Vaccines and Autism: a Controversial Issue
Our Philosophy on Pediatric Immunizations
Very common questions we are asked every day are those concerning the standard vaccines:
their risks, possible association with autism, and alternate vaccination schedules. First, let us say
that the vaccines have been thoroughly studied and are medically safe. There is no evidence to
suggest any link to autism- either in the MMR vaccine or thimerasol (which is no longer present
in modern vaccines). This section is intended to provide you with more information about these
confusing issues and to present our practice philosophy. We do support all of the immunizations
and would note that Dr .Mansour and Dr. Upton have immunized their own children using the
standard immunization schedule.
Overview on Autism
Autism is a delay in the development of multiple basic functions including communication,
language, social interaction and repetitive behaviors. Historically, only severe cases of autism
were recognized. As our understanding of the disorder has heightened, the diagnostic criteria for
autism has changed and as of 1994, autism is now defined as autism spectrum disorder,
comprising a spectrum of disorders on a continuum. This can range from mild, awkward social
skills with no language deficits (often diagnosed as Asperger’s syndrome) to severe global
developmental delays (classic autism). Since the revision of this diagnostic criteria, autism has
been one of the most commonly diagnosed conditions in the world, affecting one in 150-400
people. It is prevalent in all areas of the world. Autism may seem like a modern disease but it is
not. Reports dating back to the 1700’s can be found of people now believed to have suffered
from autism. In the 1950’s, the disorder was officially named. It was not until 1994 that rates of
autism began to dramatically rise. Studies suggest that the majority of this is from increased
reporting and better knowledge of the disorder, more so than from a disproportionate increase in
number of cases. Thousands of people previously thought to have learning disabilities, mental
retardation or ill-defined psychiatric illnesses residing in institutions now are recognized as
suffering with autism. To date, we do not have a cause or a cure for autism but there has been
marked progress with greater understanding of the disease.
Causes of Autism
Autism has a strong genetic component. Identical twins with an autistic sibling have a 75%
chance of having the disorder while fraternal twins have only a 3% chance. Autism is more
common in several genetic syndromes and more common in those with autistic parents. Autism
is also 4 times more likely to occur in boys. Autism is believed to be from several different
genes rather than one single genetic mutation, making it much harder to identify. Prenatal
genetic factors and insults soon after birth are believed to play a role and have yet to be
identified. Environmental factors cannot be ignored and this is also being heavily investigated;
studies are now underway to examine the medical burden of pollutants, pesticides, hormones in
our food, PCB’s and heavy metals. Although we do not know what causes autism, there is
plenty of evidence to suggest that immunizations, including the MMR vaccine, do not cause
autism.
Does The MMR Vaccine Cause Autism?
No. Even though it is believed that genetic factors or insults soon after birth account for the
majority of cases of autism, most children are usually not diagnosed until after 18 months of age
after children fail to meet their developmental milestones. Developmental experts believe the
majority of children often have subtle signs earlier which are not diagnosed because there is such
a large range of normal development. Parents often disagree with this. A small minority of
children have what has been termed “regression” autism where development was normal until a
relatively acute onset of developmental delay. This spawned the parental concern about the
vaccines (both MMR and thimerasol-containing vaccines) causing autism as these are given prior
to the diagnosis of most cases of autism.
This concern gained rapid momentum in 1998 after a study of 12 autistic children was published
in Britain hypothesizing that the MMR vaccine caused intestinal inflammation and an
autoimmune reaction which could have caused autism. Since that time, numerous studies from
around the world looking at thousands of cases have shown that there is no evidence for any
relationship between the vaccines and autism. The authors of the original paper suggesting a link
recanted their hypothesis in 2004 due to lack of sufficient evidence. After independent review,
the Institute of Medicine, Centers for Disease Control, and the American Academy of Pediatrics
have all issued statements about the safety of the vaccine and the fact that it is not linked to
autism. Although reviews of “regressive” autism in hundreds of children showed no signs or
symptoms within 2, 4 or 6 months of the immunization, there are still case reports of infants
developing autism shortly after the MMR vaccine, and after febrile illnesses or allergic food
reactions. These case reports are outnumbered by the scientific evidence. This controversy will
likely continue for some time until the cause of autism is better understood. We still do not
understand the exact cause of autism but we do know that there is no clear link of the MMR
vaccine to autism.
Does Thimerasol Cause Autism?
No. Thimerasol is a form of mercury which was used as an antimicrobial in the equipment used
to manufacture vaccines. It was banned from being used as a preservative by state law over 8
years ago. All of our vaccines have NO thimerasol, not even trace amounts. Thimerasol has also
been studied and has never been shown to be related to autism. Regardless, this is no longer an
issue with the modern thimerasol-free vaccines.
Do Too Many Vaccines At Once Cause Autism?
This has also been studied in very small studies. Presently, the standard schedule calls for 6
immunizations (5 intramuscular shots and 1 oral) at 2, 4, and 6 months with 3 immunizations at
12 months and 3 immunizations at 15 months. Many in the holistic and naturopathic community
are concerned that too many shots at once too early could be harmful to the immature immune
system. In theory, this makes sense but in reality infants are exposed to far more in their first
year. In the first year of life, the average infant who is exposed to other children (playgroup or
daycare) will have an average of nine viral infections (including upper respiratory infections,
gastrointestinal infections, and other febrile illnesses). These are live viruses. Giving 5 shots at
once is not too much for a baby’s immune system.
What Should I do?
We realize that this may be a difficult issue for you and hopefully this information will help you
in your decision. Again, we would strongly recommend to proceed with the standard vaccine
schedule as outlined separately. Both Dr Mansour and Dr Upton have immunized all of their
children using the standard schedule.
Alternate Vaccine Schedules
What We Can DoWe can give all separate shots for DTap, Hib, PCV, IPV, HBV rather than use the combination
vaccine Pediarix- DTaP, HBV,IPV. This would involve five shots instead of three. We can space
out the vaccines- for instance three shots followed by the remainder two shots one week later.
We would not recommend this but if this is important to you we can accommodate your needs.
Although not recommended, we can delay the MMR vaccine. In California, you may still enter
Kindergarden without any immunizations as long as you sign a waiver of liability. If you choose
not to vaccinate your child, we will ask you to do the same for our records.
What We Cannot Do- We do not stock the separate individual measles, mumps and rubella
vaccines. We only stock the combination MMR vaccine.