Autism and Vaccinations
Marylynn Adamski, Stephanie Mansfield, Kristen Ziolkowski
Ferris State University
Running head:AUTISMANDVACCINATION
Autism and Vaccination
As a group we researched scholarly literature to determine the answer to our PICO
question: What does the literature reveal about the links between autism spectrum disorder and
vaccination? We first looked at the 1998 Dr Andrew Wakefield‘s study that stated that the
Measles, Mumps, and Rubella (MMR) vaccine had the ability to cause inflammation of the
bowels. It was thought that the inflammation of the bowels made them permeable and that it
then allowed peptides to leak from the bowels. It was hypothesized that these peptides were
toxic and would spread to the brain thus causing developmental disorders including but not
limited to autism. It was after this information was release that many people began to link the
MMR vaccine as the cause of autism. After the Wakefield study was release there were several
researchers that began testing the hypothesis. Researchers have not been able to find a link
between the MMR and inflammation of the bowels. But many parents still believe that the MMR
vaccine causes Autism. Our group looked at the literature available to determine what kind of
research was done and what the results were.
Literature Review
The group found ten scholarly articles and evaluated them for use in our paper. The
articles that we considered and rejected were as follows: Measles-Mumps-Rubella Vaccine and
Autistic Spectrum Disorder: Report From the New Challenges in Childhood Immunizations
Conference Concerned in Oak Brook, Illinois, June 12-13, 2000. Lack of Association between
Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. Naturopaths and
Children Immunization: Heterodoxy Among the Unorthodox. A National Study to Understand
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Running head:AUTISMANDVACCINATION
Why Physicians Defer Childhood Immunizations. Immunization Safety in US Print Media,
1995-2005. The Annuals: Vaccine
The four articles that we determined were significant to the PICO question we were
asking were as follows: MMR: marginalized, misrepresented and rejected, MMR and Autism,
further evidence against a casual association. Parent’s Vaccination Comprehension and
Decisions and A risk-benefit analysis of vaccinations.
The first article that we reviewed was done by Hilton, Hunt Petticrew (2007) and was
titled MMR: marginalized, misrepresented and rejected? Autism: a focal group study. The
objective of this article was to determine the impact the MMR vs. Autism controversy had on the
lives of parents caring for children with autism. After the controversy many parents began
refusing to vaccinate their children. Some parents expressed the preference that their children
naturally develop autism than get it from a vaccination. Researchers approached this study from
the view of parents whose children already have autism. The researchers used a sample group of
38 parents and asked them a series of questions regarding their child’s vaccination history and
the severity of autism.
There were several beliefs that were revealed in the Wakefield study. One of the beliefs
was that the parents felt guilty that they may have contributed to the child’s development of
autism by getting them vaccinated (2007). “Parents noticed a marked change in the child’s
behavior, mood and health after receiving the vaccine” (2007). “The parents believed that the
child had a weakened immune system at the time of vaccination which caused them to react
adversely to the vaccine”. ”There were some parents that believed that there was no link
between MMR and Autism, they believe that autism is a genetic disorder” (2007).
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Running head:AUTISMANDVACCINATION
This literature looked at what parents thought about vaccinations after the Wakefield
study was released. Many parents expressed feelings of vulnerability and that they should have
known not to get their child the vaccine. They also felt that health care workers were not
supportive of the concerns that they voiced. The Wakefield study showed how the controversy
has affected the parents of children with autism and that it is the responsibility of health care
workers to provide education about the risks and benefits associated with vaccines. According to
Hilton, Hunt, Petticrew, what this study added: It is the first research to look at the impact of the
MMR controversy on parents of children with autism. There is a need for health care
professionals to be aware that these parents may find it difficult to weigh up the risks and benefit
of subsequent vaccination for their children. That health care professionals need to demonstrate
a greater understanding of the negative impact this controversy has had on these parents (2007).
The second article that we reviewed was done by Farrington, Miller, & Taylor (2001):
MMR and Autism, further evidence against a casual association. This article investigated the
claims of the Wakefield study by widening the study group. The study group consisted of 100’s
of children unlike the Wakefield Study that was based on 12 children.
Farrington, Miller, & Taylor purposed that: Evidence for an increase incidence following
vaccination was sought using case-series method (2001). Three outcome measures were used:
regression, first parental concern, and autism diagnosis. After looking at all the results there was
no casual association between MMR and Autism. There were 357 cases diagnosed with autism,
64 of the cases did not receive any MMR, 43 cases received only one MMR and 62 cases
received a second dose (Farrington, Miller, & Taylor, 2001). The amount of children used in the
study was a solid base to determine that there is no link that can be medically proven. The study
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Running head:AUTISMANDVACCINATION
does give health care personal information and research to help with educating the public. This
study provides information to help a parent make an informed decision regarding their child’s
health. The study did not report on the number of children who received the vaccination and did
not develop autism. The article was easy to read and easy to understand which would make it
more acceptable for the parents.
