Saturday, March 30, 2013

"Vaccines not Associated with Autism"

The headline provided by the CDC, in the linked article below specific to the described study states: "Vaccines not associated with Autism".

Regressive Autism is the only significant subgroup of autism that is the topic of parental observation of concern with vaccines, in the broad autism spectrum and the much broader autism phenotype. 

This study did not prove there was no association of vaccines with Autism. Specific to the vaccine concern and regressive autism, what it did provide evidence for, as quoted from the article, was this:

"Children with ASD with regression (the loss of developmental skills during the second year of life) did not receive an increased number of vaccine antigens when compared to children without ASD with regression."

This was only an analysis of regressive Autism as defined in the loss of developmental skills during the second year of life, which may have a number of different underlying contributing factors depending on the type of regression.

The regression was not defined specific to loss of language skills, so it is difficult to assess the specific characteristics and severity of the regression, in the sample of 49 children studied. A similar limitation was addressed by Matt Carey, in 2009, in the LBRB blog linked below when an association of Mitochondrial disease, fever, and Regressive Autism was suggested in research. In that study, greater detail was provided in how Regressive Autism was defined than the CDC topic study.

Regressive Autism includes a spectrum of specific symptoms and differing severity levels that were defined in the study. There are a number of potential contributing factors for regression.

For one, Hyperlexia is associated with regression in language, and that general condition is estimated in about 5 to 10% of cases of Autism. Another potential contributing factor of risk for regressive Autism is abnormal brain growth associated specific to males with Autistic Disorder.

It is not clear what the direct causal factors are in any of these conditions but there is growing evidence for identified associations that may play a role as contributing factors of risk. What is known about vaccines and identified in the link below, by the CDC, is that there is a risk of fever severe enough to cause seizures in about one out of every 3000 that are vaccinated.

There is recent research, as linked below, that seizures, language and motor development in Autism are potentially associated and linked in genetic mutations in duplications of chromosome 15q11-q13, in 1 to 3% of spectrum disorders.

One can consider that Autistic Disorder, alone, is currently defined very loosely at this point in time, where 2027 potential combinations of behavioral impairments and/or developmental delays technically could result in a diagnosis where 2 people could be assessed with Autistic Disorder without any intersection of behavioral impairments.

It is beyond reason to suggest that one underlying factor could be responsible for Autistic Disorder, considering the complexity of how it is currently defined as a disorder. PDDNOS is currently defined loosely enough by DSMIV standards that a diagnostic tool used to assess PDDNOS in recent research conducted by Catherine Lord and associates, as described in the analysis in the link below, provides a suggestion of a potential misdiagnosis in up to 90% of those assessed in a "non-autistic" group of individuals studied.

At this point in time, the DSMIV guidelines describe an Autism Spectrum of Disorders that could be associated with almost any factor, including being alive, at least per the diagnostic tool used in Lord's study. It has never been too early to suggest that Vaccines are not the definitive Cause of Autism.

However, it is much too early for the CDC to suggest that there is no association, from this very limited study and the research that has been done to this point. For whatever reason, as provided in research by the CDC, in one out of 3000 people vaccines trigger a side effect of high fevers and seizures. At this point, they do not have clear evidence for why it happens, but it happens.

This is a common issue in many side effects of pharmaceutical intervention. I suspect that if identical research was done in an attempt to disprove that seizures are associated with exposures to greater numbers of antigens from vaccines, that the results would be the same. However, if so, it would be incorrect to suggest that seizures are not associated with Vaccines. They happen. They just don't fully understand why.

It is rare that this happens, but it is also not well understood at all what the actual percentage of children with regressive autism that get severely ill after vaccines are. There is no way to objectively assess that other than a parental survey. However, in rare cases, some children do fall severely ill, and behavioral symptoms of Autism do become more noticeable leading to diagnosis. It happens. They just don't fully understand why.

The underlying factors of seizures cannot always be assessed in an individual. However, the symptoms can be measured by behavior or EEG, when there are no structural anomalies in neurology that can be assessed. There are no clues but behavior in many individuals currently assessed with behavioral impairments associated with ASD's.

At least up until this point, much of the problem in assessing what the causal/contributing factors are is poor diagnostic guidelines that have been used to define what Autism even is, as a neurodevelopmental behaviorally assessed condition.

With DSM5 standards and ICD11beta revision to date, Autism becomes a core behavioral impairment in reciprocal social communication. There is currently no one defined impairment that can be measured by either neurological or behavioral assessment that is core to all Autism Spectrum Disorders, in either DSMIV or ICD10 guidelines, so there can be no potential of one core definitive causal factor. Not even five. Not even 10.

As long as there is the potential of a contributing factor of seizures and potential brain damage, no matter what the underlying factor of the seizures may be, there is the potential of some association. However, at least at this point, per the research that exists, it does not appear to be a potential contributing factor in more than 1 to 3% of the spectrum.

