Running Head: EFFECTS OF MMR VACCINE

Effects of the MMR vaccine on Children related to Autism Spectrum Disorder

Ahlam Mishmish

Blake Veglia

Edzarae Bell

04/05/2017

NURS 3749: Nursing Research

Dr. Hoyson

Ms. Kent-Strollo
EFFECTS OF MMR VACCINE

Abstract

The purpose of this research was to study the relationship between autism spectrum disorder and

general vaccinations, including the measles mumps rubella (MMR) vaccine. The correlation

between the effects of Andrew Wakefield’s study on the public, regression, first parental

concern, autism diagnosis, infants who have been vaccinated with the MMR vaccine in

comparison with infants who have not been vaccinated, natural immunity and acquired immunity

was explored. The research was drawn from six sources and it contains ecological, case-control,

retrospective, and prospective cohort studies. It was found that there was significant evidence

that favors the rejection of the correlation between the MMR vaccine and autism.

Correspondingly, there was also no substantial verification regarding proof that vaccinating an

infant between the ages of 12 to 15 months is associated with the development of autism or

autism spectrum disorder. Overall, these findings designate that a parent should not avoid

vaccinating their child out of concern for autism spectrum disorder.

EFFECTS OF MMR VACCINE

Effects of the MMR vaccine on children related to Autism Spectrum Disorder

In the medical field there have been countless controversial issues regarding the side

effects of medications, antibiotics, and vaccinations. In recent years, the most divisible question

appears to be on the impression that vaccines trigger autism. Vaccines are generally considered

to be the most prosperous public health interventions ever developed worldwide. The chief

disagreement amongst researchers is the frequency of diagnosis of many neurological disorders

such as autism after the child has been vaccinated with a particular vaccine. Such vaccines

include the MMR, which is designed to treat measles, mumps, and rubella. This vaccine is given

to the infants in one injection, to help strengthen the immune system against each of these

viruses. It is imperative to look at every part of the statistical information that was acquired from

the numerous studies that were conducted throughout the world, in order to identify if infants

who have been vaccinated are truly at an increased risk for autism. The following research

question was addressed: Are infants who have been vaccinated with the MMR vaccine at

increased risk for autism in comparison with infants who have not been vaccinated?

Literature Review

Introduction

In order for nurses to accurately address this concern, educating parents about the

benefits of vaccinating children must be done in the nursing profession. Hence the information in

this research was acquired via Science Direct, National Center for Biotechnology Information,

and Oxford Academic databases, specifically The Lancet, Elsevier, and pediatric and child health

journals. Six sources were evaluated for widespread data collection regarding feasible relations

between immunizations and developmental disorders, most conspicuously autistic disorders.

Andrew Wakefield’s study on the public, regression, first parental concern, autism diagnosis,
EFFECTS OF MMR VACCINE

infants who have been vaccinated with the MMR vaccine in comparison with infants who have

not been vaccinated, natural immunity and acquired immunity will be further discussed.

Andrew Wakefield’s study

In 1998, Andrew Wakefield, a British surgeon, and his colleagues initially anticipated the

conviction that autism might be caused by the MMR vaccine. Although there was no scientific

verification to support their claims, there was also no robust data on the prevalence of autism in

children born before and after the introduction of the MMR vaccine in 1988. The postulated

association between the MMR vaccination and autism was based on a reported close sequential

involvement between these two events. Since the MMR vaccine is typically given to the infant

an around 12 to 15 months of age, and the mean age at which parents of children with autism

first report concerns about their child's development is 18 to 19 months, this close chronological

connotation in some autistic children would be expected by chance (Farrington, Miller, &

Taylor, 2001).

Wakefield published an article that concluded his findings after performing a study that

was based on only twelve children about the symptoms they started to develop after receiving a

dose of the MMR vaccine. He determined that “the vaccine itself was increasing autism in

children and their first behavioral symptoms varied from 24 hours to 2 months. The parents of 8

of the 12 children linked the onset of their child’s developmental problems to the vaccine”

(Farrington, et al., 2001). Wakefield’s research was ultimately cogitated as incorrect and was

discredited due to serious procedural errors, undisclosed financial conflicts of interest, and

unethical violations; the vaccine truly had no correlation to autism.

