Through the past years, parental refusal of child vaccinations has steadily increased throughout the United States in pediatrics and public health. Although vaccines have been considered to be one of the greatest public health achievements, it has recently taken a fall due to rising concern with the connection to autism.1 Autism, also known as Autism Spectrum Disorder is a complicated condition in which there is a deficiency in social interaction, verbal and non-verbal communication, obsessive behavior, and repetitive movements that is associated with genetic and environmental factors. The controversy stems from the environmental causes where there is little information and because of that, many have made acquisitions without sustained proof. The rising fear that vaccines is a cause of autism is a result of many myths abound but have yet to be officially proven: Measles-Mumps -Rubella (MMR) vaccine, thimerosal, and the number of times the vaccine is given to patient. 2Many of us received vaccinations as children or infants, and firmly believed they were provided as a form of protection from major diseases and needed to be repeated to maintain proper immunity with aging. This perception of vaccines could be justified with the eradication of small pox, measles and polio which were deadly infectious diseases that once swept through the United States. 3Due to increase numbers in child exemption of the vaccines required for school, jobs and leaving the country, pediatric providers find a struggle to respond to such claim due to connection with autism. This claim originally started in 1988 with British researchers claiming that vaccines did cause autism, but after investigation, fell short due to no evidence supporting the hypothesis. Although this was a failure to prove the connection between the two, it caught the attention of the public and became controversial. Many claims that there is evidence sufficient enough to prove that vaccines cause autism, but until the discovery of how autism originates, then evidence is considered not sufficient.
Autism spectrum disorder (ASD) is a developmental disorder with unknown causes in most cases and pertains to every ethnic group across all socioeconomic levels. It is considered to be one of the most heritable mental disorders based on small clinical studies. 4 The direct and indirect effects of autism spans across many spectrums including: housing, health, education, and employment. 5 Individuals with autism tend to have impairment in social interactions, communication, restricted interests and repetitive behavior. 67The disorder is known to be more prominent in males more than females and affects 1in 68 children in the United Sates up from 1 in 2500 during the 1960’s. 8Early targeted and behavioral interventions can improve the social qualities and reduce the anxiety and aggression. Drugs can be considered to ease symptoms, but do not solve the problems for the lack of communication.9 Over the years, there has been an increase in the concern that autism is becoming more prevalent but with no explanation has been found of why. Autism is not just a one-type disorder, but consists of many and results from a combination of environmental factors and genetics. The effects of the environmental toxicants or increased prevalence is not determined. The symptoms first start in early childhood around the ages of 2-3 and for some, affects the everyday life of the individual. The spectrum in ASD, refers to the wide range of factors that come to play in individuals that are diagnosed. The disorder is complicated as there is on going research in the factors that cause the rising symptoms. Unfortunately, many children are suffering from autism and receive no supported treatment. 10
From the Lancet article that was retracted, the Measles-Mumps -Rubella (MMR) vaccine evidently caused eight children within one month after receiving vaccine, to have symptoms of autism. All of the children’s symptoms were similar including intestinal inflammation that lead to the translocation of usually nonpermeable peptides to the bloodstream, next to the brain which is a result of affected growth development. Further investigation showed that the study did not include any control subjects which became problematic with the occurring results. The opposed question then became: was the cause of MMR to give autism coincidental or casual? Not only was results inconclusive, but data collected from experiment was not complete or collected systematically. In addition, measles, mumps, or rubella viruses has not been linked to intestinal inflammation. Although no data was confirmed to be true, more studies increased on the issue to address the concern of parents due to false leads. Secondly, thimerosal, ethyl mercury, is an antibiotic compound that that has been used in multi-dosed vaccine preparations for over fifty years. It is known in biological drug products, pharmaceutics and cosmetics. 11 In 1997, the Food and Drug Administration Modernization Act mandated the quantity of mercury in all food and drugs. With this at task, results states that infants could possibly consume more mercury than needed. With this, The American Academy of Pediatrics and the Public Health Service recommended the removal of mercury from all vaccines. With prior allegations of vaccines, this news to the public caused more concern and lead to anti-vaccine groups. Children with mercury poisonings show speech, sensory, visual, and psychiatric different from those without the condition of autism. Although there are clear neurotoxic effects of methyl mercury absorption, ethyl mercury has not been associated with those issues. 12 A later study, performed by the Centers for Disease Control and Prevention later confirmed that mercury in vaccines did not cause mercury poisoning. Lastly, when studies of the mercury and the MMR were confirmed negative, there were no differences in MMR vaccination and thimerosal dosage between controls at any age. 13One main problem that was next for panic, was that the number of times or multiple vaccines at once that were given that reported to weaken the immune system, and create a bond with the nervous system that triggers the symptoms of autism. This theory was dismissed due to knowing that vaccines do not overwhelm the immune system. 14 There are many other theories over the past years to determine what actually causes autism: from maternal infections during pregnancy to being born during influenza season or receiving the influenza vaccination. There were two previous studies that suggested that there was a connection between the influenzas vaccination and autism but presented all mixed results.15 Also, there has been findings where autistic disorder increased with increasing genetic relatedness. 6 All of these studies have been examined and results are inconclusive not excluding the fact that millions or even ten of millions dollars were used to justify such issues. 16
