Baby 411 Blog

(Stop if you've heard this before . . .) Do Vaccines cause Autism?

Like the bad guy in a horror movie that keeps coming back to life, the controversy over vaccines and autism was back in the news last week—again!

The big news involved a decision by the Vaccine Court. What’s that? Here’s an Q&A to help understand the latest events:

What is the Vaccine Court?

    The United States Court of Federal Claims created a National Vaccine Injury Compensation Program in 1988 to give no-fault compensation to people who were injured or died due to vaccination. Over the years, families have never been awarded compensation for children who have autism due to vaccination.
    In June 2007, the federal court began processing about 4800 claims by families who believe their child’s autism was caused by vaccination. This is being called the Omnibus Autism Proceeding. To expedite this process, certain individual claims will be  “Test Cases” first to get a court opinion on the arguments. The 4800 claims are divided into three main arguments or “theories of causation” from the plaintiffs:

1) Did thimerosal (mercury) preservative in vaccines cause the child’s autism?

2) Did the combination MMR vaccine cause the child’s autism?

3) Did the thimerosal preservative and the MMR vaccine cause autism?

    Cases have already been heard, but no formal conclusions will be available until the entire legal process (including appeals) are completed.

What happened in the case that we’ve been hearing about on the news?

    Hannah Poling is a 9 year old girl whose case was reviewed by the vaccine court as a possible test case. After the court reviewed the child’s medical history, it was determined that her situation was NOT appropriate to be a test case by which to judge one of the theories of causation for vaccines causing autism.
    She was born with an underlying mitochondrial disorder, which predisposed her to neurological deterioration. This case is not a typical of other children with autism. The court (not a scientific study) determined that her neurological deterioration may have been aggravated by being vaccinated and settled her case.

What are mitochondria?

    Mitochondria are the powerhouses of our cells, in charge of energy production.

What is a mitochondrial disorder (MD)?

    MD’s are actually a group of several disorders. Many children do not show any symptoms until the body is stressed and requiring extra energy. Some children will have low muscle tone. They may have several episodes of deterioration and recovery. Some disorders affect only body organ, some affect several. Because of that, kids with MD’s can have different symptoms.
    Hannah Poling had an abnormality in the DNA (genetic makeup) of her mitochondria. This type of MD is something you are born with, not something that you develop later in life.

Did the court decide that vaccines triggered a child to have autism?

    No, what the federal vaccine court said was that the vaccinations may have stressed a child who had an underlying disease—this disease predisposed her to have deterioration of her brain and nervous system. Bottom line: Being born with a genetic mitochondrial disorder like Hannah Poling’s is like being born with an aneurysm. It’s a time bomb, waiting to be set off.

Did the court think the vaccines caused the mitochondrial disorder?

    No. The mitochondrial disorder Hannah Poling has is present at birth and it may not manifest any symptoms until the body is stressed. A stomach virus with dehydration, a high fever…any stress that requires body energy may be the tipping point that causes the deterioration.

If a child has a mitochondrial disorder, should he be vaccinated?

    Yes. Neurologists recommend vaccinating even kids with known MD’s because the stress of having the vaccine preventable disease—chickenpox or flu could be far more devastating, and likely more of a problem than the stress of getting vaccinated.

Could mitochondrial disorders explain the rise in children diagnosed with Autism Spectrum Disorders?

    No. Mitochondrial disorders are rare. There is not any significant data to show that the rate of mitochondrial disorders is any higher in children with autism than in the general population.

Can parents request to do a screening test for Mitochondrial Disorders at birth?
   
    We know what the next natural question is… why not just test every child for mitochondrial disorders before vaccinating them?
    Some tests on the state newborn metabolic screens do test for a few mitochondrial disorders (MCAD, LCHAD, VLCAD disorders).
    But, the gold standard tests for diagnosing many of the MD’s are invasive, and require muscle biopsies and spinal fluid. You can’t just do a simple screening blood test for MD before vaccinating all kids.
    And, remember, even if a child has a mitochondrial disorder, the recommendation is still to vaccinate.

Will this case change the vaccine recommendations?

    No, in fact, Dr Julie Gerberding, who heads the Centers for Disease Control, commented that Hannah’s case was a very special situation and that nothing from this case could be generalized to all children.

Why do we give a number of vaccines at the same time?

    There is a method to our madness. Giving several shots at one time is not just a matter of convenience. While doing them all at one office visit will save parents time and co-payments (most insurance companies charge a co-payment for each visit, even if it is just for a nurse to administer a shot), there are three good reasons why:

1. Vulnerability. The children most vulnerable to serious consequences from vaccine-preventable diseases are the youngest. For instance, a two month old with whooping cough, is much more likely to be hospitalized or die from it than a two year old. So, we try to give as many vaccines as we can, as early as we can, as safely as we can, to protect the youngest. We want kids to be protected as soon as possible. Otherwise, it’s just rolling the dice.

