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#29 The Autism and Vaccine Story: Fiction and Deception?


CLINICAL QUESTION
QUESTION CLINIQUE
 Is there any link between the MMR vaccine and autism?

BOTTOM LINE
RÉSULTAT FINAL
 There is convincing evidence from multiple countries showing there is no association between the MMR vaccine (or thimerosal) and autism disorders. The controversy is based on unethical and untruthful findings.


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EVIDENCE
DONNÉES PROBANTES
 In 1998, Wakefield and colleagues published a study1 of 12 children that suggested a link between MMR vaccine, gastrointestinal symptoms, and autism.    Since then, at least 20 higher quality studies2,3 have failed to show any link between MMR and autism. For example, 
  • Meta-analysis4 of 5 cohort and 5 case-control studies of 1.2 million+ children: no difference in autism or autism spectrum disorder.  
  • Time series analyses reveal no association between start of MMR immunization and autism,5,6 and no association between trends in MMR vaccination rates and autism.7,8 
  • Canadian research also shows no link between MMR vaccination and neurodevelopmental disorders.9 
    • A Cochrane review of 10 studies found no association between MMR vaccination and autism.10 
  • Thimersol, a preservative in vaccines, has been suggested as another possible cause of autism but a number of studies have failed to show an association.4,11-13   
Context: 
  • The truth about the Wakefield Study:  
    • The 12 children in the study were carefully selected and many parents already felt MMR was the cause of their child’s autism.14 
    • The children’s medical histories were altered, e.g. of 9 children reported to have regressive autism, 3 did not have autism diagnosed at all.15 
    • Dr. Wakefield had serious undisclosed financial conflicts: funded by lawyers involved in lawsuits against immunization manufacturers and applying for a new vaccine patent.14,16    
    • In 2004, 10 of 13 authors retracted their support for the MMR-autism association.17   
    • Britain’s General Medical Council has subsequently investigated Wakefield and found him guilty of dishonesty and irresponsibility.16  
    • In 2010, 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.19 
dec 16 2017 by Ricky

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Author(s)
Auteur(s)
  • G. Michael Allan MD CCFP
  • Noah Ivers MD CCFP

1. Wakefield AJ, Murch SH, Anthony A, et al. Lancet. 1998; 351: 637–41.

2. DeStefano F. Clin Pharmacol Ther. 2007;82(6):756-9.

3. Hornig M, Briese T, Buie T, et al. PLoS One. 2008;3(9): e3140.

4. Taylor LE, Swerdfeger AL, Eslick GD. Vaccine 2014;3623-9.

5. Taylor B, Miller E, Farrington CP, et al. Lancet. 1999; 353: 2026–29.

6. Taylor B, Miller E, Lingram R, et al. BMJ. 2002;324:393–6.

7. Dales L, Hammer SJ, Smith NJ. JAMA. 2001;285:1183-1185.

8. Kaye JA, del Mar Melero-Montes M, Jick H. BMJ. 2001;322:460–3.

9. Fombonne E, Zakarian R, Bennett A, et al. Pediatrics. 2006;118(1):e139-50.

10. Demicheli V, Rivetti A, Debalini MG, et al. Cochrane Database System Rev 2012;2 :CD004407.

11. Hviid A, Stellfeld M, Wohlfahrt J, et al. JAMA. 2003;290:1763-1766

12. Andrews N, Miller E, Grant A, et al. Pediatrics. 2004;114;584-591.

13. Verstraeten T, Davis RL, DeStefano F, et al. Pediatrics. 2003;112;1039-1048.

14. Eggerston L. CMAJ. 2010;182(4):e199-200.

15. Deer B. BMJ 2011;342:c5347.

16. Dyer C. BMJ. 2010;340:c593.

17. Murch SH, Anthony A, Casson DH, et al. Lancet 2004;363:750.

18. Asaria P, MacMahon E. BMJ. 2006;333 (7574): 890–5.

19. Freed GL, Clark SJ, Butchart AT, et al. Pediatrics. 2010;125;654-659.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.

Most recent review: 16/12/2017

By: Ricky D Turgeon BSc(Pharm), ACPR, PharmD

Comments:

Evidence Updated: Meta-analysis; Bottom Line: Unchanged.
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