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Research ArticlePractice

The autism-vaccine story: fiction and deception?

G. Michael Allan and Noah Ivers
Canadian Family Physician October 2010, 56 (10) 1013;
G. Michael Allan
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Noah Ivers
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Clinical question

Is there any link between the measles-mumps-rubella (MMR) vaccine and autism?

Evidence

  • In 1998, Wakefield and colleagues published a study1 of 12 children that suggested a link among MMR vaccine, gastrointestinal symptoms, and autism.

  • At least 20 higher-quality studies2,3 have since failed to show any link between the MMR vaccine and autism.

    • -A cohort study following more than 500 000 children for a mean of 4 years found no association between MMR vaccination and autism or autistic spectrum disorder.4

    • -A case-control study of 1294 autistic and 4469 nonautistic children found no association with vaccination.5

    • -Time-series analyses reveal no association between the start of MMR immunization and autism6,7 and no association between trends in vaccination rates and autism.8,9

    • -Canadian research shows no link between MMR vaccination and neurodevelopmental disorders.10

  • Studies also show no association with the preservative thimerosal, another suggested cause of autism.11–13

Context

The truth about the Wakefield study is as follows:

  • The 12 children in the study were carefully selected, and many of their parents already believed MMR vaccination was the cause of their children’s autism.14

  • Dr Wakefield had serious undisclosed financial conflicts: he was funded by lawyers involved in lawsuits against immunization manufacturers and was applying for a new vaccine patent.14,15

  • In 2004, 10 of the 13 authors retracted their support for the MMR-autism association.16

  • Britain’s General Medical Council investigation found Wakefield guilty of dishonesty and irresponsibility.15

  • In 2010, the Lancet fully retracted the Wakefield study.14

The legacy of this unfortunate publication includes decreased immunization rates with increased measles rates17 and continued parental immunization fear.18

Bottom line

Convincing evidence from multiple countries shows no association between MMR vaccine (or thimerosal) and autistic disorders. The origins of this controversy incorporate unethical conduct and misleading research.

Implementation

A gap exists between ideal and actual pediatric immunization rates.19 Meta-analysis of 47 randomized controlled trials showed that patient reminders can increase immunization rates.20 Adding new babies to a register at first visits and using patient reminders when immunizations are due are effective, feasible, office-based approaches to improving immunization rates. Patient leaflets are available to help address concerns about long-term side effects.21,22

Notes

Tools for Practice articles in Canadian Family Physician are adapted from articles published twice monthly on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician. Feedback is welcome and can be sent to toolsforpractice{at}cfpc.ca. Archived articles are available on the ACFP website: www.acfp.ca.