That may not sound like many people but it could comprise 20 to 60K individuals currently estimated as diagnosed, under the loose criteria that exist now. The topic study does not come close to disproving that potential rare association, however small it may be, as a contributing factor.

As a comparative gravity of issue, there were about 7 people that participated in a flash blog that got the attention of a large charitable organization recently, per concern over how the organization describes people on the spectrum in a video about AAC. However, this article, in that same charitable entity's delivery of the research, as communicated here, received much greater amounts of outrage from parents that witnessed their children falling ill after vaccination with observation of greater behavioral impairments after that point. It happens. They don't clearly understand why.

Nevertheless, it understandably, still, is an issue of concern among those that witness this serious issue in their children, in rare cases when it happens. There might not be so much fear of government conspiracies, if the CDC could just state at this point they don't know why this happens as a potential side effect in rare cases after vaccinations. It is reported. It happens.

It is much more common than death following a vaccination but potentially less common than one out of 3000 severe fevers and seizures as a side effect of a vaccination. Additional effort at research addressing potential root associations such as genetic mutation, fever, seizures, mitochondrial disease and Autism could still provide additional answers.

However, at this point, a general assessment in a statement of no association by the CDC is not much more believable than a statement of definitive causation. At least, for the limited number of individuals that has witnessed increased observable impairments associated with Autism, happening in their children after vaccination.

It makes it sound like there are many people complaining about it if one limits their world to online resources, but the potential contributing audience, online, is one of global nature and millions of people. It is a similar issue as a couple of hundred people online taking offense at a compassionate portrayal in a video about AAC.

In the real world, it is not on the radar for most people. There are more people listening to the anti-vaccine rhetoric of Alex Jones in the US, than has been attributed to people like Jenny McCarthy. However, in the US, the CDC is doing a great job of promoting what is the overall benefit of vaccines as a lifesaving effort, as the US retains levels close to the highest it has had in the past in "Herd Immunity" in the population at about 95%.

Religious waivers are still the greatest area of refusal to vaccinate other than medical reasons. This is one area, overall, in the US, per society adherence to the medical model of disability, in advantage in keeping the population healthy. The US was hardly phased by the Wakefield Vaccine/Autism research, whereas in Europe there was a substantial causal effect associated lowering the assessed vaccination rates below "herd immunity" in 80-percentile territory.

Update on 4/21/13:

There is a very interesting discussion in the comments section of the Left Brain Right Brain, LBRB website, linked below, in a topic  where Matt Carey went through the historical element of this Vaccine Controversy along with the expression of disgust that exists among some people, associated with Andrew Wakefield and the recent outbreak of Measles in Europe.

There is good information in that discussion for anyone who may be considering Temple Grandin's recent recommendation on her website, in consideration of a delay in MMR vaccination to age 5, if there are familial vulnerabilities that Grandin identifies on her website, in what looks like a quote from her upcoming book, "The Autistic Brain". 

I support what I see as reasonable aspects of her concerns, in the comments section of the discussion linked below; however, in the discussion, I provide the evidence that I am able to locate and link, which still leans heavily toward the benefit of vaccines over the cost of potential rare side effects, even if some of the general vulnerabilities of neurology and health that Grandin identifies, exists per family history. 

My personal opinion that continues as it has been the same in the past, is that only a physician is qualified to determine what type of Health Vulnerability in each unique case is worthy of consideration on a decision whether or not to vaccinate. 

Where there is no health vulnerability assessed by a physician, all the available evidence that exists shows that the benefits of vaccination greatly outweigh the potential costs in risk of side effects that have been studied, identified, and assigned statistical risk in percentage, updated in 2012, as detailed in the discussion, linked below from the LBRB website.

I appreciate Matt Carey, allowing me to participate in the discussion, as a relative Layman on these issues, whereas some of the other individuals discussing the issue appear to have been focused on it for years. 

I do not share the same level of emotional investment that some of the other people in the comments express; however, on the other hand, I am not versed in the level of detail some others have by memory, so it is a research project for me in real time, where I stumble on some of the "vaccine related jargon" that I correct in my comments in the discussion.

In addition, Temple Grandin's website is linked below for those who wish to review the comment that I referenced from her, on that website.

(Edit on 4/28/13:  It appears that all Vaccination related advice has been removed from Temple Grandin's Website linked below)  

Part two of Update on 4/21/03:

My last and likely final comment quoted below that was not published on the Left Brain Right Brain Website, LBRB, linked below, in the discussion there on the "Vaccine Controversies".

It appears that Mr. Carey misunderstood my communication in thinking I was suggesting that Temple Grandin referred to the MMRV, in the NYT interview, when in actuality I was correcting a mistake in communication I had made earlier in the discussion

In addition, I
provided further information in support of both acknowledgement of the warranted concerns of parents of children who fall ill to severe side effects of vaccines and potential unrelated illness, as well as evidence existing that supports the overall benefit of vaccines vs. the overall cost of potential rare severe side effects.

