Paul Shattock & Dawn Savery
Autism Research Unit, University of Sunderland, UK
Article taken from 1997 Conference Proceedings "Living & Learning With Autism: Perspectives from the Individual, the Family and the Professional"
The suggestion that autism and other disorders with serious and lifelong implications could be caused by vaccinations has been in circulation for many years. There are few rational texts on the topic and most literature can be placed in one of two categories. Some authors adopt what appears to be a fanatical anti-vaccine stance and so overstate their case to the extent that even the valid points become unbelievable. On the other hand, orthodox medical literature exhibits such complacency and lack of willingness to accept that any problems could exist that it too becomes devalued.
There is no doubt that many parents are totally convinced that their children changed dramatically and quickly after the implementation of an immunisation programme. To ignore such cases and assert, without investigating the individual circumstances, that there is no case to answer is unwise, raising fears and concerns that do nothing to reassure the public. Questions about the safety of vaccines and about the desirability of vaccinating siblings of children with autism or of giving boosters to children who are autistic are frequently received, by our research unit. A complete and thorough review of the efficacy and safety of the products currently in use is vital . If the protesters are correct, the consequences for the lives of many people are extremely serious. If the protesters are incorrect and the vaccines are completely safe and effective, public confidence is being severely damaged unnecessarily and the control of potentially lethal and disabling diseases is being jeopardised by this complacent and unquestioning attitude.
Some Basic Principles
It is clearly inappropriate, in this brief presentation, to rehearse all the arguments for and against individual and mass vaccination programmes. There are, however, certain basic principles against which all decisions must be set.
If the use of a vaccination programme is to be considered:
1. There should be a serious threat from the disease in terms of:
(a) consequences of the disease to the individual;
(b) numbers of people likely to be affected.
2. The product should be effective and protection should be long-term.
(Although there is general acceptance that vaccination does provide adequate protection against many, formerly significant, diseases the claims and counter arguments of the sceptics should be addressed seriously.)
3. Side Effects should be:
(a) minimal in terms of severity and frequency;
(b) when present, adequate compensation should be available (currently, in the UK the maximal level is a single payment of £30,000).
The principle of informed consent should apply as with any other form of medication. This implies that the full facts should be available to the Practitioner and to the subject of the programme or, in the case of those unable to give such consent themselves, their parents or carers. The practice of paying substantial bonuses to physicians reaching their targets for vaccination levels could perhaps be justified under certain circumstances but it is a highly unusual practice in the medical field. It is not our intention to imply that Physicians would be persuaded to act against their judgments by such financial inducements but were the same methods to be applied in other areas where medicines are supplied the legality of the methods would be open to question. Legal requirements in many US states make it very difficult to avoid vaccinations if children are to be permitted to attend school at all. The intention of controlling diseases, which are a genuine danger to public health, is well understood but the principle of financial inducements is an unfortunate one. Given the increasing tendency towards litigation it is a brave Physician who risks enormous financial penalties, via the Courts, should his advice to avoid vaccination result in serious problems from the disease. Given these legal and financial pressures it is absolutely necessary that the public be totally confident that the products they are using are both safe and effective.
Constituents of Vaccines
The active components of vaccines have many of the properties of the diseases they are designed to prevent. They are designed to encourage the body’s defence systems to rapidly recognise any invasive organism and to produce antibodies of various types which will result in the eradication of the disease. These antigenic principles may consist of dead organisms; they may consist of toxoids or extracts from the organisms that will provoke an immune response or they may consist of attenuated or mild strains of the disease promoting organism. Although these organisms, which may be bacterial or viral in origin, are alive and have the ability to promote an immune reaction, they are so weak in terms of causing symptoms that these effects can, in a normal individual with a fully competent immune system, be ignored totally. There are, however, many other components in vaccines, which could, potentially, cause problems in particular, sensitive, individuals.
Amongst these, particular mention should be made of the following:
From the preparation of the vaccine – normally used to kill bacteria;
* Antibiotics (e.g. Neomycin)
* Aluminium salts;
* Preservatives such as thiomersal / thimerosal (contains mercury);
Residues from growth media
* African Green Monkey Kidney (Polio vaccine)
* Other animals
The reports of the isolation of stealth viruses from at least two children with autism must remain tentative and under investigation .
Gulf War Syndrome (GWS)
Many members of the armed forces who fought in the Persian Gulf suffer from an extensive range of symptoms . The precise nature of these symptoms varies within individuals in both extent and nature. Many theories have been put forward to explain the causation of these symptoms including the intense immunisation programmes to which the troops were treated in a very short period of time. The precise nature of the vaccines used to protect the troops remains classified information but the majority were immunised against at least a dozen serious diseases. The list includes the following.
