission of the AAP and to the health, safety and well-being of children. Dr. Offit is a pediatrician, chief of infectious diseases and the director of the vaccine education center at the Children’s Hospital of Philadelphia. He serves as a board member of the Autism Science Foundation and is the author of Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. The AAP honored Dr. Offit in recognition of his ongoing commitment to promote immunization.

All of us at the Autism Science Foundation congratulate Dr. Offit on this very well deserved honor and thank him for his ongoing dedication to the health and well-being of our children.

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By Jonathan Rabinovitz
Stanford Medical School

Advocacy groups can play a vital role in advancing treatment of a disease, but a small but vocal group of parents of children with autism may be hindering as much as helping the latest efforts to promote research on the disorder.

Case in point: when the Interagency Autism Coordinating Committee meets on Oct. 23 to consider revisions to its strategic plan for autism research, it will no longer include one of its most esteemed scientists: Story Landis, PhD, director of the National Institute of Neurological Disorders and Stroke.

Landis had chosen to step down from the IACC in the face of complaints from some parents that she was dismissive of their concerns about vaccines being a cause of autism.   Read more

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By Lydia McCoy
Executive Director of the Colorado Children’s Immunization Coalition.

Thimerosal and the MMR vaccine do not cause autism.

 

There I said it.

 

I know parents are scared. I know parents just want to do what is best for their children. I also know that vaccines are not the thing to fear, it is disease that should be feared.

 

Measles is not something that any child needs to endure. The MMR vaccine has been incredibly powerful in protecting children and our entire community.

“The measles vaccination has resulted in a decrease in reported measles cases from about 500,000 cases and 500 deaths per year to a few dozen cases each year in the US.”

 

Parents must continue to vaccinate children to continue to see this success rate. Sadly, we have already seen the leaks in our immunity. Measles outbreaks are back! In early July, there was a measles outbreak in Brooklyn, NY In February 2008, San Diego was hit with an outbreak which lead to 11 children being infected with the disease and one baby being hospitalized.

 

So how did parents lose so much confidence in something that is proven to protect children from disease? In the July issue of the Journal of Specialists in Pediatric Nursing, Lisa Miller, MD, MSPH and CCIC Board Member Joni Reynolds, RN, MSN penned the article “Autism and Vaccinations – The Current Evidence” outlines the many concerns that parents have about the MMR vaccine and the evidence against a causal relationship between MMR and autism.

 

How did we get here?

 

We have been battling the false connection between MMR and Autism for over a decade.

 

It all started in 1998 with Dr. Andrew Wakefield and his survey of 12 children in which he concluded that 6 of the 9 children’s parent or physician linked the onset of developmental regression with the administration of the MMR shot. This study set off the fire storm around the MMR vaccine and this study has been closely scrutinized and questioned.

 

It is to be noted that by 2004 10 of 11 of Dr. Wakefield’s co-authors had retracted the interpretation and just this year, the Sunday Times reveled evidence that Wakefield fixed the data of his 1998 study.

 

As good stewards of science and holding public health as its number one priority, in fall 2000 the CDC and National Institutes of Health convened to examine the MMR vaccine. After examination of the science behind the issue,

“they rejected the causal relationship between the MMR vaccine and ASD based on the facts that there was a lack of epidermologicic evidence and lack of biologic models.”

 

Other countries also examined this issue, trying to recreate Dr. Wakefield’s results. The JSPN article outlines numerous studies which have examined this issue. Here are a few highlights:

 

In 2002, scientists in Denmark studies over one million children and found no difference in the risk of autism between MMR-vaccinated and unvaccinated children.

 

To pile on more evidence, even through Japan has withdrawn the MMR vaccine in 1993, autism rates continues to increase there.

 

In February of this year, The US Court of Federal Claims found that “after reviewing 5,000 pates of transcripts, 939 medical articles, 50 expert reports and hearing testimony from 28 experts” that MMR and thimerosal-containing vaccines do not cause autism.

 

Just recently on September 22, 2009, the National Health Service (NHS) Information Centre found that autism rates are consistent among adults is identical the rates of autism among children -at about 1%.

 

Autism is continuing to increase even though we’ve eliminated MMR as a cause. That’s one fear we can eliminate from our list.

 

The big bad Thimerosal

 

Scientists have also looked at the ingredients of the MMR vaccine for reasons why it could cause autism. One of its ingredients prior to 2001 was thimerosal.

 

Vaccine manufacturers widely used thimerosal as a preservative in vaccines. It is approximately 50% mercury by weight. Some say that mercury poisoning symptoms can look a lot like some of the symptoms of autism.

 

Thimerosal is an ethylmercury , which needs to be distinguished from methymercery.

 

Methylmercury is the dangerous mercury that accumulates in the brain and causes neurological damage. Methylmercury can be found in some forms of pollution and in some of our waterways.

 

Thimerosal has ethylmercury which does not accumulate in the body or the brain. It is metabolized and cleared from the body.