2. Insurance issues. While it is fine to give one vaccine or two vaccines at a time and return next week for a couple more, some families don’t have that luxury. They may have health insurance this week and not again for six months. Having a very staggered schedule leaves more risk of kids missing much needed shots.

3. Separation requirements for live vaccines. While some vaccines can be given one week apart, others cannot. Live vaccines must be separated by at least four weeks. Those are measles, mumps, rubella, varicella, flumist, rotavirus. If you decide to separate those out, you have to space them by at least four weeks each time—thus delaying protection until the series can be completed.

Whew! We know this is a bit much to digest—but the important message here is that vaccines do NOT cause autism. And vaccines save lives.

HIB Vaccine Recall

As expected, the Centers for Disease Control have recommended that the booster dose of HIB vaccine (given at either the 12 or 15 month well check) be postponed until the vaccine shortage is over. Children who are considered high risk of getting HIB infection are still prioritized to get their booster shots.

Babies will continue to receive their primary HIB vaccinations at 2 months and 4 months, +/- 6 months of age, depending on which HIB vaccination is used.

We will let you know when the shortage is over so if you have a toddler who misses that booster dose, you can get back into your doc's office to get it.

HIB Vaccine Recall

As you may have heard, Merck pharmaceutical company has recalled 10 lots (batches) of vaccinations that protect against the bacterial infection known as HIB (Haemophilus Influenzae B). This amounts to about 1 million doses being taken off the market. Merck voluntarily did this as a precautionary measure when manufacturing equipment was found to be contaminated with a bacteria called Bacillus cereus. It is unlikely that any individual dose of vaccine would contain any/enough of this contaminant to cause a health problem.

Bacillus cereus can potentially cause a localized infection at the injection site. Thus far, there have not been any reports of infection. If it has been more than a week since your child received a HIB vaccine  with one of the recalled lots (Pedvax HIB, Comvax--lot numbers are available on at cdc.org) and your child did not have any problems, you can stop worrying now.

Because vaccine production is an elaborate process, it will take several months for Merck to get the HIB vaccine supply back up to a steady volume. And, there is only one other vaccine manufacturer that makes HIB vaccine. In the meantime, it's likely that children who have never received HIB vaccine (2 month olds) or those with higher risk of invasive infection with HIB (kids without spleens, leukemia, other cancers, immunecompromised) will be prioritized over those who need a booster dose (usually done at 12-15 months of age).

We anticipate recommendations soon from the Centers for Disease Control and the American Academy of Pediatrics for who will be prioritized to receive HIB vaccine during a shortage. Stay tuned.

The New McCarthyism: Vaccines & Autism

Here is a reprint of guest opinion authored by Dr. Ari Brown in this weekend's Wall Street Journal:

October 27, 2007
   
Vaccines and Autism
By ARI BROWN
October 27, 2007; Page A8

Dangerous vaccines that harm kids. An epidemic of disabled children, hurt by an uncaring medical establishment.

Sounds like a B-grade Hollywood thriller. But this is supposedly a true story as told by actress Jenny McCarthy, author of the best seller, "Louder Than Words: A Mother's Journey in Healing Autism."

When I heard Ms. McCarthy tell Oprah and Larry King that vaccines caused her son's autism, I had a flashback to a cold winter's night, 13 years ago. I was the senior pediatric resident on call in the Intensive Care Unit. Cradled in the arms of her parents, a seven-year-old girl was brought to the emergency room at Children's Hospital Boston. The girl had come down with chickenpox a few days earlier -- she had a fever and hundreds of itchy skin lesions. That night, she had taken a turn for the worse. Her fever shot up to 106 and she became confused and lethargic. She was unresponsive and limp in her mother's arms.

The ER doctors suspected that her open sores allowed Strep bacteria to get under her skin and rage through her bloodstream. Now she was in "multiple system organ failure" -- every square inch of her body was shutting down all at once. IVs were placed into her veins to start fluids, antibiotics and medications to stabilize her heart and blood pressure. She was placed on a ventilator machine to breathe. Then she was brought to the Intensive Care Unit.

By the time I met my patient, she had tubes coming out of every opening and weeping skin lesions all over her body. I was used to blood and gore, but it was hard to look at her and not cry. Imagine how her parents felt when they saw their once-beautiful little girl in this grotesque state, struggling to survive.

My attending physician told me to grab dinner. This child would need me for the rest of the night. I returned to the ICU to find that my patient had gone into cardiac arrest and died. I watched, helplessly, as the nurses placed the little girl into a body bag.

Fast forward five months: The first chickenpox vaccine was approved. That day, I vowed never to let a child on my watch suffer from a disease that was preventable by vaccination.

