New Study Shows No Link Between MMR Vaccine and Autism – Should Parents STILL Delay and Split Up the MMR Shot? Tuesday, September 9, 2008 A multicenter study (Harvard, Columbia, Mass General, CDC, and the AAP) involving 38 children (25 with Autism and 13 without) was released today, Sept 3, 2008. Its purpose was to duplicate the original research done by Dr. Wakefield in 1998 that raised questions about a link between MMR vaccine and autism. Dr. Wakefield had found measles virus infecting the intestines of children with autism and chronic diarrhea and proposed that further research be done to see if the measles virus in the vaccine could be a trigger for intestinal inflammation, chronic diarrhea, and autism. Dr. Thompson had published a study in the Lancet medical journal in 1995 (three years before Wakefield) showing a strong association between inflammatory bowel disease and Measles vaccine in adults. Wakefield tried to study this association in children with autism. Thousands of parents across the U.S. have described how their developmentally normal infant developed diarrhea and then regressed into autism between age 1 and 2 years. I have personally heard this same story from about 300 families in my own office. While many things in an infant’s life can trigger chronic diarrhea (like antibiotic overuse and milk/wheat allergies), because of Wakefield’s work many parents have suspected that the measles virus in the MMR vaccine (given at age 1) could be a trigger. In the last 10 years, many doctors have tried to discredit Wakefield’s research, without simply repeating his work to try to prove him wrong. This new study is the first to try to do just that. Doctors from some of the most reputable medical institutions did intestinal biopsies on 25 children with autism and 13 children without, and found only one child in each group with measles virus in their intestinal lining. Wakefield, on the other hand, had found measles in most of his 12 autistic patients and only a small percentage of his non-autistic control patients. The authors of this new study conclude that their results provide “strong evidence against an association of autism with persistent Measles Virus RNA in the GI tract or MMR vaccine exposure.” While the authors of this study don’t go so far as to conclude that their results completely prove that there can be no link between MMR vaccine and autism, their findings should allow parents to feel more comfortable giving the MMR vaccine. What should parents do with this information? It has been my practice to delay the measles part of the MMR vaccine until age 3 years (to bypass any possible connection between that vaccine virus and the susceptible age of regressive autism), and provide the mumps vaccine and rubella vaccine in separate doses at ages 1 and 2. This is one of the most controversial parts of my Alternative Vaccine Schedule. This recommendation was made based on Wakefield’s findings, and the fact that no other study had yet repeated his work and proved him wrong. In fact, Uhlmann published findings similar to Wakefield’s in Molecular Pathology in 2002, but in a much larger group of 91 kids with autism. His study was also discredited by most doctors and researchers. Now, in light of this new and seemingly credible study, the need to delay the Measles vaccine and split up the MMR has come into question. I have always known that my MMR vaccine precautions were not based on any solid proof of a connection with autism. But I felt that until someone proved Wakefield wrong, delaying the Measles vaccine was a legitimate precaution. So the question is, does this new study prove Wakefield wrong? Does it prove there is no connection between Measles vaccine and autism? The authors of the study put it this way: “This study provides strong evidence against an association of autism with persistent Measles Virus RNA in the GI tract or MMR vaccine exposure.” It isn’t absolute proof, but it certainly is a giant step in that direction. I am not yet ready to throw out the precaution of delaying the measles vaccine and splitting the MMR. There may not be any good scientific evidence that is necessary to delay Measles vaccine or split the MMR in regards to autism prevention (in light of this new study), but in my mind there are other potential benefits to getting only one live-virus vaccine at a time. Live-virus vaccines (MMR, Chickenpox) mimic the natural infection. Since children don’t catch all 4 of these infections simultaneously in nature, why induce them all together with vaccines if we don’t have to? I know the immune system can handle exposure to many simultaneous diseases, but when it comes to major diseases of childhood, like Measles, Mumps, Rubella, and Chickenpox, I feel it’s safer to expose infants and children to just one of these at a time. I believe the vaccines may work better this way, and may create fewer side effects when separated. What should parents do? Finding a doctor who is willing to split the MMR up is very difficult, and the separate Mumps and Measles vaccines are in short supply. Because we don’t really have any good evidence that the Measles vaccine should be delayed in order to bypass the age of regressive autism, I think it is fine to get the full MMR at age one if a parent can’t find the separate vaccines or can’t find a doctor to split them up. Parents should feel more confident giving their infant this shot at age one in light of this new study’s findings that the MMR or plain Measles vaccine probably does not have any relationship to autism. However, any parent who has access to the separate MMR component vaccines and wants their infant to get the shots split up according to my schedule should continue to feel free to do so. I will continue to offer this service in my office. I will continue to take the position that parents should have the freedom to choose a vaccine schedule that they are comfortable with, even if it goes outside the customary government and medical recommendations. Click here for a link to the new study: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003140 Dr. Bob Labels: Vaccines and Autism posted by Dr. Bob Sears @ 3:48 PM   35 Comments: At September 9, 2008 6:20 PM ,  Earth Kitty said... In light of this study and the difficulty of finding a cooperative doctor, if we decide to go ahead and have our son receive the MMR combo shot at age one is there any reason it shouldn't be grouped with the polio vaccine. We have been following the alternative vaccine schedule thus far. Thanks for your help.   At September 9, 2008 6:28 PM ,  Anonymous said... Are you concerned that the study only included who followed the pattern of regression so many parents report? My initial take on the study was that it was very credible, but as I read the details, I became confused as to why they only included 5 kids with developed GI problems and autism AFTER MMR vaccination (most had GI problems before the MMR vaccine). 