Or, “On Vaccines and Autism”.

I am going to jump off into the great divide.  With my previously-withheld, but now-spewing-forth, opinion.  

Before I give my little spiel, I will say this:  I am not going to try to give you a comprehensive literature review on this subject.  There is a TON of evidence out there.  I just checked back very quickly with Dr. Google prior to starting this entry, and was bowled over by the sheer number of web pages devoted to spewing out the research, dissecting the research, and interpreting the research for you, the concerned parent/interested party.  

If I were the parent of a 17-month old, about to be 18-month old, I think I’d want to crawl into a corner.

So I am not going to delve into the research, although I would be happy to help anyone who has questions or would like full-text articles for a citation.   You can find a link here that summarizes  the majority of the MMR-autism studies, although you will need to trust that they summarized the findings correctly.  And if you are doing research, you should DEFINITELY check out CHOP’s website on the topic, which is my absolute favorite.  They update it regularly. 

With that disclaimer, here is where I stand, as someone who has been working in autism research for the last several years.  I’ve interviewed hundreds of families with kids on the spectrum, from 12 months old to 55 years old.  

More than that, however, you should also know that I speak as someone who is not only at risk of having a biological child with a 1 in 150 chance of having a spectrum disorder (that is the population incidence rate) – my husband and I have a fairly significant family history of it.  So instead of 1 in 150, our biological child has roughly a 1 in 30 chance of having autism.  

Yes, it’s genetic.  

Genetics play a significant role in autism genesis.  It’s not genetic like hemophilia, or color blindness, or celiac disease is – it’s not even genetic like an autoimmune disease is.  It’s genetic in ways we don’t fully understand yet.  However, there are lots of studies occurring now to try to unearth the genetic underpinnings of the spectrum:  some rely on family phenotyping.  Some rely on biomarkers, like blood samples and DNA swabs (usually from cheek cells).  But we’re still working on what predisposes kids to developing a spectrum disorder and what causes them to actually evidence the symptoms that contribute to a diagnosis.

If you are curious about phenotyping, Simon Baron-Cohen has a great questionnaire online that will give you a sense of whether you might be more spectrum-y than not:  The Autism Quotient.

So anyway… vaccines?

Honestly, I wish it was so easy as to know it’s a vaccine that causes autism.  Do you know how much easier it would be?  We could just say to parents, “Screw the vaccine,” and we would have no more autism.  My husband and I could have a baby and just not vaccinate him/her, and we would be confident that he would be as neuro-typical as the next kid.

But, see, it’s not that easy.

I am vehemently against indicting the vaccines for the “rise” (and rise is in quotes:  there are a lot of reasons we have a higher number of recognized cases of autism, and while there is a moderate rise in cases today, it is not nearly the spike that it would appear to be) of autism spectrum disorders.  For one, vaccines do prevent the illnesses they are designed to prevent.  Those illnesses can kill kids or those with weakened immune systems.  Historically, we’ve allowed parents and families to make individual decisions about vaccinations because the rate of immunization remained high enough to protect the population (called herd immunity).  When the immunity (or vaccination rate) of the population falls below a critical mass, the entire population is at risk of an outbreak (and we’ve seen recent outbreaks of vaccine-preventable diseases in Utah, San Diego, Colorado, and other places).  It is in the public interest to vaccinate.  Telling a parent that her child has autism because she vaccinated – a civic duty, in my honest opinion – is an abdication of the truth, and it does the kids with autism a disservice.  If we truly believe that autism is caused by the MMR vaccine, kids who were not exposed to the vaccine would not get autism – but they do.  Many, many, do.  

Here’s the kicker, though:  we give the MMR vaccine at 18 months, right?   Guess what age is the most typical onset of a regression in a child with autism?  Yes, you would be correct:  18 months.  

It actually turns out that kids who reportedly regress are often not actually typical to begin with.  That sounds very harsh, and I mean no disrespect – and for sure, some children *do* regress.  But it is not the norm for children on the spectrum.  In general (with many exceptions), kids on the spectrum *never* really look typical in early childhood.  They may echo, they may lay on the floor staring at the wheels of a toy car, they may spin around in circles and look up at the ceiling or out the sides of their eyes at the edge of the counter.  They may give you a high five in response to you throwing up a hand, but they’d never ever initiate it.  

At 15-20 months, when a regression typically occurs, they are regressing from atypical, not typical, toddler behavior.  Which is tragic in its own right, but it is *not* due to a vaccine.  

And in those children who do not regress, as time passes and they emerge into toddlerhood, it is simply that those differences become more marked as speech and gestures fail to come online, play behaviors are distinctively lacking, and social skills are significantly different from toddler peers.  

It is convenient to blame these differences on a vaccine, but it is not accurate. 

However, obviously something is causing autism, right?  What is it?

Well, that is the million dollar question that I cannot answer outside of a sincere belief in role of genetics and a curiosity (on my part) in things like the food supply and other environmental exposures.  It appears that genetics plus an environmental exposure triggers autism, and it appears that is a first-trimester exposure (which is freaky, right?  Because that’s halfway over before some women even know they are pregnant), versus an exposure later in pregnancy or after birth. 

(Which, again, just to hammer it home, is an exposure way, way, way before a parent might even debate vaccinating their child.)

So what are we (my husband and I) doing?

My husband and I plan to vaccinate our child, EVEN THOUGH we know that we have an increased genetic risk of having a child on the spectrum.

Let that sink in a little.

Yes, we will be vaccinating our child.

Are we insane?

No, I do not think so.  I have combed through the research and I have read the IOM report (ok, some of it.  It is long).  I actually know the person who headed up a lot of the IOM research and I trust her research and methodology implicitly, particularly on this topic.  The research against vaccination is weak, and the studies are poorly conducted that cannot be replicated. (My public health degree was good enough for me to determine that, and perhaps a follow-up post to this would be critiquing the myriad studies on this topic.)

A few years ago, my colleague gave birth to an adorable baby boy.  Two weeks later, he fell very, very, very ill – with pertussis.  He survived, but not without ending up in the NICU once again for several weeks.  His parents were terrified.  Do we make individual decisions (at very little personal cost) that can cost other innocent citizens their lives?  No, I do not think so.  Given the research that is out there – that contraindicates vaccinations in very few populations – no, we don’t.

That being said, I do not think my husband and I will vaccinate on a traditional schedule.  The only person I’ve ever had sex with is my husband, and the same goes for him (I know, right?  Gasp!  We freakish prudish people DO exist!) and I don’t know why on Earth my child needs to be vaccinated for a sexually transmitted disease at birth.  Moreover, I have an autoimmune disease, and my child has a strong chance of being born with a mild autoimmune condition him/herself – I simply do not believe that his nascent immune system needs to be insulted as with the traditional vaccination schedule.  However, that being said, our child will be fully vaccinated by his/her fifth birthday, at the age that he will become more likely to be a vector of disease than any previous time in his life.  We may make more trips to the doctor, and we may split up the vaccines (giving an M/M/R series, rather than a single MMR jab), but we will fully vaccinate.

And in the absence of a religious or moral objection, you should, too.

Commence kind dissent below.

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