Tuesday, October 30, 2007

Japan Autism Link Revisited

It's been over two years now since the Yokohama study was released. This is the study that supposedly dispelled the possible link between vaccines and autism.

But did it really?

The problem I have with the study is that they do not mention how much mercury was actually in the vaccines, both before and after. And yes the kids were still vaccinated. All they did was give one shot instead of three separate shots. But how much mercury was in the damn vaccines? Hello? And did they really go from 3 shots to one shot, or did they go from 3 shots on three separate visits to 3 shots in one visit? This study really does leave me with a sick stomach. Why so much obfuscation?

Here is the Guardian article claiming the link was dispelled.




Now check this out:

http://www.bmj.com/cgi/eletters/330/7491/558-a#99989

There is way too much rebuttal on this page, and it contains many links to yet even more rebuttal. I'll just post some of the commentary.

John Stone:

Perhaps the most striking single emerging point is that when MMR was abandoned in Japan it was largely replaced not by three staggered injections, but three separate injections administered in the same visit. The study therefore sheds no light on Andrew Wakefield's original proposition that it was advisable to space the shots a year apart, but this point is not acknowledged and would seem to invalidate its main claim. I think the authors, and other MMR proponents, should be prepared to discuss this point.


John P. Heptonstall:

Takahashi et al 2003 (1), although a small study that requires larger follow-up, makes two very important observations. The team found a “statistically significant association of ASD with monovalent measles immunisation, non-mumps and non-rubella immunisation” and that “results suggest a decreased risk of developing ASD with MMR compared to monovalent antigens”.

Taking Honda et al together with Takahashi et al, one might suspect that

1. Replacing MMR vaccine with monovalent measles vaccine may be expected to cause a rise in the incidence of ASD and

2. If monovalent measles vaccine poses a significant risk of ASD then MMR, which contains the equivalent of a monovalent measles component, might also be expected to pose a risk of ASD.

The rate of increase in ASD throughout the period of Honda et al, 1988-96, might not result solely from any increase attributable to monovalent vaccines but also to other as yet unspecified agents and any alterations to the criteria for diagnosis under review through that period and beyond.

Thimerosal, and therefore ethyl mercury, is suspected of causing ASD. If this is the case, the study period being for children born between 1988 and 1996 includes children born between 1988 and 1992 who may have received MMR vaccine, and up to 150ug mercury in scheduled DTP (3 doses of 25ug in first year of life) and Japanese Encephalitis (JE) vaccines (3 doses of 25ug between 3 and 4 years of age), whereas those born between 1993 and 1996 would be likely to have received monovalent vaccines and no MMR (banned in April 1993) vaccine plus a potential for up to 75 ug mercury as they would not have attained the age for JE vaccination (3 to 4 years of age) before study end 1996.

Also statistics show there was considerable parental concern over MMR vaccines prior to withdrawal as uptake dropped from almost 70% in 1988 to 1.8% in 1992 – and some parents may have become suspicious of other vaccines during the study period confusing the study outcome.

In addition to ethyl mercury there are other potential agents of cause of ASDs and other adverse effects within the MMR and M, M and R vaccines. They range from the attenuated viruses themselves (measles virus was found in autists and not controls by Singh et al and Wakefield et al; MMR vaccine virus was found in the brains of autists and not controls by Singh et al; rubella virus has long been associated as congenital rubella with autism) and adjuvants such as neomycin (2) which is a highly toxic antibiotic and gelatine (3) which has caused anaphylaxis after MMR vaccination. If MMR and monovalent vaccines cause ASDs the constituents must be investigated and adjuvants might feature more highly if, as Takahashi et al suggests, monovalent vaccines carry greater risk of causing ASD; each child may have received several monovalent jabs instead of a single MMR jab.

To complicate analysis further, the Japanese MMR vaccines used at the time of these studies were of different types and might present separate risks for causing ASDs. Kimura et al 1996 (4) shows that Standard MMR was associated with 16.6 cases of aseptic meningitis/10,000 recipients compared to Biken MMR which had 0 cases/10,000, Takeda MMR with 11.6/10,000 and Kitasato MMR with 3.2 cases/10,000 recipients of the vaccine. One might reasonably expect any risk of ASD to vary with vaccine type.

Rather than an uninterrupted increase in incidence of ASD from 1988 to 1996 as the conclusion suggests, the incidence varied considerably during the 8 years covered. The 47.6 (per 10,000) 1992-3 incidence almost returned when it dropped from 85.9/10,000 in 1990 back to 55.8 and 63.3 respectively in 1991 and 1992. In 1993 it jumps to 96.7, then to 161.3 in 1994, then falls back to settle at 115.3 and 117.2 in 1995 and 1996. I see no scientific merit in ignoring those considerations and concluding that a rise in incidence from 47.6 to 117.2 over 8 years when MMR was withdrawn in 1993 proves that MMR had no part to play in that increase. Important statistical variations may have been ignored.

Children born between 1988 and 1992 might have lesser risk of ASD from MMR compared with monovalent vaccines but a greater risk from a potential 150ug mercury intake which contrasts with the 1993-96 cohort who may have realised a greater risk of ASD from the monovalent vaccines but a lesser risk of mercury-induced ASD from a lesser potential intake of 75ug mercury. Other vaccines carrying additional toxic burdens might add to the risk such as the 6 or more doses of neomycin injected via varicella, rubella, OPV, mumps and measles vaccines and 4 doses of gelatine injected with mumps, measles, rubella and varicella vaccines. These variables might eventually explain why Honda et al’s incidence rate is not of constant increase.

Contrary to Cole’s and Evan Harris’s rather overenthusiastic acceptance of Honda et al 2005, when one considers both the Honda and Takahashi studies one must surely suspect that both MMR and monovalent/single antigen vaccines are probable causes of ASDs. If that is the case all haste is required from Members of Parliament and the Health Protection Agency to direct that identification of the risk posed by MMR and monovalent vaccines to our children is a national priority.

Regards

John H.

References

1. "An epidemiological Study on Japanese Autism concerning Routine Childhood Immunisation History" by Takahashi H et al, Jpn. J. Infect. Dis 2003; 56: 114-117

2. Kwittken PL et al “MMR vaccine and neomycin allergy”, American Journal of diseases of children 1993; 147(2): 128-9

3. Kelso JM et al “Anaphylaxis to measles mumps and rubella vaccine mediated by IgE to gelatine”, Journal of Allergy & Clinical Immunology 1993; 91(4): 867-72

4. Kimura M et al “Adverse events associated with measles mumps and rubella (MMR) vaccines in Japan”, Acta Paediatrica Japonica 1996; 38(3): 205-11



Clifford G. Miller:

The problems with the Honda/Rutter MMR/autism paper from Japan are only just the start of this. The fact of a dip in autism followed by a large rise when vaccinations increased over 150% in 1993 in Japan (according to official Japanese government figures) is actually evidence of at least two things. It is strong evidence of a causal association between the combination of vaccines and autism-like and related disorders.

It is also evidence of the existence of a dechallenge/rechallenge case series at a population level. Now that is beyond any doubt powerful. The dechallenge occurred by taking MMR away with a positive dip in autism on a population level. This was followed by a rechallenge with a positive rise in autism by reintroducing the single vaccines in place of the MMR. The single vaccines were meant to be administered at 4 week intervals, but according to an NHS publication, Japanese children received them on the same day.

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