Regression, First Parental Concern, Autism Diagnosis

EFFECTS OF MMR VACCINE

In 1999, professor Brent Taylor and his coworkers from The Department of Community

Child Health at University College Medical School, London did a arduous study on 357 cases to

scrutinize the affiliation between the receipt of the MMR vaccine and the development of autism

succeeding the vaccination. Their evidence was sought using a case series method in order to

evaluate the immediate risks following the transient exposures. Taylor measured three main

sequels in the children that he studied: regression, first parental concern, and autism diagnosis

(Farrington, et al., 2001). Regression was supervised in the child for up to six months once the

vaccination was administered, but in order to adjust any diagnostic delays lengthier periods of

investigation had to be conducted for parental concern and autism diagnosis.

In conclusion, his discoveries were pretty significant; he established that the best

elucidation of the close correlation observed in the twelve cases of the Wakefield study is a

combination of selection bias and chance association. He determined that the age of regression

parallels with the age at which MMR vaccine is administered. Respectively, Taylor was able to

resolve through his research that there was no difference in the age of the diagnosis of autism in

vaccinated and unvaccinated children, and that the onset of these regressive symptoms did not

occur within two, four, or six months after receiving the vaccine (Farrington, et al., 2001). In the

three groups that were assessed, most of the diagnoses were made amongst 24 and 48 months of

age, signifying the rejection of the notion that there is a correlation between vaccinations and

autism in the subsequent risk periods (Farrington, et al., 2001).

Infants who have been vaccinated with the MMR vaccine in comparison with infants who have

not been vaccinated

Even though there was enough verification to support that there was no liaison between

the vaccine and the diagnosis of autism, there was still an apprehension in the public that a child
EFFECTS OF MMR VACCINE

may be in danger from the specific immunization, which has led to a fall in vaccine coverage

worldwide. Nonetheless, there was still an innumerable amount of well-controlled studies being

performed internationally, which still have found no evidence that MMR vaccine causes autism.

In the early 1900s, The Inflammatory Bowel Disease study group (IBDSG) at the Royal Free

Hospital, London published a document advocating a potential relation amongst MMR vaccine

with autism and adult inflammatory bowel disease. Both propositions were consequently negated

by other researches as well as the IBDSG themselves.

There were several restrictions to the methods and approaches used in the above study; it

was a self-selected group of children with no control group to equate with, which has caused an

augmented potential for recall bias. Moreover, the ages at which the vaccine was administered to

the children would normally coincide with the age at which the onset of the behavioral problems

accompanying with autism arises. The IBDSG concluded that the randomized controlled trials

and observational studies that they were engaging in were considered to be unethical in assessing

the clinical efficacy of a child becoming autistic from the MMR vaccine. The IBDSG advanced

their research to a national level in order to collect population surveillance data. The approach

that this group used to acquire their results was a cross sectional series method applied to a large

cohort study of “537,000 children of whom 18% didn’t receive the vaccine” (Sengupta, Bedford,

Elliman, & Booy, 2004). After methodically studying the children, the evidence favors rejection

of the correlation between MMR vaccines and autism.

Between the years of 1999 and 2006, countless studies that varied between ecological,

case-control, retrospective and prospective cohort analyses were implemented after Wakefield’s

publication. These assessments took place in various parts of the world with massive amounts of

participants, all of which revealed there were no connotations of the vaccine truly causing
EFFECTS OF MMR VACCINE

autism. Researchers predominantly performed ecological studies that compared vaccination rates

with autism diagnoses at a population level.

An inclusive study that was completed in the United Kingdom to essentially analyze the

vaccination rates with autism diagnoses which assessed 498 autistic children born between the

years of 1979 to 1992. Although there was an escalating trend of autism diagnoses by a year of

birth, there was no alteration in the percentages of autism diagnoses after the 1987 introduction

of the MMR vaccine. The MMR immunization frequencies of autistic children were analogous to

those of the all-inclusive study population. Researchers did not detect any discrepancy in autism

rates amongst vaccinated and unvaccinated children, and they also established there was no

complications to be present in the child who received the MMR vaccine before or after 18

months of age. After acquiring these outcomes, researches then extended their analysis to

incorporate a lengthier time after the child received MMR exposure, or attained a second dose of

the MMR vaccine and still achieved the same results in the end (Gerber & Offit, 2009).

