Immunization Safety Review Thimerosal-Containing Vaccines and Neurodevelopmental Disorders (2001) / Chapter Skim
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Appendix A
Appendix A
Pages 95-106
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From page 95... ...
Immunization Safety Review Committee, presents an assessment of the evidence regarding a hypothesized causal association between the measles-mumps-rubella (MMR) vaccine and autism, an assessment of the broader significance for soci95
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In 1999, as a result of previous IOM work on vaccine safety and the Institute's access to independent scientific experts, CDC and NIH began a year of discussions with IOM to develop the Immunization Safety Review project to address existing and emerging vaccine-safety concerns. The Immunization Safety Review Committee, convened in the fall of 2000, comprises 15 members with expertise in pediatrics, neurology, immunology, internal medicine, infectious diseases, genetics, epidemiology, biostatistics, risk perception and communication, decision analysis, public health, nursing, and ethics.
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From page 97... ...
, refers to a continuum of related cognitive and neurobehavioral disorders that reflects the heterogeneity of these symptoms. ASD includes autistic disorder, childhood disintegrative disorder, Asperger's syndrome, Rett's syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS or atypical autism)
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From page 98... ...
Twelve children with a history of normal development followed by loss of acquired skills and gastrointestinal symptoms were referred to a London gastroenterology clinic that was interested in the connection between measles virus and bowel disease. For eight of these children, the onset of their behavioral problems was associated, through retrospective accounts by their parents or physicians, with MMR vaccination.
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From page 99... ...
Furthermore, it is not possible to describe from this study the nature of any relationship among vaccinestrain measles virus infection, ASD, and bowel symptoms. In addition, case reports submitted to the Vaccine Adverse Event Reporting System, a national pas
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Finally, there is no relevant animal model. The model based on Borna disease virus infection in rats may be useful for studying the induction of symptoms of ASD by insults, especially infectious, to brain development during the prenatal and perinatal periods, but this model is not adequate for studying the association between the MMR vaccine and the subsequent onset of ASD.Also, primate models which are effective for the study of vaccine safety and immunogenicity or the neurobehavioral aspects of ASD do not adequately represent any relationship between the MMR vaccine and ASD.
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From page 101... ...
RECOMMENDATIONS Public Health Response Although the committee has concluded that the evidence favors rejection of the causal relationship at the population level between MMR vaccine and autistic spectrum disorders, the committee nevertheless recommends that this issue receive continued attention. It does so in recognition that its conclusion does not exclude the possibility that MMR vaccine could contribute to ASD in a small number of children, as well as the following factors: the identified limitations of the evidence, the burden of ASD, the burden of the diseases prevented by the vaccine, the immense concern of parents, and the prominence of the issue in public debate.
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From page 102... ...
. Conduct further clinical and epidemiological studies of sufficient rigor to identify risk factors and biological markers of ASD in order to better understand genetic or environmental causes.
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From page 103... ...
However, this conclusion does not exclude the possibility that MMR vaccine could contribute to ASD in a small number of children, because the epidemiological evidence lacks the precision to assess rare occurrences of a response to MMR vaccine leading to ASD and the proposed biological models linking MMR vaccine to ASD, although far from established, are nevertheless not disproved. Because of the limitations of the evidence, the significant public concern surrounding the issue, the risk of disease outbreaks if immunization rates fall, and the seriousness of ASD, the committee recommends that continued attention be given to this issue.
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From page 104... ...
1996. Polymerase chain reaction detection of the hemagglutinin gene from an attenuated measles vaccine strain in the peripheral mononuclear cells of children with autoimmune hepatitis.
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From page 105... ...
1998. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.
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