5 seems like a very small sample size.   At September 10, 2008 9:23 AM ,  Dr. Bob said... Earth Kitty - when I give shots to older kids, I usually do group two together. I think doing the MMR and polio would be fine. Anon - You are right. There are some minor details about the study that people are wondering about. It doesn't take away from the findings of the study though. I think that some people will want a better study that includes more kids who both regressed and developed GI symptoms after MMR. I would add, though, that an infant could have GI symptoms BEFORE the shot, then get the shot, then show regression into autism, and IF the measles virus played a role in the regression, we could still expect to find it in the GI system. We don't NEED to only consider kids who developed GI symptoms AFTER the MMR.   At September 10, 2008 9:27 AM ,  Dr. Bob said... I have one thought to add to my blog. For many years most doctors and researchers were claiming it's impossible for the measles virus to travel from the injection site, into the bloodstream, and them find it's way into the lining of the GI system. That's one reason why Wakefield's work was frowned upon - people just couldn't believe the virus could do that. THIS new study demonstrates that it IS possible for the virus to do that. NOW, that fact doesn't prove that the virus will then trigger autism, of course. And the fact that virtually all kids in the study didn't have Measles virus is a strong argument against a connection. I just thought it was interesting that they did find TWO kids with the virus.   At September 10, 2008 12:21 PM ,  Science Mom said... I have personally heard this same story from about 300 families in my own office. While many things in an infant’s life can trigger chronic diarrhea (like antibiotic overuse and milk/wheat allergies), because of Wakefield’s work many parents have suspected that the measles virus in the MMR vaccine (given at age 1) could be a trigger. In the last 10 years, many doctors have tried to discredit Wakefield’s research, without simply repeating his work to try to prove him wrong. Dr. Bob, the problem with the belief that MMR causes autism is that is was based upon a fallacious 'study' to begin with. Wakefield et al. relied heavily upon parental reporting either directly or via physician with the pre-conceived notion that MMR was responsible for the GI disturbances that lead to the ASD diagnosis. Let's not forget how that pre-conceived notion was generated; attorneys waved money Wakefield's way to find a connection, litigation-driven hypothesis. So now, of course you have parents that will 'recall' the administration of MMR within a temporal relationship to GI disturbances and/or ASD diagnosis. It has been my practice to delay the measles part of the MMR vaccine until age 3 years (to bypass any possible connection between that vaccine virus and the susceptible age of regressive autism), and provide the mumps vaccine and rubella vaccine in separate doses at ages 1 and 2. This is one of the most controversial parts of my Alternative Vaccine Schedule. This recommendation was made based on Wakefield’s findings, and the fact that no other study had yet repeated his work and proved him wrong. In fact, Uhlmann published findings similar to Wakefield’s in Molecular Pathology in 2002, but in a much larger group of 91 kids with autism. His study was also discredited by most doctors and researchers. Well congratulations, you are basing your recommendations upon some very bad and very dangerous science. Let's review the problems with the Wakefield et al. and Uhlmann et al. studies. Wakefield's own graduate student, Nicholas Chadwick (who published his findings subsequent to Wakefield's) discovered that the samples were contaminated and upon subsequent testing, could not find any MV in the samples; he notified Wakefield who went ahead and implicated MV in the biopsy specimens. Next, Dr. Bustin's audit of the laboratory that Wakefield's and Uhlmann's samples were assayed in was fraught with problems, serious problems. Measles virus is an RNA virus which means you must perform an RT step prior to the PCR step to transcribe it to cDNA. This step was performed incorrectly so there was no way they could have transcribed and amplified their RNA samples, DNA contamination must have been present for them to have gotten the results they did. Alternatively, they fudged the entire data set; take your pick. Next, they did not validate their samples, they used Southern blot analysis which not only would have validated contamination, it is not the gold standard which they had available to them. Sequencing the amplicons would have definitively revealed that it was not the target sequence. Why didn't they do this? And more importantly, why aren't YOU questioning this? So the question is, does this new study prove Wakefield wrong? Does it prove there is no connection between Measles vaccine and autism? The authors of the study put it this way: “This study provides strong evidence against an association of autism with persistent Measles Virus RNA in the GI tract or MMR vaccine exposure.” It isn’t absolute proof, but it certainly is a giant step in that direction. That is what the responsible thing is for the authors to state. Unless you test the entire (as in everyone in the world) population, then one can never say absolutely but this, taken with all the other 'good science' out there should put this to rest so that research dollars aren't spent chasing a wild-goose. What this study also reveals, that should be expanded is the association between severe GI disturbances and ASD, not going on and on and on with the 'measles in the gut' hypothesis that has been thoroughly debunked. Yes, an ASD child was found with a low copy number of measles RNA but so was a control child, with no autism; that is what we call 'by chance and chance alone'. I am not yet ready to throw out the precaution of delaying the measles vaccine and splitting the MMR. There may not be any good scientific evidence that is necessary to delay Measles vaccine or split the MMR in regards to autism prevention (in light of this new study), but in my mind there are other potential benefits to getting only one live-virus vaccine at a time. Live-virus vaccines (MMR, Chickenpox) mimic the natural infection. Since children don’t catch all 4 of these infections simultaneously in nature, why induce them all together with vaccines if we don’t have to? I know the immune system can handle exposure to many simultaneous diseases, but when it comes to major diseases of childhood, like