Editor's Commentary: The Continuing Controversy over Autism and Vaccines Nine-year-old Sara Poling probably does not realize it but her medical case has brought new attention to the old charges that vaccinations can cause autism. Despite well-documented refutations (see below), the Georgia case has become the subject of widespread media attention. Community providers, school nurses and school-based health centers may anticipate inquiries from parents and other caregivers. Early in March, a special federal court that compensates people who may have been harmed by vaccines agreed to pay her family an undetermined amount because Sara developed autism-like symptoms around the time she received the standard childhood immunizations and the inoculations may have aggravated her symptoms. The Internet is now bristling with messages and postings from parents claiming Sara’s case validates their claims that the vaccines can cause autism and the government has conceded the point. The family appeared on CNN's Larry King show and repeated their assertion that the government accepted their argument. The decision has rekindled the dispute over the safety of all immunizations. The American Academy of Pediatrics and public health officials are increasingly concerned that a small but growing number of parents are refusing to get their children inoculated. Diseases once thought controlled are returning. Sara, whose father is a neurologist and whose mother is a lawyer who trained as a nurse, was a bright, normal-behaving child who received her standard vaccinations at the age of 18 months eight years ago. Because that was a bit late, she received all five shots simultaneously. She quickly began screaming and ran a high fever. Then her behavior changed and she demonstrated symptoms much like autism, her family told a news conference. "Suddenly," her mother, Terry said, "my daughter was no longer there." Claim filed The family filed a claim with a special court set up to handle such cases and the government agreed to a payment without hearing any testimony. That led to the belief by many parents of autistics that the government had finally agreed to their position. Hundreds of blogs and websites trumpeted that position. Not so. The U.S. Centers for Disease Control and Prevention (CDC)'s director, Julie Gerberding told a March 6, 2008 news conference, days after the decision, that the case "does not represent anything other than a very special situation." According to the CDC, Sara may not have autism at all. DNA tests have shown she has a genetic disorder called mitochondrial disease, which affects the ability of cells (including brain cells) to use nutrients. Symptoms of mitochondrial disease sometimes match those of autism. Autism itself has no physical manifestations that can be demonstrated in a laboratory, so it is impossible to prove whether the girl has the disorder. The vaccines could have caused a fever that exacerbated the mitochondrial disease. Or, the worsening could have simply been coincidental. The Associated Press reports there have been similar cases, so that while Sara's case is rare, it is not unique. The medical establishment maintains there is no scientific evidence linking autism and vaccines. Sanjay Gupta, a physician and medical reporter for CNN, said his PubMed search of published research papers came up with 404 studies that specifically denied a relationship. Recent studies in England and Sweden also failed to find a connection. In 2000, the Institute of Medicine at the National Academy of Sciences reviewed all the evidence of a correlation between the disorder and vaccines and found none. The American Academy of Pediatrics came to the same conclusion the same year. Nothing has changed since those reports. Alleged threat of vaccinations However, the furor over immunizations is leading to an unexpected problem: the reemergence of diseases once almost eliminated in America. Last month, according to the New York Times, 12 children fell ill with measles in San Diego. Nine had not been vaccinated because of objections from their parents; the other three were too young to get the shots. One child had to be hospitalized. Measles is virtually unknown in the United States. Every state allows exemptions from laws requiring vaccination for medical reasons; most states permit exemptions for religious reasons. According to the National Conference of State Legislators, 20 states permit parents to claim exemption for personal or philosophical reasons. Johns Hopkins Medical Institutions has reported that in 1991 less than 1 percent of school children were unvaccinated due to parent personal belief refusals. By 2004, the percentage was up to 2.54. Epidemiologists warn that children who are not vaccinated are at risk for preventable diseases, and endanger other children. Some children are too young for vaccinations and are therefore susceptible, and some vaccines, such as measles, are not 100 percent effective. The transcript of the CDC's news conference following the Poling case can be found at: http://www.cdc.gov/od/oc/media/transcripts/2008/t080307.htm. The November 2006 issue, Vol. 7, No. 8, Assessing Effects of 'Personal Belief' Vaccination Exemptions, provides additional background information. http://www.healthinschools.org/News-Room/EJournals/Volume-7/Number-8/ Assessing-Effects-of-Personal-Belief-Vaccination-Exemptions.aspx
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