Nevertheless, countless parents are firm believers that immunizations are unnatural and

there are still uncertainties present about the link between vaccinations and autism, but a

groundbreaking report led by the University of Sydney appears to have settled that argument. Dr.

Guy Eslick and researcher Luke Taylor performed a meta-analyses to recapitulate accessible

evidence from case controlled and cohort studies deliberating this topic. The study was done on

five cohorts involving 1,256,407 children and five case controlled groups involving 9,920

children to conclude if there truthfully was an affiliation between vaccination and the subsequent

development of autism (Taylor, Swerdfeger, & Eslick, 2014). Dr. Eslick and Taylor reexamined

their findings and both were definitive in their discoveries that vaccinations are not associated

with the development of autism or autism spectrum disorder.

EFFECTS OF MMR VACCINE

Dr. Eslick and Taylor’s analysis unequivocally measures the difference in autism

between these two groups using the method of an odds ratio (OR). If the OR is above one it

indicates that there is an increased risk for autism, and if the OR is below one then that group

was at a decreased risk for developing autism. However, if the OR was at one then there was no

difference for an increased or decreased risk for developing autism. The study indicated that,

“one of the results of the groups was at an odds ratio of 0.84, which designated a reduced risk for

autism” (Taylor, et al., 2014).

Dr. Eslick and Luke Taylor’s meta-analysis can speak volumes because they obtained

quality data amongst multifarious studies. It gave the public a better representation of the

correlation between the risks of autism related to vaccines. To summarize the findings of Dr.

Eslick and Luke Taylor, they amalgamated the results of the ten studies to have a detailed

overview of their analysis. Each of the five cohort studies had a different part of the vaccination

component they were investigating (MMR, Thimerosal, Mercury); however, there was one part

of each study that remained the same; the development of autism or autism spectrum disorder as

the outcome. Furthermore, the five case control studies were specific in regards to the MMR

vaccination and autism or autism spectrum disorder. In the end, all the groups shared the same

conclusion that there was refutation between the immunization and autism (Taylor, et al., 2014).

Dr. Wendy Roberts, a co-director of the autism research unit at Toronto's Hospital for

Sick Children, in Ontario, also repudiated any ties between the MMR vaccine and the diagnosis

of autism. Dr. Roberts added that she is also concerned that this fear will contribute to a further

decline in immunization rates. She decided to perform a research analysis of her own and wrote

an article about her findings titled “Immunization and children at risk for autism.” Dr. Roberts

stipulated many informational studies such as the MMR debate, along with the relations between
EFFECTS OF MMR VACCINE

mercury and autism. She also spoke about the Wakefield’s study and the origin of the

assumption between the immunization and autism.

Dr. Robert’s work with the Canadian Paediatric Society in 1998 continued to conflict

Wakefield’s studies when evidence to refute these ideas were proposed. Along with his

procedural errors, there were undisclosed financial conflicts of interest, and unethical violations.

The society showed convincing evidence that heavily swayed against Wakefield’s claims. These

results concluded that the children who were vaccinated and unvaccinated around the same time

of the diagnosis for autism proved no increased likelihood of acquiring or producing the autism

disorder. The outcomes were determined not only within the United States but in the other

countries as well, consisting of Canada and the United Kingdom. One superior example of the

lack of correlation between autism and immunizations was revealed in the United States when

the population experienced an increase of autism in the late 1980s, but shockingly that was two

decades after the vaccine was introduced. The studies in the United Kingdom and Canada were

identical to the incidences within the United States (Roberts & Harford, 2002).