Measles, Mumps, Rubella, and Chickenpox, I feel it’s safer to expose infants and children to just one of these at a time. I believe the vaccines may work better this way, and may create fewer side effects when separated. This is one of the most overused anti-vax canards there is. Since the MMR viruses in the vaccine are attenuated, they do not produce full-blown pathogenesis (basic immunology) so how many of your patients exhibit full-blown measles, mumps and rubella that receive the vaccine Dr. Bob? All of them by your statement right? I would like to add that in order for the MMR to be the culprit of some ASD diagnoses then there should have been an absolute explosion of mysterious GI disturbances followed by a neurological regression when the vaccine was introduced oh say, 37 years ago (U.S.) and after each country recommended MMR. Yet nothing of the kind has been observed. I guess you can take this for what it is worth but there is no shame in re-defining one's perspective based upon the dynamic nature of science. On the contrary, it is the mark of a good critic to change recommendations based upon the best available science i.e. evidenced-based medicine. There is however, something to be said of clinging to very bad science and making vaccine recommendations upon that and potentially putting children in danger. Your MMR recommendation is more fashionable than scientific but as patronising as this may sound, you are getting there. There is no reason that you cannot address parental concerns using the best available science, they are not mutually exclusive.   At September 10, 2008 1:42 PM ,  Dr. Bob said... Thanks for the thorough input. I appreciate, as always, your science-based viewpoints. You are right about most of this from a scienfitic standpoint. A question though - if Wakefield's techniques were so flawed, why does this NEW STUDY say that they used the SAME techniques as Wakefield? Or did they use different techniques? The study said that in order to do a good comparison to Wakefield, they wanted to duplicate his techniques. Am I reading that wrong? From what you say here, you make it sound like they did things very differently to avoid his mistakes. But I think the study said they tried to duplicate him? Finally, of course people don't catch a true case of measles, or any other disease, from the vaccine. I never said that. The attenuated viruses DO mimic the natural infection in the way they act on the immune system (except that it is injected instead of ingested or inhaled, so not a good mimic). But the issue of whether it's better to give one live virus at a time versus all 4 CAN'T BE ANSWERED BY SCIENCE. Not everything can be answered by science. I have never found a study comparing the efficacy and the safety of single component live virus vaccines versus giving all four together. So, I make that recommendation, not based on science, but on the lack of science. Maybe it WAS studied, and I just can't find it? I think here is maybe where we differ in a basic premise. Most doctors (and maybe you too? I don't know) assume that vaccines are safe until proven otherwise. That would mean that the MMR would be assumed SAFER than the separate vaccines unless proven otherwise. I don't operate that way. I want proof something is safe before I do it. And if there's no proof, I look for a theoretical or logical way around the problem until it is proven. So, now we have some good proof that the measles virus may not be connected to autism. Most people can put that issue behind them. Maybe I can too. BUT, due to the lack of science that shows giving 4 live virus vaccines is better and safer than allowing the body to be exposed to one at a time (as it is in nature), I don't like doing it. With live virus vaccines, we are trying to mimic nature in how to induce an immune response. So, in my mind it's better to do it in a way that is a close to the natural infection as possible without actually causing an infection or bad side effects. I believe one-at-a-time is better, looking at it that way. When I wrote the vaccine book, I didn't make up these issues. There were already MANY people worried about multiple live virus vaccines. They were already worried about the MMR and autism. SO, what I set out to do is to help these families find a way around their worries. To vaccinate in a way that circumvents their worries. Because the problems with Wakefield's research weren't as clear a few years ago as they are now, I couldn't offer parents enough evidence to dismiss the MMR/autism connection. So, I looked for a way AROUND it - to delay the measles vaccine. In the next book writing, of course, this new information will provide a lot of reassurance to parents. But I'll still offer an alternative for those that are worried. As for splitting the MMR, and my basic view of spreading out shots, I do this to help parents circumvent their biggest vaccine worries, when science hasn't looked at the issue. ONCE someone does a study comparing vaccine side effects and efficacy in separate M, M, R and VZ shots with giving them all together, and find no problems, then that's another thing I can revise. There isn't always a scientific answer to everything. I agree, where this IS, we need to attend to it. Where there isn't, we do the best we can. I do appreciate you keeping me honest, and stimulating my thinking, so thanks for all you great input. Bob   At September 11, 2008 4:36 AM ,  Anonymous said... Dr. Bob, thank you for your insight. My daughter is 20 months old and I've been delaying the MMR component of the vaccination schedule. However, with the measles outbreak highest in Illinois (where we reside) I'm concerned about delaying the vaccination. My doctor is willing to split the shots, but informed me about the shortage of the measles component (not scheduled to be released until mid-october or later). Do you know where we can get the shot broken up? I'd be willing to travel and would feel much more at ease with administering one live vaccine at a time. Thank you so much for your time.   