Anthrax; Plague; Yellow Fever; Typhoid; Botulism; Hepatitis B; Cholera; HiB; Pertussis; Polio; Rubella; Tetanus.
The UK Ministry of Defence has admitted to the inclusion of five or six ‘other organisms’ but has declined to confirm their identities. The effects of such an intense battery of vaccinations in such a short period of time could be serious indeed particularly where the immune system is already compromised for any reason. Factors such as stress and environmental agents such as pesticides or drugs as well as genetic factors could all result in the compromising of the system . It is, perhaps, pertinent to note that French troops, serving alongside the American and British troops have not experienced such problems. It may also be relevant that they did not undergo these vaccination programmes in such a compressed time zone and also that different insecticidal agents were used (semi-synthetic pyrethroids as opposed to the organo-phosphorous (OP) compounds favoured by the British and American authorities.). The reaction of the public to the revelations about these vaccination schedules is usually one of shock. However, it is also worth considering the vaccination schedules applied to infants in various parts of the world. The schedules used in the United States of America (USA) are amongst the most aggressive (listed in the accompanying table).
Immunisation Schedules (USA October 1996)
|Hepatitis B #1 (if not given in hospital)|
|Diphtheria, Pertussis and Tetanus (DPT) #1, Oral Polio #1, Hepatitis #2; Hib #1.|
|DPT #2; Hib #2; Oral Polio #2.|
|DPT #3; Hib #2; Oral Polio #3.|
|DPT #4; Hib #3; Measles,Mumps and Rubella (MMR) #1; TB Test|
|Boosters for DPT; Oral Polio and MMR|
Thus in the first year of life, the immune system of an infant, as well as the infant itself, is challenged by injections, directly into its body, of at least 10 diseases. Many of these are derived from attenuated strains of living bacteria or viruses. An infant with an under-developed immune system or one which is already challenged or compromised for any reason must be vulnerable when such an a battery of vaccinations are used in such a short period of time. It should also be borne in mind that these injections are directly into the body so that those elements of the body’s immune system, which rely upon mucous membranes or skin are completely by-passed. This may be of particular relevance when the effects of the adjuvants and additives previously mentioned are considered.
Reported Side Effects
The British Government has a system, the yellow card scheme, which encourages physicians (and others involved with the administration of medicines) to report any adverse reactions to medications including vaccines. When suspicions are aroused, these are investigated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the response is usually rapid. The problem with vaccines is that the side effects may not always be immediate and may only infrequently appear in such a form that they are immediately recognised as being attributable to the vaccine. A particularly striking example of this under-reporting of problems was highlighted by the vaccine used against mumps in the United Kingdom. Until 1992, the attenuated strain of the virus which was in common use was the Urabe strain. This combined comparatively mild effects with a comparatively high antigenic effect. The side effects consisted of what has been called mumps-induced meningitis. This only became evident between 10 days and 5 weeks after the inoculation. Therefore, any such symptoms, when seen, were only rarely associated with the inoculation.
Records show that the normal yellow card system, described above, indicated an incidence of side effects (which may have been very trivial) of around 1 in 250,000 cases. When, with the knowledge and advantages of hindsight, much more exhaustive investigations were made the incidence of side effects was very much higher. When notifications of meningitis from Physicians were included; when the vaccine records of hospital cases of meningitis were included; when cross linkage of vaccine records from laboratory reports (4 laboratories) was performed and included the figure was increased to 1 in 11,000. It should be noted that in the case of one particular laboratory, this was 1 in 4,000.
Since it is possible that there are many instances where such reaction are not reported at all, because the symptoms were not sufficiently dramatic or, perhaps, because they were misinterpreted, it is more than likely that the incidence are a huge under-estimate of the seriousness of the problem. It is interesting to note that the Urabe strain was withdrawn from regular use in the UK late in 1992 so that the only vaccine available was from the Jeryl Lynn strain.