The mistrust in science, has compromised the idea of having sound policy for such concerns that have increased over past years. The public wants to be knowledgeable for new information regarding their health. There are many sources due to: television, radio, and newspaper that helps with the insights of vaccinations. 17 The Vaccines for Children Program was implemented in 1994 to help children from contracting vaccine preventable diseases because of financial standing from the measles outbreak in the United States that resulted from over 55,00 cases from 1989-1991. The believed cause of this outbreak was that uninsured children were not vaccinated at the recommended age from 12-15 months of age. It was estimated that from 1994-2013, vaccination would prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 hospitalizations with savings of 295 billion in direct cost and 1.28 trillion in societal cost. With these estimations, vaccinations are an effective tool for the health of U.S. citizens. With the help of the VFC, children are able to get vaccines free of charge which helped increase the availability of vaccines and would eventually lead to no outbreaks. Coverage for new vaccines were increasing rapidly, and the importance of maintaining and monitoring the immunization program became known. 18
The anti-vaccination movement used social media to become a threat to the public health as newcomers interact and become more aware of the movement. It is critical to understand the drive of pro/con attitudes of participants that play a major role in social media. One study `found that those with long-term anti- vaccination attitudes creates conspiratorial thinking, while “adopters” of anti- vaccine attitudes shows more suspicion and have conspiratorial ideas before creating a true anti-vaccine attitude. From these results, it is determined that the “adopters” are already liable to form anti-vaccine attitudes. This could be problematic for health officials trying to correct false accusations and might prove to be ineffective. Measles once was a highly contagious viral infection that killed an estimated 122,000 people worldwide but was eradicated from the United States in 2000 due to vaccinations. The issue was linked to low-income, inner-city populations where patients were pushed to clinics where vaccines were available at no cost. In 2014, measles rebounded and from studies shows that it only affected people who were not vaccinated. A reason for the rebound could very well be a result of the anti-vaccination movement with less people being vaccinated. A controlled study showed that parents’ refusal most likely received information through the internet unlike those who are continually being vaccinated. As misconception continue to be believed and people opt out of vaccinations, the immune systems are weakened which could lead to a major disease outbreak. New ideas need to form such as weakening the long-term conspiracy ideal of the government based on a movement that is needed. 19
Refusal of vaccination results in many factors including family lifestyles, vaccine efficiency, effects of child’s body and immune system and perceived risks of diseases. 20 Not only do parents need to take responsibility to make sure children receive vaccinations, but also Public Health need to take initiative with communication with the public for misconceptions.21To some degree the academics in public health must accept part of the blame also. As the study of Autism Spectrum disorder increases, ASD costs will eventually exceed those of diabetes and ADHD combined by 2025.22 Patients who received their vaccinations from private physicians had a better rate than those who attended health department clinics. With this information, race was determined not to be a factor when concluding results for when socioeconomic status was controlled. 23 The main issue is to help parents with updated awareness and education to fix miscommunications. 24 From many theories and hypothesis that were proven wrong, we can agree that vaccinations do not result in autism. While autism has reached its heights, it does not change the effect of vaccinations in children. If continues, the infant mortality rate can possibly rise due to decisions not to be vaccinated and the medical field can have one major setback. For whatever reason that autism exists, every avenue for vaccination to be the cause has failed and have scientifically been proved to not be a result. There are both pros and cons to this subject but both parents and scientist want answers. It is crucial to lean towards evidence that supports the truth, instead of making invalid points. I believe that vaccines do not cause autism and will remain until proof is shown otherwise. Many individuals diagnosed with autism today has a promising future with new applications to be able to speak, read and live in the community unlike 50 years ago where they were institutionalized. 25 The question still remains of why autism is rising, but we can confirm that it is not a result of the vaccine. We should remain hopeful that scientific research plays its part in finding the answer to the given issue.
- Parasidis, E.; Opel, D. Parental Refusal of Childhood Vaccines and Medical Neglect Laws. Am. J. Public Health 107, 68–71. https://doi.org/10.2105/AJPH.2016.303500.
- Offit, A. P. Vaccines and Autism in Primate Model. Proc. Natl. Acad. Sci. 2015, 112 (40), 12236–12237. https://doi.org/doi:10.1073/pnas.1516574112.
- Krishnan J, Denizer G, Friedland LR, Shapiro M., V. V. Understanding Modern-Day Vaccines: What You Need to Know. Ann. Med. 50 (2), 110–120. https://doi.org/10.1080/07853890.2017.1407035.