The third article that was written by Downs, Bruine de Bruin, & Fischhoff from the
Carnegie Mellon University and was chosen was Parent’s Vaccination Comprehension and
Decisions. This article surveyed thirty parents to further understand their perception about
vaccination and what their basic knowledge about vaccination entailed. The parents were
surveyed one on one by phone and were asked twenty four questions that had a scale rating of
one to seven, with one being not at all and seven being completely or extremely safe,
trustworthy, and sufficient. The parents were then asked to explain their ratings. The parents
were also asked open ended questions that gave interviews insight into their views regarding
vaccinations. Most parents acknowledged that they had heard about the adverse reactions
coming from the MMR vaccine but stated that it did not deter them from getting the vaccine for
their children. Most of the parents interviewed were favorable towards vaccination but many
had a limited understanding of how the vaccine works. When asked where they get their
information at about vaccines, twenty one parents replied that they would get their information
from the internet and ten parents stated that they would ask their doctor. When asked why they
would use the internet the parents cited convenience and trustworthiness. The researcher went
on line and entered the terms vaccination, MMR, vaccine, and measles into the six commonly
used search engines (Google, Yahoo, Lycos, Metacrawler, MSN, and AOL). The top ten results
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Running head:AUTISMANDVACCINATION
on all pages were anti-vaccine web sites. It is very alarming that parents were more apt to refer
to the internet than ask their health care provider for information. This study showed the
importance of health personal educating the patients and having an understanding of the
misinformation that is available on the internet. The article was easy to read and well thought
out, it showed the importance. Although the sample size was small they were from various areas
of the country and represented a diversity to race, background and vaccination attitudes.
The last article that we reviewed was written by Ulrich Heininger and was titled: A riskbenefit analysis of vaccinations. This article explained the differences in risks and benefits of
vaccination. The articles look at two different kinds of risks; they are real risks and alleged risks.
“Real risks described as each vaccine is capable of causing adverse effects and alleged risks are
described as suspected side effects of vaccines” (2009). The articles presented the importance of
differentiating between coincidence and causality. Sometimes this is not very easy to do if the
events are rare and the background rates are not available. It is also important after an adverse
event happens to look at the severity of the side effect. The author also presented two different
benefits; they are vaccine efficacy and herd immunity. Vaccine Efficacy is the percent level of
risk reduction, which means how many people need to be vaccinated to prevent an undesirable
outcome in the population (2009). Herd immunity is described as the majority of people that are
vaccinated helping the ones who are not vaccinated by limiting the spread of organism from one
person to another (2009). Vaccinations in general have an overwhelming success records and
side effects are generally well known. But it is important that risk-benefit analysis should be
performed regularly and repeatedly to maintain public confidence in immunization programs.
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Running head:AUTISMANDVACCINATION
Performing risk-benefit analysis allows professional to work as part of an interdisciplinary team
to seek the best patient outcomes. It is also important that the information given to patients is
relevant and current. The benefit of immunizations should be emphasized and any
misconceptions should be clarified and corrected. The article was designed to provide
information that is helpful to health care professionals and parents. It is an educational tool that
can be used to help parents understand the risk and benefits associated with vaccinations.
References
Downs, J. S., Bruine de Bruin, W., & Fischhoff, B. (2008, February 8). Parents’ vaccination
comprehension and decisions. Vaccine, 26, 1595—1607. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science?_ob=MImg&_imagekey=B6TD44RSRNJ219&_cdi=5188&_user=1536291&_pii=S0264410X08000315&_origin=search
&_zone=rslt_list_item&_coverDate=03%2F17%2F2008&_sk=999739987&wchp=dGLz
Vzz-zSkzS&_valck=1&md5=d190f037c7133672aefe24286e3d5b9c&ie=/sdarticle.pdf
Farrington, C. P., Miller, E., & Taylor, B. (2001, March 7). MMR and Autism: further evidence
against a causal association. Vaccine, 3632-3635. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science?_ob=MImg&_imagekey=B6TD443B8K4F61&_cdi=5188&_user=1536291&_pii=S0264410X01000974&_origin=search
&_zone=rslt_list_item&_coverDate=06%2F14%2F2001&_sk=999809972&wchp=dGLz
Vzz-zSkzS&md5=957d5cd1d905e86
Heininger, U. (2009, October 5). A risk-benefit analysis of vaccination. Vaccine. Retrieved from
www.elsevier.com/locate/vaccine
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Running head:AUTISMANDVACCINATION
Hilton, S., Hunt, K., & Petticrew, M. (2007, January 20). MMR: marginalised, misrepresented
and rejected? Autism: a focus group study. Arch Dis Child. doi:10.1136/adc.2006.109686
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