Evidence from Evaluation of Urinary Profiling
As described in Part 1 of this presentation, we have isolated a compound; trans-Indolylacryloylglycine (IAG) in substantial quantities in the urine of an estimated 75% of the subjects with autism that we have examined. Although other explanations are feasible, we speculated that this compound may be the detoxified derivative of a parent acid which could have severe implications for the permeability of many membranes throughout the body. In the context of autism and the opioid-excess theory, these effects would be particularly relevant for the membranes lining the gut (in terms of gut permeability to peptides) and the blood-brain-barrier. Increased permeability of either or both of these membranes would result in greatly increased levels of opioid peptides reaching the CNS with predictable results. Examination of the clinical histories of this remaining 25% of subjects, where IAG is not a very major component, suggests that a proportion of parents strongly suspect some other factor to be involved. Sometimes this relates to hypoxia or anoxia at birth, but in other cases, parents strongly suspect, and have usually already suggested, the involvement of vaccines and, in particular, the MMR vaccine. It must be conceded that there are a number of instances where parents strongly suspect vaccine involvement even though the IAG compound is present in substantial amounts. These situations are not common and may represent fallacious beliefs on the part of the parent. On the other hand, it may well be that the vaccines have exacerbated an existing situation. A full discussion of all the relevant factors would be inappropriate for this communication but there are a number of points, which are worthy of mention at this juncture.
The clinical presentation of the symptoms in children where vaccines are believed, by parents, to be involved are virtually indistinguishable from those of other children with autism. The majority of children with autism appear to have shown regression in terms of language, comprehension and behaviour so that this alone cannot be taken as evidence of vaccine damage. The rate of the regression is, according to reports, very much more rapid in these children and other specific problems are described below. Our own preliminary observations would seem to confirm the view (Gail Gillingham - personal communication) that the incidence of problems of movement and, in particular, gait, is higher with this group .
The suggestion has been made that, in some cases of autism, the measles element of the MMR programme could be a significant factor. Evidence has already been published which has linked measles particles to a greatly increased incidence of Crohn’s Disease, which has been recorded over recent years (although other evidence has countered such claims). Work is currently in progress to identify the presence of these same particles in the lower intestinal walls of some people with autism. If present, these particles would certainly increase the permeability of the intestinal walls so that increased levels of gut derived peptides would reach the blood stream and, ultimately, the blood-brain-barrier. In those children where such a sequence of events is believed to have take place, parents report a rapid and serious reaction, within hours or at least within a couple of days from administration of the vaccine. Epileptic fits; coma; incessant screaming; rapid loss of bowel function and control are all reported; concomitant with the appearance of, or increase in severity of autistic behaviours
In another, smaller, group of subjects, the clinical picture is different. There is no sudden, rapid or spectacular event but the child still loses abilities very soon after the MMR injection. Although it may not have been mentioned initially, subsequent questioning frequently reveals that there has been a quite serious illness some weeks afterwards. Meningitis has often been mentioned but, in other cases, although the indications are that such an infection has occurred, no firm diagnosis has been made. Occasionally, such as in the case where one young boys testicles still swell up from time to time, there is strong circumstantial evidence for the causation of this meningitis being connected to the mumps element of the vaccine. One suggestion is that the disruption caused to the meninges, which form an integral part of the blood-brain-barrier is such that high levels of peptides which may be circulating in the blood can now reach the CNS. It is worth mentioning that such children seem to do very much better than the majority of children with autism in the comparatively short term. It is interesting to speculate that those children who are reported as making spectacular recoveries might be from this group. It may well be that, with time, the attenuated strain of mumps is eventually eliminated by the immune system so that the meninges recover and the blood-brain-barrier can operate as effectively as before. Whatever the form of therapy being employed with such children will be credited with responsibility for this cure.
The Use of Multi-Component Formulations
There is little evidence (even anecdotal evidence) that the older, single component vaccines, could result in such problems as autism. Reports of such problems appear primarily after the introduction of the multi-component MMR vaccine (1988 in the UK). If these reports are correct it would seem that it is this combination, which may be responsible for these problems. Given the fact that the Measles virus is known to be immuno-suppressant, its inclusion in combination with other disease causing organisms is, in any case, inherently problematic. Perhaps the combination of the effects on the gut wall (measles) and the blood-brain-barrier (mumps) are necessary for these effects to become evident.
1. Suspicions about the role of common childhood viruses and vaccines in the causation of autism have existedfor many years ; current indications suggests that these suspicions should be treated seriously.
2. Given the current interest in the combined MMR vaccine, a thorough investigation on the safety and efficacy of the vaccine is a matter of urgency .
3. The principle of informed consent must be respected.
4. Realistic and reliable guidelines should be provided so that patients and Physicians are in a position to understand the current status of the research and Governmental position. We always advise parents and others who request advice to consult their General Practitioner (GP).We would, however, suggest that the following factors be considered before a decision is reached.
- Is there a serious risk from the disease?
- Is the subject/patient likely to react abnormally?
- Does the patient already have sufficient levels of circulating antibodies so as to render unnecessary the administration of further doses?
- Would it be safer to delay the process until the child is older? Is it necessary to inoculate at such a young age?
- Could the risk be reduced by using single vaccines rather than multiple component products?