Here is the comment that was not published, to this point in time, with some minor edits for reading clarity:

(Note: Matt Carey from LBRB, did approve my last comment and clarified he had problems with the mobile version of his Wordpress Blog. :)

"For clarification and correction regarding my earlier statement in this discussion about the MMRV vaccine, it is approved by the FDA. It is the CDC, not the FDA that does not recommend the MMRV be administered before age four, per recent findings by the Kaiser Vaccine Center.

The CDC's recommendation, as linked below, is for separate vaccinations of MMR and the Varicella vaccine before the age of 48 months (4 yrs.), due to the doubled risk of severe fever and seizures that have been identified in studies of children under the age of two.

The CDC recommends the MMRV vaccine after age four if the MMR vaccine has not been administered separately before age 4.

The risk of severe fever and febrile seizure at age 2 and below is identified as a little over two in 3000, for the MMRV vaccine, as opposed to one in 3000, with the MMR vaccine alone.

Per the 2012 study linked below, from the Kaiser Vaccine Center, the risk drops to 1 in 15,500 at age 4 to 6 for the MMRV vaccine and 1 in 18,000 for the MMR plus Varicella Vaccine.

Temple Grandin may be making her personal risk assessment of recommendation for vaccination at age 5, and what she sees as her own personal list of vulnerabilities associated with ASD, based in part, on this information from the Kaiser Vaccine Center.

However, the danger of not being vaccinated before age 5 based on these numbers alone, which is the newest government reported statistics on risk and side effect of high fevers and febrile seizures associated with MMR and MMRV, definitely does not outweigh the overall risk of what is associated with contracting the actual diseases before age 5 if one is not vaccinated with the MMR or MMRV or MMR plus Varicella Vaccines.

Febrile Seizures alone are not studied as increasing the risk of Epilepsy or Brain damage in the general population.

However, as quoted below from the article that provided further details from the linked abstract, it is worth noting that the peak of the high fevers and febrile seizures occur at 18 months, and typically do not occur after age 5.

The time frame of 18 to 24 months is where the correlation, to date, per regression and timing of event of high fever and illness among children has been identified and reported by parents of a relatively small subgroup of children exhibiting symptoms of developmental regression shortly after these high fevers and/or other elements of illness reported by parents.

This data from the Kaiser Vaccine Center presents a strong case, by itself, of a factor of correlation rather than causation in these vaccine related serious side effects and developmental regression occurring in the same time frame, among a rare sub group of individuals on the spectrum.

"The researchers noted that febrile seizures typically occur in children ages 6 months to 5 years, and the incidence of these seizures peaks at about 18 months of age."

One of the other greatest factors of correlation that may rule out vaccines as an actual direct causal factor per developmental regression is that research has also determined that there is abnormal brain growth specific to males assessed with regressive Autism, which happens well before vaccinations are administered.This abnormal brain growth is not significantly assessed in a group of females with regressive autism or other children diagnosed on the spectrum at the same age, in that study, linked below:

There was a presentation scheduled in the upcoming IMFAR, (International Meeting For Autism Research), in May, on the neuro-pathology of Cavum Septum Pellucidum and Cavum Vergae in Macrocephaly and Autism Spectrum Condition, that could have potentially shed additional light on this issue, but it appears that abstract has been withdrawn and may still be published in the future.

Cavum Septum Pellucidum and Cavum Vergae are already implicated in association in some co-morbid and inter-related genetic based disorders associated with the spectrum such as 22q11 deletion syndrome and Schizophrenia.

I am a relative "nobody" on the internet, but based on all the evidenced facts that have been presented in this entire discussion, I personally recommend that children should be vaccinated according to CDC recommended vaccination schedule unless a medical doctor advises not to do so based on medical evidence of substantial risk of vulnerability, where the potential cost assessed may be advised as outweighing the potential benefit of vaccination, in rare instances where that determination is made by a qualified physician.

For anyone that made it this far, in this compiling of data, in three of my blog posts here is an additional avenue of potential interest. :)

The Autism Research Scientist that writes in the Blog linked below provides a virtual "Goldmine" of resources addressing the Co-morbid conditions associated with what is currently described and defined as the Autism Spectrum under DSMIV guidelines.

In regard to GI issues and Autism, and all the research that is coming out now, that is farther removed from the "vaccine controversies", this Autism Research Scientist's post linked here and the comments on it, provide an excellent overview of the state of science on this issue of GI difficulties and Autism, leaving the "vaccine controversies" in the dust, so to speak.

All of the blogs he lists on his blogroll are worth taking a look at when one who is interested in this kind of science, has the time.


Additional attempts to bridge understanding and knowledge on this overall issue of Vaccines and Autism:

From the Left Brain Right Brain website:

From the Wrong Planet website:

From the Thinking Person's Guide to Autism Facebook Page:

Autism, the Internet and "Ideological First Identity", a Collection of Thoughts:

"AutisticS Peeks!"

It's Good

to Hear




Autistic Spectrum



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