At September 11, 2008 9:27 AM ,  Dr. Bob said... You can try Hopewell Pharmacy in New Jersey - google search them. Or try asking on the Forum   At September 11, 2008 1:12 PM ,  Anonymous said... Dr. Bob, Thank you so much. I spent a majority of this morning trying to track the single dose vial down, and thanks to your resources I located one in the area even with the shortage. One last quick question if that's okay... We followed the standard vaccination schedule until 6 months of age. We skipped all the shots at 12-15 months of age and went in for the 4th round of DTaP at 18 months. It's two months later and I'm wondering if it's safe to administer the measles vaccine (her first live vaccine). Is two months sufficient time? Gratefully, Concerned parent   At September 11, 2008 1:42 PM ,  Science Mom said... Dr. Bob, A question though - if Wakefield's techniques were so flawed, why does this NEW STUDY say that they used the SAME techniques as Wakefield? Or did they use different techniques? The study said that in order to do a good comparison to Wakefield, they wanted to duplicate his techniques. Am I reading that wrong? From what you say here, you make it sound like they did things very differently to avoid his mistakes. But I think the study said they tried to duplicate him? Hornig et al. simply did what Wakefield and Uhlmann should have done i.e. control groups (Wakefield had none), properly maintained and calibrated machines, experienced technicians/scientists conducting the assays and most importantly, validation. Using multiple laboratories is a robust protocol and sequencing discordant results. Wakefield nor Uhlmann did not do this, they didn't verify the products that they claimed they got. If they had then it would have been so obviously contamination. Finally, of course people don't catch a true case of measles, or any other disease, from the vaccine. I never said that. The attenuated viruses DO mimic the natural infection in the way they act on the immune system (except that it is injected instead of ingested or inhaled, so not a good mimic). Call me a stickler for semantics then but your statement could very well imply to a lay person that live viral vaccines are pathogenic. The immune response is mimicked would have been my choice of words. But the issue of whether it's better to give one live virus at a time versus all 4 CAN'T BE ANSWERED BY SCIENCE. Not everything can be answered by science. I have never found a study comparing the efficacy and the safety of single component live virus vaccines versus giving all four together. So, I make that recommendation, not based on science, but on the lack of science. Maybe it WAS studied, and I just can't find it? You're kind of shifting the goal posts here. The issue at hand is MMR, not MMR-V and while the vast majority of children can tolerate this just fine (it's not going to be giving them 4 viral vaccines concomitantly that will provoke an adverse reaction, it will most likely be an exipient present in one of the viral strains), I don't agree with the recommendation to administer varicella at 12 months. Frankly, varicella is another discussion so I would prefer to keep this within the realms of MMR and the recent study. If you haven't seen this systematic review then you should: http://www.cochrane.org/reviews/en/ab004407.html The study inclusion criteria did not allow the authors to make a definitive statement about the safety of MMR although what they did discuss was the lack of any real differences in safety between the monovalent and trivalent vaccines. Their implications for practise were: "Existing evidence on the safety and effectiveness of MMR vaccine with that of the combined vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with mumps and rubella." So certainly yes, more definitive safety studies are in order however, without Wakefield's and the media's 'chicken-little' declaration, the issue of MMR causing autism wouldn't even be an impetus for your recommendation to split them up. When I wrote the vaccine book, I didn't make up these issues. There were already MANY people worried about multiple live virus vaccines. They were already worried about the MMR and autism. SO, what I set out to do is to help these families find a way around their worries. To vaccinate in a way that circumvents their worries. As I stated in my previous post, addressing parental concerns and abiding by science (not anecdotes and bad pseudo-science) need not be mutually exclusive. Measles encephalopathies occur in 1/1000, SSPE in children <2 years old, 1/2000, not to mention pneumonias (1/15) are very real and well-documented complications compared to the very very tenuous claim of measles-autism, the latter what you base your recommendation of 3 years old and a lot of children may be left very vulnerable. SM   At September 12, 2008 10:33 AM ,  Dr. Bob said... Thanks SM - good points here. Here is what Thoughful House and Dr. Wakefield have to say on the new study though: Managing Editor's Note: The following is a statement from the doctors at Thoughtful House. A study published yesterday in the Public Library of Science One (PLOS1), an on-line journal, failed to find evidence of measles virus in the intestinal tissue of 24 children with autistic regression and gastrointestinal symptoms. The findings contrast with those published in 2002 in which researchers from Ireland and the UK found measles in 75 of 91 biopsies from autistic children with GI inflammation, and in only 5 of 70 samples from non-autistic children . The children with autism in the 2002 study developed gastrointestinal symptoms and autistic regression after the MMR vaccine. In the study published yesterday, conducted by three independent laboratories, only 5 of the 25 children developed these symptoms after the MMR vaccine and therefore, only these five are comparable to the 2002 study. This new study confirmed that results from the laboratory of Professor John O’Leary (one of the collaborators on the new study, and senior author of the 2002 study) were correct, and identical to the results obtained by the laboratories of the Centers for Disease Control and Prevention (CDC) and Dr. Ian Lipkin of Columbia University. In that this new study affirms the reliability of Professor O’Leary’s laboratory and therefore of his previous findings, a major impact upon the current hearings in vaccine court is likely, wherein the government’s defense relies largely on the claim that Professor O’Leary’s finding of measles in the intestinal biopsy of Michelle Cedillo (a child with severe autism and epilepsy) was unreliable. The historical reliability of the measles assay used in Professor O’Leary’s laboratory is now confirmed. The authors of the PLOS1 study make the erroneous claim that epidemiological studies have not supported an MMR-autism link, when in fact the CDC’s own study published in 2004 shows a significant association between autism and younger age at the time of MMR vaccination. We are pleased to see that this new study provides further confirmation that children with autism suffer from gastrointestinal problems that deserve to be addressed as a priority. Dr. Andrew Wakefield, Executive Director of Thoughtful House Center for Children, whose work has focused on intestinal disease, and on the possible role of MMR vaccine in regressive autism in children with GI symptoms, welcomed these new findings. Dr. Wakefield was a co-author of the 2002 paper that, unlike yesterday’s