 

Regardless, the CDC has removed all thimerosal from most vaccines in an effort to boost public confidence. Since 2001, vaccines routinely administered to children under the age of 6 are produced without thimerosal except for some types influenza vaccines.

 

So since there is not thimerosal in MMR and thimerosal doesn’t cause neurological damage, we can eliminate it from our list of fears as well.

 

It’s time to protect our children again

 

We have exhausted all the possible connections to MMR and autism. It’s not the smoking gun some hoped it would be.

  1. Studies have found no difference in the risk of autism between MMR-vaccinated and unvaccinated children
  2. Thimerosal has been removed but autism rates continue to increase
  3. Thimerosal never was a cause of neurological damage
  4. Wakefield’s original study has been dismissed as falsified

I am empathic with concerned parents who want to find an answer to why the autism rate continues to climb. I am an advocate for finding research dollars to explore other avenues of causes for this devastating diagnosis.

 

I also want to protect children from disease. I want to save lives. I agree with the article when it states that “Vaccines are one of the greatest achievements of biomedical science and public health.”

 

Parents cannot continue to hold onto misplaced fear that by avoiding the MMR vaccine they can save their child from a diagnosis of autism. The MMR vaccine is protecting children. We have made great inroads over the years diminishing the necessity to fear disease because of the success of vaccination. Protect your children, immunize them.

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By Bruce Cohen, M.D.

Dr. Cohen is a staff neurologist in the Neuroscience Institute at the Cleveland Clinic Foundation. Dr. Cohen served nine years on the Board of Trustees of the UMDF from 1998-2006 and is currently Secretary of the UMDF’s Scientific and Medical Advisory Board. He has been the chairman or co-chairman of the 2000, 2005 and 2008 UMDF Annual Symposium and will be the CME Chairman for the 2009 meeting.

There have been questions regarding recommendations about people with mitochondrial disease receiving the H1N1 vaccine. The Scientific and Medical Advisory Board (SMAB) of the UMDF did discuss the issue in great detail and these comments reflect the board’s discussion. Much of the factual information has been obtained from governmental websites.

The H1N1 virus, also called “the swine flu” typically causes fever, cold symptoms (cough, sore throat, runny or stuffy nose), body aches, loss of appetite, and headache. As with any fever, chills may be present. Fatigue is part of most flu illnesses. Vomiting and diarrhea are reported in some and there are now cases where people have respiratory symptoms without a fever. These symptoms range from mild to severe. There are some people that get sick, but never are sick enough to think about seeing a doctor, whereas others with the same virus will die as a result of their infection. At this point it is not possible to know if the infection will spread to epidemic proportions, or if the virus, which now seems as “bad” as most influenza viruses but no worse, will shift to a strain that will cause more or less severe disease.

If you think anyone in the family may have the H1N1 virus, we advise that you seek out immediate medical attention. As part of general medical practice, both fever and dehydration should be treated with standard medical management. Sometimes bedrest, ibuprofen or acetaminophen and fluids are what will be recommended. Use of antiviral medication is given for more severe cases (which are believed to be safe in those with a mitochondrial disorder). For those people that have shown to be susceptible to regression after dehydration, the use of IV hydration and appropriate IV rehydration therapies is reasonable. Aspirin should be avoided.

Immunization for the H1N1 is now available. The immunization comes as a live attenuated product delivered by spraying it into the nose and as a killed form, which is delivered by injection. The nasal form (live attenuated vaccine) is not recommended for people with chronic health problems, but can be used in people 2-49 years of age that are healthy (such as healthy family members). The inactivated (dead virus) vaccine contains the preservative thimerosal, which was investigated because of the concern it was linked for causing autism. However, in 2004 the experts at the Institute of Medicine concluded there was no evidence of this and further research has indicated there is no health risk or link to autism. It is this inactivated (dead virus) vaccine that is being recommended for those with health problems, which would include mitochondrial disease.

It is important to know that it takes several weeks after the immunization is given for the body to build up immunity against the virus. The Center for Disease Control’s Advisory Committee on Immunization Practices has recommended that certain groups receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare personnel, persons between the ages of 6 months and 24 years old,

and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. The government is not recommending the immunization for those less than six months of age. For those under 9 years of age the recommendation is two doses of the vaccine separated by four weeks. The group of healthy people between 25-64 years of age are not in the recommended category for immunization because they are less likely to have a bad outcome if they get an H1N1 influenza viral infection.

It is reasonable to believe that an H1N1 infection, or any influenza infection in a child with a mitochondrial disease will be worse than that of an otherwise healthy person. The presence of a fever, reduced food intake, risk of dehydration in addition other parts of the body’s cytokine response to the flu will result in a higher risk of injury and subsequent mitochondrial dysfunction that would likely occur in a healthy person. As with any influenza, a certain percentage of infected people will die. Historically this has been the elderly and those that are already ill. The concern among doctors who care for children and adults with mitochondrial disease is that because of the frail state, parents (or affected adults) will choose not to get immunized for fear that the vaccine will make them sick. Understanding the possible risks and the possible benefits should help alleviate this fear.