- Lichtenstein, P.; Carlstrom, E.; Rastam, M.; Gillberg, C.; Anckarsater, H. The Genetics of Autism Spectrum Disorders and Related Neuropsychiatric Disorders in Childhood. Am. J. Psychiatry 167 (11), 1357–1363.
- Masi, A.; DeMayo M, M.; Glozier, N.; Gaustella J, A. An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neurosci. Bull. 2017, 33 (2), 183–193. https://doi.org/https://doi.org/10.1007/s12264-017-0100-y.
- Sandin, S.; Lichtenstein, P.; Kuja-Halkola, R.; Larrson, H.; Christina, H. M.; Reichenberg, A. The Familial Risk of Autism. jama 2014, 311 (17), 1770–1777. https://doi.org/10.1001/jama.2014.4144.
- Prevalence of Autism Spectrum Disorder among Children Aged 8 Years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. Morb. Mortal. Wkly. Rep. 63 (SS-2).
- Bail A, C. Emotional Feedback and the Viral Spread of Social Media Messages About Autism Spectrum Disorders. Am. Public Heal. Assoc. 106 (7), 1173–1180.
- Lai, M.; Lombardo, M.; Baron-Cohen, S. Autism. Lancet 2014, 383 (9920), 896–910. https://doi.org/10.1016/S0140-6736(13)61539-1.
- Hillman, J.; Snyder, S.; Neubrander, J. Childhood Autism: A Clinician’s Guide to Early Diagnosis and Integrated Treatment; 2014.
- Gier a, D.; King G, P.; Hooker S, B.; Dorea G, H.; Kern J, J.; Sykes K, L.; Geier R, M. Thimerosal: Clinical, Epidemiologic and Biochemical Studies☆. Clin. Chim. Acta 444, 212–220.
- Walter, O. A.; Jerome, P. A.; Michael, B. T.; Louis, C. Z.; Seib, K. Global Vaccination Recommendations and Thimerosal. Off. J. Am. Acad. Pediactrics 131 (1), 149–151.
- Uno, Y.; Uchiyama, T.; Kurosawa, M.; Aleksic, B.; Ozakic, N. Early Exposure to the Combined Measles–Mumps–Rubella Vaccine and Thimerosal-Containing Vaccines and Risk of Autism Spectrum Disorder. Elsevier 33 (21), 2511–2516. https://doi.org/https://doi.org/10.1016/j.vaccine.2014.12.036.
- Plotkin, S.; Jeffrey, G. S.; Ofitt A. Paul. Vaccines and Autism: A Tale of Shifting Hypotheses. Clin. Infect. Dis. 2010, 48 (4), 456–461.
- Zerbo, O.; Permanente, K. Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder. JAMA Pediactrics 171, 1–7.
- Eggertson, L. Lancet Retracts 12-Year-Old Article Linking Autism to MMR Vaccines. Can. Med. Assoc. J. 2010, 182 (4), 199–200. https://doi.org/10.1503/cmaj.109-3179.
- Harmsen A, I.; Doorman G, G.; Mollema, L.; Ruiter AC, R.; Kok, G.; Melker, E. H. Parental Information-Seeking Behaviour in Childhood Vaccinations. BMC Public Health 2013, 1219 (13).
- Cynthia, W. G.; Zhou, F.; Singleton, J.; Schuchat, A. Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013. Morb. Mortal. Wkly. Rep. 63 (16), 352–355.
- Mitra, T.; Counts, S.; Pannebaker W., J. Understanding Anti-Vaccination Attitudes in Social Media. Proc. Tenth Int. AAAI Conf. Web Soc. Media 269–278.
- Harmsen A, I.; Liesbeth, M.; Robert, R. A.; GW Theo, P.; Melker, E. H.; Kok, G. Why Parents Refuse Childhood Vaccination: A Qualitative Study Using Online Focus Groups. BMC Public Health 2013, 1183.
- Jr. Camargo, K.; Grant, R. PublicHealth,Science,AndPolicyDebate:BeingRightIsNotEnough. Am. Public Heal. Assoc. 2015, 105 (2), 232–235.
- Paul, L. J.; Du, J. Brief Report: Forecasting the Economic Burden of Autism in 2015 and 2025 in the United States. J. Autism Dev. Disord. 45 (12), 4135–4139.
- Marks S, J.; Halpin L, H.; Irvin J, J.; Johnson A, D.; Keller R, J. Risk Factors Associated with Failure to Receive Vaccinations. J. Am. Acad. Pediatr. 1979, 64 (3), 304–309.
- Daniels M, A.; Mendell S, D. Explaining Differences in Age at Autism Spectrum Disorder Diagnosis: A Critical Review. Autism 18 (5), 583–597.
- Lord, C.; Elsabbagh, M.; Baird, G.; Vanderweele-Veenstra, J. Autism Spectrum Disorder. Lancet 392 (10146), 508–520.