study, examined children in the majority of whom there was a clear temporal link between MMR exposure and regression. Dr. Wakefield comments, “The search for the ‘footprints’ of measles virus in the intestine is merited, based upon the previous findings and the intestinal disease that is commonly found in these children. This new study rules out only one possibility – that the measles virus must remain for the long term in the intestine. We need to consider that the MMR vaccine can cause autism as a hit-and-run injury, but not necessarily leave the measles virus behind.” While we welcome this study as a piece in the ever-growing body of evidence that illuminates the complexity of autism and the possible factors that cause it, it is clear that yesterday’s study does not establish that the MMR vaccine is not associated with autism. This work examines one small part of a very complex equation, and in fact by affirming Professor O’Leary’s laboratory and assay methods, it inadvertently endorses the validity of his 2002 findings of vaccine-strain measles virus in the gut tissue of a group of children with autism. Contact info: Thoughtful House Center for Children info@thoughtfulhouse.org 512.732.8400 www.thoughtfulhouse.org DR. BOB'S THOUGHTS ON THIS: Everyone has been focusing on Wakefield's work in 1998, because that was published in a mainstream journal. Uhlmann and O'Leary's work, done in 2002, replicated Wakefield's findings, but in a much larger group. HERE IS MY MAIN QUESTION NOW: IF O'LEARY'S LAB WAS USED IN THE NEW STUDY, AND IN THE 2002 STUDY, THEN DOESN'T THAT HELP VALIDATE HIS 2002 FINDINGS? I KNOW I'VE HEARD FROM SCIENCE MOM, SAYING "Hornig et al. simply did what Wakefield and Uhlmann should have done i.e. control groups (Wakefield had none), properly maintained and calibrated machines, experienced technicians/scientists conducting the assays and most importantly, validation. Using multiple laboratories is a robust protocol and sequencing discordant results. Wakefield nor Uhlmann did not do this, they didn't verify the products that they claimed they got. If they had then it would have been so obviously contamination." HERE'S MY QUESTION - I STILL CAN'T FIND ANY INDICATIONS THAT O'LEARY USED ANY DIFFERENT TECHNIQUES IN THE OLD VERSUS THE NEW STUDY? I KNOW SM AND OTHERS POINT OUT THE CONTAMINATION ISSUE FROM THE OMNIBUS HEARINGS, BUT I'M NOT SURE THAT JUST BECAUSE THE OMNIBUS HEARINGS BROUGHT THAT UP DOESN'T MAKE IT TRUE. THIS NEW STUDY CLAIMS THEY USED THE SAME TECHNIQUES AS WAKEFIELD. BUT WHAT ABOUT O'LEARY AND UHLMANN'S STUDY? SAME TECHNIQUES? OR DIFFERENT? IN FACT, THE NEW STUDY DOESN'T EVEN MENTION O'LEARY AND UHLMANN FROM 2002 (DOES IT?). SINCE O'LEARY'S LAB WAS USED IN BOTH THE 2002 AND THIS NEW STUDY, WHY WOULDN'T THE NEW STUDY ADDRESS THE 2002 FINDINGS? LET'S SET ASIDE WAKEFIELD FOR A BIT AND SHIFT OVER TO O'LEARY AND UHLMANN FROM 2002. I WOULD LIKE TO HEAR PEOPLE'S THOUGHTS ON THIS. WHERE IS THE PROOF THAT O'LEARY'S LAB WAS CONTAMINATED IN 2002?   At September 12, 2008 10:42 AM ,  Anonymous said... Dr. Bob, We followed the standard vaccination schedule until my daugher was 6 months of age. Then we researched, skipped all the shots at 12-15 months of age and went in for the 4th round of DTaP at 18 months. It's two months later and I'm wondering if it's safe to administer the measles vaccine (her first live vaccine). Is two months sufficient time? Thank you.   At September 13, 2008 11:36 AM ,  estherar said... I don't know why you feel the need to yell, Dr. Sears, but the answers are really very simple: "IF O'LEARY'S LAB WAS USED IN THE NEW STUDY, AND IN THE 2002 STUDY, THEN DOESN'T THAT HELP VALIDATE HIS 2002 FINDINGS? " Nope. It merely proves that the O'Leary lab cleaned up its act sometime between 2002 and 2008 - very possibly after Prof. Stephen Bustin, who is probably the world's foremost expert in PCR, visited the lab in 2004 and found much fault with their lab technique. But hey, Prof. Bustin was only testifying under oath at the Autism Omnibus. Why believe him when you can believe Dr. Wakefield, whose scientific misconduct borders on the criminal? (Kevin Leitch, who has no conflicts of interest other than being the parent of an autistic child, has a very good post on this here). "LET'S SET ASIDE WAKEFIELD FOR A BIT AND SHIFT OVER TO O'LEARY AND UHLMANN FROM 2002. I WOULD LIKE TO HEAR PEOPLE'S THOUGHTS ON THIS. WHERE IS THE PROOF THAT O'LEARY'S LAB WAS CONTAMINATED IN 2002?" In 2006, D'Souza and colleagues attempted to replicate Uhlmann's molecular findings in the mononuclear white blood cells in the peripheral blood of ASD and normal children using the PCR primers from the Uhlmann experiment. They found that almost all the specimens tested positive, but most were obvious false-positive for technical reasons. However, even when they checked the samples that couldn't be dismissed as such...none of the PCR-amplified gene sequences had anything to do with the measles virus. The Uhlmann primers were apparently derived from contaminant DNA. (Which, given that the O'Leary lab skipped over the reverse transciptase step, was in any case a foregone conclusion). http://pediatrics.aappublications.org/cgi/reprint/118/4/1664 I really am curious why you keep in insisting there's a chance Wakefield is right, despite all the evidence of his misdeeds (which, to my utmost dismay, you never even bothered to mention in your book!) and all the accumulated scientific evidence against the hypothesis, of which your blogpost is just the latest example. You're right that a state of perfect knowledge (i.e, proving a negative) will probably be impossible. But using your criteria for 'perfect knowledge', I should be telling all mothers to quit nursing their babies when I give them antibiotics for their mastitis or dental issues. After all, have you seen any randomized controlled studies comparing the long-term effects of amoxicillin transmitted via breastmilk vs. placebo in infants? I know I haven't. And yet, you would probably consider a doctor ignorant and anti-breastfeeding if they suggested the above to their lactating patients (and so would I, mind). The lack of any role for MMR in the pathogenesis of autism has been studied far more intensely, and is fr better established, than the effects of most medicines on the nursing infant.   