Footnotes

  • The opinions expressed in this Tools for Practice article are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Wakefield AJ,
    2. Murch SH,
    3. Anthony A,
    4. Linnell J,
    5. Casson DM,
    6. Malik M,
    7. et al
    . Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351(9103):637-41.
    OpenUrlCrossRefPubMed
  2. ↵
    1. DeStefano F
    . Vaccines and autism: evidence does not support a causal association. Clin Pharmacol Ther 2007;82(6):756-9.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Hornig M,
    2. Briese T,
    3. Buie T,
    4. Bauman ML,
    5. Lauwers G,
    6. Siemetzki U,
    7. et al
    . Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. PLoS ONE 2008;3(9):e3140.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Madsen KM,
    2. Hviid A,
    3. Vestergaard M,
    4. Schendel D,
    5. Wohlfahrt J,
    6. Thorsen P,
    7. et al
    . A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 2002;347(19):1477-82.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Smeeth L,
    2. Cook C,
    3. Fombonne E,
    4. Heavey L,
    5. Rodrigues LC,
    6. Smith PG,
    7. et al
    . MMR vaccination and pervasive developmental disorders: a case-control study. Lancet 2004;364(9438):963-9.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Taylor B,
    2. Miller E,
    3. Farrington CP,
    4. Petropoulos MC,
    5. Favot-Mayaud I,
    6. Li J,
    7. et al
    . Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet 1999;353(9169):2026-9.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Taylor B,
    2. Miller E,
    3. Lingam R,
    4. Andrews N,
    5. Simmons A,
    6. Stowe J
    . Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324(7334):393-6.
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Dales L,
    2. Hammer SJ,
    3. Smith NJ
    . Time trends in autism and in MMR immunization coverage in California. JAMA 2001;285(9):1183-5.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Kaye JA,
    2. del Mar Melero-Montes M,
    3. Jick H
    . Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 2001;322(7284):460-3.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Fombonne E,
    2. Zakarian R,
    3. Bennett A,
    4. Meng L,
    5. McLean-Heywood D
    . Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics 2006;118(1):e139-50.
    OpenUrlAbstract/FREE Full Text
  11. ↵
    1. Hviid A,
    2. Stellfeld M,
    3. Wohlfahrt J,
    4. Melbye M
    . Association between thimerosal-containing vaccine and autism. JAMA 2003;290(13):1763-6.
    OpenUrlCrossRefPubMed
    1. Andrews N,
    2. Miller E,
    3. Grant A,
    4. Stowe J,
    5. Osborne V,
    6. Taylor B
    . Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. Pediatrics 2004;114(3):584-91.
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Verstraeten T,
    2. Davis RL,
    3. DeStefano F,
    4. Lieu TA,
    5. Rhodes PH,
    6. Black SB,
    7. et al
    . Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics 2003;112(5):1039-48. Erratum in: Pediatrics 2004;113(1):184.
    OpenUrlAbstract/FREE Full Text
  13. ↵
    1. Eggertson L
    . Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ 2010;182(4):e199-200.
    OpenUrlPubMed
  14. ↵
    1. Dyer C
    . Wakefield was dishonest and irresponsible over MMR research, says GMC. BMJ 2010;340:c593. DOI: 10.1136/bmj.c593.
    OpenUrlFREE Full Text
  15. ↵
    1. Murch SH,
    2. Anthony A,
    3. Casson DH,
    4. Malik M,
    5. Berelowitz M,
    6. Dhillon AP,
    7. et al
    . Retraction of an interpretation. Lancet 2004;363(9411):750.
    OpenUrlCrossRefPubMed
  16. ↵
    1. Asaria P,
    2. MacMahon E
    . Measles in the United Kingdom: can we eradicate it by 2010? BMJ 2006;333(7574):890-5.
    OpenUrlFREE Full Text
  17. ↵
    1. Freed GL,
    2. Clark SJ,
    3. Butchart AT,
    4. Singer DC,
    5. Davis MM
    . Parental vaccine safety concerns in 2009. Pediatrics 2010;125(4):654-9.
    OpenUrlAbstract/FREE Full Text
  18. ↵
    1. Guttmann A,
    2. Manuel D,
    3. Dick PT,
    4. To T,
    5. Lam K,
    6. Stukel TA
    . Volume matters: physician practice characteristics and immunization coverage among young children insured through a universal health plan. Pediatrics 2006;117(3):595-602.
    OpenUrlAbstract/FREE Full Text
  19. ↵
    1. Jacobson Vann JC,
    2. Szilagyi P
    . Patient reminder and recall systems to improve immunization rates. Cochrane Database Syst Rev 2005;(3):CD003941.
  20. ↵
    1. Health Canada
    . It’s your health—misconceptions about vaccine safety. Ottawa, ON: Health Canada; 2009. Available from: www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/misconception-eng.php. Accessed 2010 Jul 24.
  21. ↵
    Vaccine safety. Ottawa, ON: Canadian Paediatric Society; 2008. Available from: www.caringforkids.cps.ca/immunization/VaccineSafety.htm. Accessed 2010 Jul 24.
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Canadian Family Physician: 56 (10)
Canadian Family Physician
Vol. 56, Issue 10
1 Oct 2010
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