The vaccine given for the 1976 swine flu (a different strain — so if you were immunized in 1976 it does not help this year) was possibly causally linked to Guillain-Barre syndrome (GBS) in a small minority — 450 cases for the 45 million people that got the shot, or about 1 in 100,000. This is a paralyzing disorder that is now treatable (and most people that got this disorder did recover). However in 1976 there were no therapies and 30-40 of those 450 people died. It has never been proven that the vaccine caused the increase in GBS. I have spoken with senior scientists that are convinced there was a link and those that truly believe there was no link. Even after more than 30 years this has not been resolved in the scientific community. In the studies of vaccines that followed the 1976 vaccine, no clear answer has emerged and the number the government decided upon is that the risk is on the order of one in one million. Because of this situation it is recommended that people that have ever had GBS in the past do not get the vaccine. This one in one million risk (or one in 100,000 if you chose that number) needs to be considered along side of the risk of death and disability caused by the flu itself. There have been 10-11 deaths in children this week alone from the swine flu, with 86 confirmed pediatric deaths since the swine flu began being tracked in April 2009. Two-thirds of the hospitalizations in children have been in those with underlying medical problems.

This vaccine has been tested in children and adults using standard methods. There is no evidence that this vaccine will result in any more adverse reactions than other influenza vaccines. There are no special concerns about this vaccine in particular that are worrisome. Waiting to see if the H1N1 virus will cause an epidemic before making a decision about getting the vaccine (or your child) is the wrong strategy. By the time we know if this is an epidemic, given the month or so it takes to achieve immunity, it will be too late. It is easy to find information on the web that will cause you (or me) to question vaccine safety but when you read past the questions of concern, there are no clear data to support the concern.

There is no way to prevent getting the flu. Of course common sense and strict hand washing are important, but unless you live by yourself and never have contact with another person, you will be exposed to people, and the 100 people every person came into contact with that day.

It is simply not possible to make the blanket recommendation that “all children and adults with mitochondrial disease get the H1N1 immunization.” That is a decision between you and your doctor. In the last several months almost all of my patients (and their families) have asked me if I recommend the vaccine and I have said to all of them so far “I recommend the H1N1 and the regular flu vaccine in your situation.” In addition I have not told a patient they should not receive the vaccine. I am not sure what I will say with the next patient, but to date all have had my recommendation to get the vaccine.

In summary, any influenza poses more of a health risk to a person with mitochondrial disease than to an otherwise healthy person. There is no evidence that the H1N1 vaccine poses a risk of injury above and beyond other influenza vaccines (which I have been recommending to my patients for years). If there is an influenza epidemic caused by the H1N1 virus (or other virus that is covered by the regular seasonal flu vaccine) several months from now, getting the vaccine in the middle of the epidemic will likely not be very helpful. It is everyone’s hope there is no epidemic. But if there is an epidemic, those having received vaccination will have the necessary protection. There is a lot of good information in the web, which can be found by going to your search engine and typing “H1N1 Virus Vaccine”. The CDC.GOV website can give you up-to-date information about the influenza situation and immunizations.

On a personal note, the vaccine just rolled into Cleveland today. My wife just got her H1N1 vaccine when she went into work this evening, I will get mine hopefully when I return to work and we are awaiting instructions from the pediatrician so I can get all my children immunized against the swine flu ASAP (they all have gotten immunized against the seasonal flu).

Bruce H. Cohen, MD

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Wired Magazine  (November 2009) has published a cover story and several additional sidebar stories on the anti vaccine crusade.  They all well worth reading.

Cover Story: An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All http://www.wired.com/magazine/2009/10/ff_waronscience/

The MisInformants: Prominent Voices in the AntiVaccine Crusade (list includes Jenny McCarthy, Jim Carrey, Joe Lieberman, Robert F Kennedy Jr, Don Imus, and MSNBC’s Joe Scarborough) http://www.wired.com/magazine/2009/10/ff_waronscience_misinformants

What’s the Real Story on the Vaccine Debate. Learn More (calls out disguised anti-vaccine websites, and provides links to reputable information on CDC and NIH websites) http://www.wired.com/magazine/2009/10/ff_waronscience_reading

How to Win an Argument About Vaccines (sets out myths and facts) http://www.wired.com/magazine/2009/10/ff_waronscience_argument

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This week’s show focused on the new study in Pediatrics indicating autism prevalence rates are now 1 in 91. Autism Science Foundation President Alison Singer discusses the data, describes what the autism community really needs, and answers the question of whether autism is caused by vaccines.

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by Shannon Des Roches Rosa

Autism Science Foundation president Alison Singer is well known in the autism community for her formative role at Autism Speaks and for leaving Autism Speaks to found the Autism Science Foundation.  

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