At September 15, 2008 12:06 PM ,  Bob Sears said... Anon - yes, 2 months is fine. Estherar - Didn't mean to "yell". Is that what caps lock means? I just did it to distinguish from the other text. I don't think I keep insisting that Wakefield may be right anymore. THANKS FOR THE VERY GOOD INFO HERE. YOU STATE SOME VERY GOOD POINTS, AS HAVE OTHER MOMS HERE. I'll tell you why this issue won't be put to rest by the autism community of doctors and parents. I think the main problem now is that the autism world of doctors and parents are so convinced there might be a connection, that it will now take a larger study of MAINLY regressive kids (maybe 200 or so?) who developed GI Sxs and regression after the MMR. If we can fail to find measles in their guts, we can let this lie forever. Now, I know everyone screams (in caps lock!) that we shouldn't subject kids to scopes and biopsies like that, BUT I will say that most of these kids may benefit from being scoped anyway - so why not study it in a large group. if you want the autism world to stop worrying about the MMR, this is what is going to need to be done.   At September 15, 2008 9:46 PM ,  Permission to Mother said... I know it's hard to find a physician to split the MMR. Because of your book, I have had more mothers ask me this past year. I do believe in giving families choices and individualizing care. I just wanted to point out that the reason I don't offer split choice is not to be stubborn, its that I don't have enough demand. It wouldn't be worth the overhead. I'd end up tossing out the rest of the doses. When the last mother asked about this, I decided to keep a list of families interested in split MMR. Since that time no one else has asked me. It may be easier for a Pediatrician (only sees kids) to justify stocking up on vaccines this way. I have all ages and some of my babies are for lactation consults only, and some stick with me for primary care. Of those, many refuse MMR completely. It doesn't leave much families wanting to split. Thank you for taking the time to organize all this info and keep your blog up. Denise Punger MD IBCLC   At September 16, 2008 12:36 PM ,  estherar said... Dr Sears:"I'll tell you why this issue won't be put to rest by the autism community of doctors and parents. I think the main problem now is that the autism world of doctors and parents are so convinced there might be a connection, that it will now take a larger study of MAINLY regressive kids (maybe 200 or so?) who developed GI Sxs and regression after the MMR. If we can fail to find measles in their guts, we can let this lie forever. " I don't think you can say that about "the autism community of doctors and parents" in general. You've got a rather shrill minority of parents of autistic children who base their beliefs on anecdote, and a small cadre of doctors who have a vested financial interest in keeping the non-controversy alive. The fact remains that after 10 years, there is no evidence whatsoever to connect the MMR vaccine to any type of autism and/or GI issues in any child (the idea that there is such a thing as "regressive autism" being debatable to begin with). In fact, there is much evidence to dispute it. This last study is but another nail in an already tightly-shut coffin; in fact, it's the equivalent of a six-inch-long nail, as it invalidates the study that was the very premise of the MMR/autism theory to being with. And I don't believe for one minute that the study design would convince either you or anyone else who still believes in the autism-MMR connection; you'd simply make up another excuse and ask for even more proof, perhaps in the form of spinal taps or brain biopsies. You admitted yourself in the original post that you still would recommend to split the MMR because of a belief, not founded in either science or empirical evidence, "there are other potential benefits to getting only one live-virus vaccine at a time". As I intimated before, that's taking the precautionary principle to unreasonable lengths. Can I at least suggest that this be weighed against the potential harms of sticking a toddler/preschooler (who knows what's about to happen to him and may very well be screaming hysterically in anticipation of the trauma) with three times as many needles as he should be getting? How does that square with the "attachment" you father is so fond of invoking?   At September 16, 2008 2:41 PM ,  Dr. Bob said... permission to mother - I totally understand - you DO have to have demand to stock the separate shots. Now that they are out of stock (on and off) it's even tougher. Estherar - I would actually say it's the majority of parents with autism, as well as the majority of doctors who work with biomedical treatments for autism. Out of the 500 patients with autism that I've seen so far in my office, 60% of them were REGRESSIVE. Regressive autism is without a doubt REAL. As for your statement: "And I don't believe for one minute that the study design would convince either you or anyone else who still believes in the autism-MMR connection; you'd simply make up another excuse and ask for even more proof, perhaps in the form of spinal taps or brain biopsies." I think you are mis-categorizing me. It's not that I believe in the connection. It's that it's now an issue, and I want it disproven with science. This study is a good start.   At September 16, 2008 5:05 PM ,  Anonymous said... I am pleased to watch the trend of this discussion, one parent commenting on getting the full MMR, Dr.Bob acknowledging the reasonableness of using this vaccine format (with some trepidation in certain situations), reading, re: the "the autism-MMR connection", Dr. Bob's comments, " It's not that I believe in the connection", followed by carefully considered comments of Science Mom, leading to the reasonable statement, "clinging to ... bad science and making vaccine recommendations upon that... potentially putting children in danger". Children need the health benefits that come from the protection of vaccines, including the MMR. Marc Lerner, M.D.   At September 22, 2008 5:09 PM ,  Anonymous said... Hi Dr. Bob, First, I want to let you know that my pediatrician thanked me for introducing him to your book. He now recommends it to other patients who are uncomfortable with or have questions about the traditional vaccination schedule. Though he stands behind and recommends the AAP schedule, he appreciates that I've done my homework and presented him with a thoroughly researched alternative (we're going with your complete, yet delayed vax schedule). So, thank you! I am so grateful The Vaccine Book came out the month my daughter was born. Which leads to my reason for posting: She's due for her mumps vaccination in October, and I've found a local pharmacy that can fill the scrip, but it's not available until at least January. Do you see any problem with waiting? Best, Jessica   At September 23, 2008 6:00 PM ,  Anonymous said... "She's due for her mumps vaccination in October, and I've found a local pharmacy that can fill the scrip, but it's not available until at least January. Do you see any problem with waiting? Best, Jessica" I know you weren't asking me, but I do see a problem with waiting. You will be risking