Is there a link between autism and the Measles, Mump and Rubella Vaccine?

Practitioners continuously have the dilemma of giving vaccinations to children. I will be researching the controversy over the measles, mumps and rubella vaccination (MMR). There has been issues surrounding the vaccine that it may be the cause, a contributing factor or not a factor at all of autism.

In 1943 Leo Kanner researched 11 children who were previously labelled as ‘idiots’ or ‘schizophrenic’. He noticed they acted in a unique way. They could not relate themselves to people as other children did. He reported this condition as ‘autism’. Horton (2004)

It has been suggested that the MMR vaccine is the cause of ‘variant’ autism. This is where the child develops autism and bowel problems post the MMR vaccine. Dr Andrew Wakefield is opposed to the MMR vaccine. He conducted a study involving 12 children, 11 of these children were boys, with chronic enterocolitis and regressive developmental disorder. These children were taken to a paediatric gastroenterology unit. They had a history of regressing from normal development to loss of language and abdominal pain. They under went gastroenterological, neurological and developmental assessment. Ileocolonscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalograph (EEG) and lumbar puncture were tests taken under sedation. 9 out of the 12 children were discovered to have autism. The parents related this to the MMR vaccine which 8 out of the 12 children had. Wakefield et.al. (1998)

Wakefield’s research method was experimental. The quantitative data led practitioners to suspect a possible link between the MMR vaccine and autism. The experiment includes both objective and subjective methods.

The objective methods are beneficial as they help recognise the problem and have the advantage of allowing each individual to be placed in programs that can provide the children with ongoing developmental care. The experiment was subjective as it allowed the individual participants to be observed closely by health professionals to monitor their development. However a subjective method has disadvantages, as it should only be used when there is sufficient supporting evidence that children are suffering from a form of disability.

The participants that Wakefield put under assessment could be biased. A confounding variable is that Wakefield had no choice in the children that were brought to him for investigation, there was a lack of experimental control in this study. An advantage of the study is that it was carried out in a laboratory setting. The participant’s behaviour can not be effected by distractions in the environment. Wakefield’s study was primary data as it was collected through his own experimental research. The study was ethical as the children and parents gave informed consent.

One of the most important ...

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One of the most important aspects of research is reliability. Wakefield’s study did not have ‘test-retest reliability’, as others found it hard to establish a link between the MMR vaccine and autism such as Azfal, M.A. (Lancet (1998) 351 (9103) p.611).

To be valid the research has to have a degree of reliability. Wakefield’s experiment did not have ‘construct validity’, as the infection Ileal-lymphoid-nodular hyperplasia is non-specific, and the experiment was associated with the parents’ opinion, therefore making it subjective.

In contrast with Wakefield’s study was a population-based study illustrating no link between MMR and autism. This study was performed mid 1998 in eight NorthEast London health districts. It included 427 children with ‘core’ autism and ‘atypical’ autism. This study showed no evidence of increased regression in children who had been given the vaccination 2-12 months previously. Andrews et.al. (2002).

The advantage of using a population-based study is that it allows researchers to access large and various populations. A stratified sample was used as Andrews chose particularly to look at eight North-East London districts, and 427 children who had autism. Researchers are not focusing on individuals, therefore there is not much information on the individual participants.

In comparison with Wakefield the study used quantitative data. However unlike Wakefield this study was not subjective, as it did not focus on one particular individual. Andrews study was structured as there was a very detailed framework that codes people in a particular group, i.e. those with autism in NorthEast London. Andrews et.al. Report was referenced to the work of which had been read. Although everything was referenced correctly, the bibliography was not in the order of the author’s surnames.

In comparison with the study conducted by Andrews et.al is a report named ‘ Time Trends in Autism and in MMR Immunization Coverage in California (March 7 2001). Research was carried out to investigate the relationship between the MMR vaccine and autism occurrence.

There was analysis of MMR immunization coverage rates among children born between 1980-1994. These children were Californian kindergartens. The survey included 600-1900 children a year. The children’s school immunization records were analysed to see the age at which they first received their MMR vaccine, and the number of children diagnosed with autism within these years.

The main outcome measure of this study was the measles, mumps-rubella immunization rates of children aged between 17 and 24 months, and the number of those diagnosed with autism and enrolled in the Department of Developmental Services system.

The results showed there was no trend between childhood MMR immunization rates in California and those enrolled in California’s regional service centre system. Between 1980-1994 births, a sustained increase in autism case numbers was noted. 44 cases per 100,000 births in 1980, to 208 cases per 1000,000 births in 1994, resulting in a 373% relative increase. However changes in the MMR vaccine over the same time period were much smaller and of a shorter duration. Dales, Hammer & Smith (2001).

The method used was a survey. It has the advantage of gaining information on large amounts of the population. Positivists favour surveys as it allows them to make generalisations about the topic. Researchers however can construct the survey so it becomes bias to the researchers desired answers. Although a survey is not time consuming and a skilful survey allows investigation of many types of invisible behaviour. In comparison with Wakefield et.al and Andrews et.al. quantitative data was used as it was based on numbers and dates. The study was structured, as they used those born between 1980-1994, and used a sample of 600-1900 a year as their survey sample.

Between the dates of June 12-13, 2000 there was a conference held in Oak Brook Illinois relating to the MMR vaccine and autistic spectrum disorder (ASD). It is understandable that parents and physicians are worried about the causes and treatments of autism. There are many gaps in people’s knowledge about what causes autism.

The American Academy of Paediatrics held a conference named’ New Challenges in Childhood Immunization’. Parents, scientists and practitioners put across information on the MMR vaccine and ASD. They reviewed data on the genetics and the epidemiology of autism and available data on the MMR vaccine, illustrating their method seen a secondary source. Positivists view this as an advantage as the information is already available and it saves time, effort and cost. The results of the study showed that autism could be caused by a variety of factors. Genetic predisposition to autism may involve 10 genes. Experts believe that that abnormal brain development in autism occurs under 30 weeks gestation. Increased reporting of autism has occurred after the introduction of the MMR vaccine in the United States in 1971 and the widespread use of the vaccine for routine immunization of children 12-15months. In Europe epidemiological studies show no association between the two. This debate has caused much public and political attention, practitioners may have believed there is a link between the two due to personal experiences. Neal et. al. (2000)

References

Horton, R. (2004) The lessons of MMR. The Lancet. 363. (9411) March, pp.747.

Dales, L. Hammer, S.J. Smith, N.J. (2001) Time trends in autism and in MMR immunization coverage in California. Jama. [Internet] March 7. 285 (9) p.1183.Available from: [Accessed 25 May 2004]

Andrews, N. Miller, E. Taylor, B. Lingam, R. Simmons, A. Stowe, J. Waight, P. (2002) Recall bias, MMR, and autism. Arch Dis Child. 87, December. pp. 493-494.

Neal, A. Halsey, MD. Susan, L. Hyman, MD. and the Conference Writing Panel. (2000) Measles-Mumps-Rubella Vacine and Autistic Spectrum Disorder: Report From the New Challenges in Childhood Immunizations Conference Convened in Oak Brook, Illinois. Pediatrics. [Internet]5th May. 107 (5) pp. 1-23. Available from: [Accessed 14 May 2004]

Wakefield, AJ. Murch, SH. Anthony, A. Linnell, J. Casson, DM. Malik, M. Berelowitz, M. Dhillon, AP. Thomson, MA. Harvey, P. Valentine, A. Davies, SE. Walker-Smith, JA. (1998) Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet. 28;351(9103):February, pp. 637-41.

33009493 Introduction to Research Module Sue Warren