That's a story that doesn't grab headlines or guest shots on Larry King. Vaccines are one of mankind's greatest scientific achievements. This year alone, they prevented 14 million infections, $40 billion in medical costs, and most important, 33,000 deaths. Yet vaccines are victims of their own success. Today's parents are unfamiliar with the diseases they prevent, but these diseases are alive and well in the U.S. -- I have personally seen children suffer from them.

Call it the New McCarthyism: Who cares about 100 years of scientific research? Vaccines are evil, because the Internet says they are. When a well-meaning parent like Ms. McCarthy blames vaccines for her child's autism, it's dangerous. Celebrity books come and go, but the anxiety they create lives on in pediatricians' offices across the country. A small but growing number of parents are even lying about their religious beliefs to avoid having their children vaccinated, thanks in part to the media hysteria created by this book.

Parents go through stages of grief when their child is diagnosed with a disorder like autism. We all want to blame someone for our suffering. That's understandable. Was there something we could have done as parents to prevent this? But why hasn't the media called out Ms. McCarthy on all the medical inaccuracies in her book? Has anyone actually read it? I have -- cover to cover. Here are two revealing points:

Ms. McCarthy told Oprah that her son was a normal toddler until he received his Measles, Mumps and Rubella vaccine (at 15 months of age). Soon after -- boom -- the soul is gone from his eyes. Yet she contradicts herself in her book: "My friends' babies all cracked a smile way before Evan did . . . he was almost five months old." Which is it? Was he normal until his MMR vaccine or were some of the signs missed before he got that shot?

Ms. McCarthy also contends that mercury in vaccines caused damage to her son's gut and immune system, leading to autism. Yet the mercury preservative Ms. McCarthy assails was removed from the childhood vaccination series in 2001. Her son, Evan, was born in 2002. It's hard to trust Ms. McCarthy's medical degree from the University of Google -- she comments about the Hepatitis C vaccine that wreaked havoc on a friend's child. An inconvenient truth: There is no Hepatitis C vaccine.

Doctors do need to do a better job of guiding families through the maze of autism treatments. I also desperately want to know why autism happens and how to treat it. But let's put our energy into funding autism research and treatment, not demonizing our vaccination program.

Ms. McCarthy is in the trenches, fighting for her son. I, too, am fighting. I am on the front lines everyday, trying to keep our kids healthy and protected. And, after all I have seen, one thing is certain -- I've vaccinated my own kids and would do it again in a heartbeat.

Dr. Brown, a pediatrician in Austin, Texas, is a fellow of the American Academy of Pediatrics.

Rotavirus vaccine, adverse events

Hi All,
For those of you who have infants 6 months old or younger:

You may have heard that the FDA has made a statement regarding 28 cases of bowel twisting (intussusception) and potential link to the rotavirus vaccine (Rotateq)

Now, before anyone panics....
There have been 3.5 million doses of the vaccine distributed since its approval one year ago. The number of intussusception cases are no greater than one would expect in the general population of infants--so no increased risk of intussusception due to vaccination has been determined.

The FDA posted this information to make families aware that intussusception is a rare, potentially adverse effect of the rotavirus vaccination and that any concerns should be reported to the Vaccine Adverse Events Reporting System (VAERS) at www.vaers.hhs.gov or call 1-800-822-7967.

Watch for severe abdominal pain, vomiting, diarrhea, blood in the poop, or grape jelly looking poop and contact your child's doctor if you see these symptoms.

New Rotavirus vaccine debuts

Rotavirus is a horrible stomach virus that causes severe vomiting, diarrhea, and dehydration. Over 50,000 kids get hospitalized in the United States every year due to this bug. Almost all kids get this infection, but it is most severe in infants and children under age three.

The rotavirus vaccine was approved by the Food and Drug Administration in February 2006, and is now routinely recommended for babies under six months of age. The vaccine is a live inactivated virus, and given by mouth. Many insurance plans are covering the cost for this new vaccine, but it’s a good idea to check your individual policy before heading into your doctor for it.

Chickenpox booster shot

Because we’ve received some questions from our readers, we wanted to give you a little more info regarding the new chickenpox recommendations.

The Centers for Disease Control and their advisory committee on immunization practices (ACIP) recommended on June 29, 2006 that the chickenpox vaccine should be a series of two doses instead of just one. The reason? About 1 in 5 kids who get vaccinated will still be susceptible to a mild case of chickenpox. A two-dose series provides better protection. The first dose is given at 12-15 months of age. The second dose will be routinely given at the 4-6 year old well check, along with other booster vaccinations. And, any child over six years of age who has already gotten the first dose needs a second “catch-up” dose (unless he has had the disease). The CDC has posted these recommendations on their website this month.

The American Academy of Pediatrics has not made their official recommendations yet, but their recommendations are coming soon. Many doctors have already begun giving the chickenpox booster based on the CDC’s recommendations.