Autism, inflammatory bowel disease, and MMR vaccine

Abstract

The account given by Andrew Wakefield and colleagues'1Wakefield AJ Murch SH Anthony A et al.Ileal-lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children.Lancet. 1998; 351: 637-641Summary Full Text Full Text PDF PubMed Scopus (1788) Google Scholar is interesting, yet the structure of the study with biased case ascertainment and no suitable controls makes the findings no more than anecdotal. Perhaps the only saving grade for The Lancet is the accompanying well balanced commentary.2Chen RT DeStephano F Vaccine adverse events; causal or coincidental?.Lancet. 1998; 351: 611-612Summary Full Text Full Text PDF PubMed Scopus (121) Google ScholarChronic non-specific colitis, as described by Wakefield, is a common form of non-infective colonic inflammation in the age group studied. Furthermore, of 329 consecutive colonscopies done at Great Ormond Street Hospital (children aged 1 month to 16 years with chronic diarrhoea), 40 children were noted to have macroscopic ileal/ileocolonic lymphoid nodular hyperplasia, giving a prevalence in this selected population of 12%. 85% of these children had minor immunodeficiencies, as reported by Wakefield, but none had neuropsychiatric disorder.The investigators concede that they have not proven an association between MMR immunisation and the syndrome described, and have in reality presented no hard data on this matter. The report has led, intentionally or otherwise, to the erroneous assumption by the media and parents of a cause and effect relation between MMR immunisation, inflammatory bowel disease, and developmental disorder, resulting in parental confusion about the safety of immunisation. This country's childhood immunisation programme has dramatically reduced wild-type measles infection with its associated significant morbidity and mortality. Wakefield's account risks setting back child health 30 years through disruption of this programme. If these researchers are able to prove cause and effect between immunisation and the described syndrome they should do so straight away. If they are unable to do so they should publicly set the matter straight lest the health of our nation's children suffers. The account given by Andrew Wakefield and colleagues'1Wakefield AJ Murch SH Anthony A et al.Ileal-lymphoid-nodular hyperplasia, nonspecific colitis, and pervasive developmental disorder in children.Lancet. 1998; 351: 637-641Summary Full Text Full Text PDF PubMed Scopus (1788) Google Scholar is interesting, yet the structure of the study with biased case ascertainment and no suitable controls makes the findings no more than anecdotal. Perhaps the only saving grade for The Lancet is the accompanying well balanced commentary.2Chen RT DeStephano F Vaccine adverse events; causal or coincidental?.Lancet. 1998; 351: 611-612Summary Full Text Full Text PDF PubMed Scopus (121) Google Scholar Chronic non-specific colitis, as described by Wakefield, is a common form of non-infective colonic inflammation in the age group studied. Furthermore, of 329 consecutive colonscopies done at Great Ormond Street Hospital (children aged 1 month to 16 years with chronic diarrhoea), 40 children were noted to have macroscopic ileal/ileocolonic lymphoid nodular hyperplasia, giving a prevalence in this selected population of 12%. 85% of these children had minor immunodeficiencies, as reported by Wakefield, but none had neuropsychiatric disorder. The investigators concede that they have not proven an association between MMR immunisation and the syndrome described, and have in reality presented no hard data on this matter. The report has led, intentionally or otherwise, to the erroneous assumption by the media and parents of a cause and effect relation between MMR immunisation, inflammatory bowel disease, and developmental disorder, resulting in parental confusion about the safety of immunisation. This country's childhood immunisation programme has dramatically reduced wild-type measles infection with its associated significant morbidity and mortality. Wakefield's account risks setting back child health 30 years through disruption of this programme. If these researchers are able to prove cause and effect between immunisation and the described syndrome they should do so straight away. If they are unable to do so they should publicly set the matter straight lest the health of our nation's children suffers. Autism, inflammatory bowel disease, and MMR vaccineAuthors’ reply Full-Text PDF Autism, inflammatory bowel disease, and MMR vaccineAuthor's reply Full-Text PDF