exposing your child to a potentially serious disease called mumps. Mumps is real, it is often serious (that is why we vaccinate) and it is in circulation in the US. Dr. Bob I have to compliment you on probably the most logical and evidenced based argument on the anti-vaccinate (or in your case postpone-vaccinate) side of this so-called controversy. What is missing, as it always is when my patients balk at getting vaccinated, is any discussion or even awareness of the risk of NOT being vaccinated. I have not read your book, so I apologize if it is covered there, but please, PLEASE (shouting intended) pass on to every questioner like Jessica above, that while you have hypothetical concerns about the safety of administering multiple live vaccines (or whatever the fear de-jure is), that there are real and predictable risks of forgoing or delaying vaccination as evidenced by the resurgence of measles in our country. Curt Watkins, MD Pediatrics/Allergy/Immunology   At September 23, 2008 6:21 PM ,  Anonymous said... Perhaps this should be required reading for anyone who is considering delaying Measles vaccination: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4914a2.htm A CDC report on a Measles outbreak on the Netherlands in a school where vaccination levels were low. Three people died in this outbreak. That is the risk parents are taking by leaving their children unvaccinated. Granted, the risk assumed in the US is low because vaccine rates are high, but it seems to me the families who do not vaccinate their children are freeloading on the rest and, even worse, are exposing the broader community to the potential for an epidemic that will strike innocents such as infants who have yet to be vaccinated, or aging doctors like myself who have waning immunity from the original vaccine I got when I was a kid. Curt Watkins, MD   At September 24, 2008 1:26 PM ,  DR. Bob said... Hey Marc - glad to see you are still checking in on the site. Please drop in anytime. Anon - it is okay to delay the mumps, yes. It is not a common disease, and most child cases are harmless. There ARE, however, occasional bad cases, so beware. But those are rare. If you end up not being able to get it, go with Rubella now instead. Dr. Watkins - Welcome! Thanks for jumping in. You are totally right. Parents DO need to be aware of the disease risk. I would say that about 1/4 of my book is devoted to clearly explaining each disease and it's risks. Not vaxing for mumps, I believe, is fairly low risk. But not vaxing for measles is a bit more of a risk, as you've pointed out. Parents simply need to be educated and know the risks on each side.   At September 26, 2008 3:39 AM ,  Anonymous said... I find the shrill concerns raised about conflict of interest of those pushing/raising the MMR-autism possible link to be a bit laughable considering the conflicts of interest on the pro-vaccination side - corporate profits and interests that seem to have thoroughly taken hold of US regulatory bodies in all areas, not just the FDA. (The lack of regulation of Wall St is a particularly timely example of this.) And don't think the scientific community in terms of either research or education is immune from this pervasive bias. I am a scientist and a mother who has no connection to any health care profession or industry. As a scientist, I understand the nature of scientific debate - including how well-meaning people on both sides of a particular question can be passionate and turn out to be wrong. And how easy it is for scientists to fail to notice their own biases and preconceived notions, in spite of the hype that science is supposed to be free from these kinds of influences. I read this paper and had the same concern as the first anon and Dr. Wakefield. Why do so many in the "cases" group have prior onset of GI and/or AUT? Further, why can't we have a control to non-vaccinated children? Third, would the date of manufacture at time of vaccination have potentially had an impact on results? For example, if Thimerosal was no longer present in the MMR for the majority of cases in the study where as it was likely in all the cases in Wakefield's study, might that be another source of variation in outcomes? Add to that not just the Thimerosal in the MMR but the overall dosage that subjects would have likely received in say 1995 versus 2002? And after reading Wakefield's comments, is it possible that the time elapsed from MMR exposure and testing was too long? That is another relevant question to be examined. As a mom who only recently stopped breast-feeding, I would be extremely cautious about taking anti-biotics. And Dr. Bob is correct when he says that science doesn't have an answer for everything. Sometimes risks are not studied or can't be studied for ethical reasons. As a parent who holds the ultimate responsibility for the health and well being of my child, I always try to assess the known risks as well as consider other risks that may not have been considered and make the choice that I then will take responsibility for. Further, I try to consider the structural and other biases in sources of "knowledge." I applaud Dr. Bob and other physicians who seek to provide information and guidance to empower parents to make these decisions rather than lecture or demean as some of the other posters on this blog seem to do. I know enough about science to know that it can make us arrogant. I think humility in the face of questions about MMR, autism, vaccination, individual health, public health and many other issues are desperately needed. And for Dr. Watkin's post - I have never had a health care provider warn me about the risks of vaccine injury, only about the risks of complications for communicable diseases - so don't worry. Your drum is getting beat quite a lot out there. In fact, I believe the doctor I took my child to see today said "vaccines have been proven safe and effective." He did not even hint at the known fact of the risks of adverse reactions.   At September 27, 2008 7:35 AM ,  wcl said... Dr.Bob, Is it safe to give the live virus MMR vaccine to a two-year-old with a mother in the first trimester of pregnancy? (The child has not as yet been immunized for this, due to the mother's concern about the above autism controversy.) The CDC says it's safe to vaccinate the child of a pregnant mother even in the first trimester, but is that completely true? Is there even a small risk? Would you suggest delaying the shot, and if so, until when? wcl   At September 27, 2008 2:43 PM ,  Anonymous said... I wonder whether this study will have any effect in tightening up vaccination policies in states with loopholes used by anti-vax folks. It's talked about a little bit on this blog: http://jolt.unc.edu/blog/2008/09/26/anti-vaccination-movement-takes-turn-worse   At September 29, 2008 6:30 PM ,  concerned mama said... Dr. Bob, My pediatrician does not offer separate M, M, R vaccines, so my child will be getting the MMR together. I would like to wait until he is more than 1 year to give MMR. What are the risks/benefits of waiting until my child is 2 or 3 years old versus giving it at 1 year? Thanks!   