Natural Immunity and Acquired Immunity

Supplementary studies have taken place consequently to investigate whether the MMR

vaccine may be casually associated with autism. In the article “Autism and measles, mumps, and

rubella vaccine: no epidemiological evidence for a casual association” correspondingly shows

that there is no correlation between the two. This precise study was composed of 489 cases of

autism, where the ICD or International Classification of Diseases could corroborate the

diagnosis. The diagnosis of autism was checked against information in the available records of

the child’s present condition, and his or her condition between the ages of 18 months and 3

years. They confirmed that there was a continual intensification in cases from 1979 to 1988, with
EFFECTS OF MMR VACCINE

no upsurge in the trend after the introduction of the MMR vaccine. Although there are

antithetical reactions to immunizations, the statistics substantiate that the correlation between the

two does not coincide (Taylor, Miller, Farrington, Petropoulos, Favot-Mayaud, & Waight, 1999).

It has been determined that the heightened anxiety in the public about the MMR vaccine

is due to claims that have been made by biased researchers. While there still is a fear of children

acquiring autism because of the MMR vaccine, the public must be reassured that the vaccine

itself has no correlations. Natural immunity by infants is stressed to be very imperative for their

growth and development, but the acquired immunity that they will gain from vaccinations is just

as vital to their health. If the infant is solely contingent on their natural immunity, it puts them at

a greater risk for contracting a disease than the side effects that can come along with a vaccine

such as MMR. This research study uniformly segmented the outcomes into a statistical format to

show the heightened increase chance of dying from measles, which is 1 in 500, compared to

having an allergic reaction to the MMR vaccine, which is roughly 1 in a million (Taylor, et

al.,1999).

Analysis

In all of the six sources that we evaluated and analyzed, they all shared equivalent results,

that the MMR vaccine was not interconnected to autism spectrum disorder. Each individual

source that we studied had its own methods of corroborating to the public why parents should

disregard the idea that vaccines were linked to autism. All the obtained data did not support the

causal association between MMR vaccine and autism. If such an association occurs, it is so rare

that it could not be easily identified in a large regional sample. Furthermore, each source was

also irrefutable in their discoveries that vaccinations are not concomitant with the development

of autism spectrum disorder between the ages of 12 to 15 months.

EFFECTS OF MMR VACCINE

Conclusion

The prime purpose of vaccinations is to prevent potential threats and diseases that the

child can possibly acquire throughout their lifetime. As nurses, it is tremendously critical to

educate parents when it comes to vaccinating their children to protect their health. Once parents

are aware of certain conditions or potential threats that their child may be at risk for, they may

want to take action to resolve, reduce, and prevent further damage to their child’s health. There

are many ways to prevent diseases, and conceivably one of the simplest ways is to vaccinate.

Unfortunately, there is still an undesirable stigma around the idea that immunizations are linked

to autism. There are some people who still debate whether or not they should give their children

vaccines due to these claims. Nurses should take the time to educate parents that vaccines are far

worth the minimal risks that they have. The public needs to be more knowledgeable in the fact

that it is healthier to protect their child with vaccinations in order to build up immunity, rather

than to remain vulnerable and potentially contract a detrimental disease.

EFFECTS OF MMR VACCINE

References

Farrington, C., Miller, E., & Taylor, B. (2001). MMR and autism: further evidence against a

causal association. Vaccine, 19 (27), 3632-3635. doi:10.1016/s0264-410x(01)00097-4

Gerber, J., & Offit, P. (2009). Vaccines and autism: A tale of shifting hypotheses. Clinical

Infectious Diseases, 48 (4), 456-461. doi:10.1086/596476

Roberts, W., & Harford, M. (2002). Immunization and children at risk for autism. Pediatrics &

Child Health, 7 (9), 623–632.

Sengupta, N., Bedford, H., Elliman, D., & Booy, R. (2004). Does the MMR triple vaccine cause

autism? Evidence-based Healthcare and Public Health, 8 (5), 239-245.

doi:10.1016/j.ehbc.2004.08.004

Taylor, B., Miller, E., Farrington, C., Petropoulos, M., Favot-Mayaud, I., Li, J., &

Waight, P. A. (1999). Autism and measles, mumps, and rubella vaccine: No

epidemiological evidence for a causal association. The Lancet, 353 (9169), 2026-

2029. doi:10.1016/s0140-6736(99)01239-8

Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with

autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine,

32 (29), 3623-3629. doi:10.1016/j.vaccine.2014.04.085