At October 2, 2008 7:04 PM ,  Anonymous said... What number of children that you have given the separate shots too have come down with autism. I would think if you had some children in your practice come down with autism it would be a good measuring tool. If none of your patients have then that would say volumes of it being bad to combine   At October 7, 2008 12:33 PM ,  Emily, Jeremy and Peyton said... After searching on the web I found a place to order the vaccines seperately. The doctor can fax information to American Medicine Merck and order the seperate vaccines for $140 (2007 price) Have you heard of this? Also, if I can get the vaccines seperately which should we start with first and second? What is the time frame that we should wait between each vaccine? My son is turning 2 this month and I have waited for this vaccine hoping more information would be found, but I am afraid to wait longer. Also, do you know of any doctors in Missouri who offer this vaccine seperate? I am currently living in Springfield, MO thank you!   At October 11, 2008 7:47 AM ,  Kimberly Abbott said... Does anyone know anywhere in the U.S. where the single dose measles vaccines are currently available? I have tried Hopewell in NJ and they are on backorder, and the same at GW Hospital in DC which usually carries separate shots. I am traveling to Brussels with my 13 month old son next month and I need to vaccinate him before I go since Belgium is one of the countries that has been exposed recently. I am willing to travel anywhere to get this done, but it has to be in the next few weeks. Are there any single shots in existance right now?   At October 22, 2008 3:19 PM ,  Jennifer H said... Dr. Bob, would it be possible for me to use an excerpt of this blog in the book "The Moms' Guide to San Diego"? This website is a great resource I'd like to share with the 3,000 moms of the Parent Connection   At November 7, 2008 10:25 PM ,  ..depezahrial.. said... Dr Bob, I don't think I can found a doctor here in my country who can do the separated shot of M,M,R. My daughter is only 2 years old, and she haven't got the MMR... Because I am still not very sure about its effect. so.. It is really OK to postponed the shot until she reach 3 years old? just making sure (^_^)   At April 17, 2009 1:43 PM ,  Anonymous said... My Ped said that the MMR vaccine is no longer split up by the manufacturer (Merck, I think?) Is this true and if so, what is your recommendation for how to administer it to child? My daughter is 13 months old and is showing signs of bowel distress (chronic, severe constipation since 5 months old, and was just diagnosed with Sensory Processing Disorder). I am afraid to give her the full MMR shot now. My state, IL, requires 2 doses of measles for kindergarten. Please help!   At June 7, 2009 5:56 AM ,  Anonymous said... Science MOM, are you really a mother? As a mother myself, I think I would know if my child was developmentally normal up until the MMR vaccine. I think I would know that my child no longer looks me in the eye or calls me mom. I think I would know if my child was walking and suddenly could not walk. I ask again, are you really a mom? Because ONLY a mom/dad can tell you such truths. AND for all the rest of the scientist and doctors, i find it insulting on behalf of all those poor parents, that you simply deny what they know to be the truth. THAT is, they once had a perfectly normal, healthy child, who regressed horribly after the vaccine. I would imagine that if your child had suffered like this, you may think differently. Well I would hope you would. AS far as I am concerned, ALL the so called scientist, doctors etc, that are in denial of these facts, are simply NEGILGENT. Also, can someone explain to me why it is HIGHLY recommened that I stay completly away from foods containing mercury whilst I am pregnant, BUT yet its ok to INJECT the POISON into my childs body? This is what I would say the greatest contradiction in modern medicine... All you heartless doctors, PLEASE learn to think for yourself for once..AND yes, I am yelling!!!!!!!!   At July 16, 2009 3:17 PM ,  Anonymous said... Please forgive if you have already answered this somewhere. I want to use your alternate vaccine schedule, but my doctor (and I'd like to stay with him for other reasons) does not offer the MMR separately and will not buy it that way. So my quesstion is, where would you recommend fitting the full MMR in on your alternate schedule, with as little harm to baby as possible? I'd like to do it by itself but see no place to do that on the schedule. Thanks.   At July 23, 2009 6:23 AM ,  Anonymous said... in response to anonymous post on june 7th at 5:56am. I think the point is that autism symptoms are typically delayed and may not be noticeable until around the point in the child's life when the mmr vaccine is to be administered. as far as mercury goes: there is a difference between ethylmercury in thimerosal and environmental methylmerucry. a big difference. i think it is a bit over the top to suggest that doctors and scientist who have differing opinions are heartless and unable think for themselves. i do not fault them for their desire to spend money on really getting to the bottom of autism, instead of wasting it on these hyped concerns. I would suggest you maybe yell less and read more. i read recently that a typical tuna sandwich can contain 5 times more mercury than your average flu vaccine. so, maybe tuna sandwiches cause autism? i am sure we could get some lawyers and pay Wakefield to do a study for us. i think the real problem here is that so many people seem to have bought into this hype while, at same time, filling their children up with obscene amounts of unhealthy fast foods. i am pretty sure that childhood obesity, with its future health ramifications, are of far greater concern to our children's health here in the US than an mmr vaccine.   Post a Comment << Home   The 12 Childhood Vaccines Vaccine-preventable Diseases Boost Your Child's Immune System FAQs Parents Who Choose not to Vaccinate Current Outbreaks and Epidemics Vaccine Discussion Forum Read Dr. Bob's Online Interviews Updates & Corrections to The Vaccine Book Find a vaccine-friendly doctor near you Alternative Vaccine Schedule American Academy of Pediatrics 2007 Vaccine Schedule Vaccine News Vaccines and Autism Vaccines and their diseases

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