AMA Tries to Calm Fears That Vaccines Cause Autism

There is no evidence that vaccines cause autism.

Moreover, the failure of parents to have their children immunized out of fear of an association with autism has led to sporadic upsurges in acute, even deadly, but preventable conditions.

So said the AMA in a resolution approved at the annual meeting of the policymaking House of Delegates in June. The resolution was sponsored by the Section Council on Psychiatry, which consists of delegates from APA, the American Academy of Psychiatry and the Law, and the American Academy of Child and Adolescent Psychiatry.

The resolution, which received vociferous support from physicians in all specialties, asks the AMA to reaffirm its support for universal vaccination and continue collaborative efforts to communicate that vaccines do not cause autism.

It was one of several resolutions introduced by the section council addressing broad public health concerns; other public health initiatives included a motion asking the AMA to reassess regulations around lead levels in children and one seeking universal neonatal screening for heritable and treatable diseases.

The latter stemmed in part from a campaign for universal neonatal screening launched by child psychiatrist Jenna Saul, M.D., of Milwaukee, and the family of a young boy who died last year of a heritable disorder for which there is now a genetic test. (Complete coverage of the issue and the house resolution on neonatal screening will appear in the next issue.)

The resolution on vaccines was one of eight that the section council put forward, seven of which were approved by the house during what was an unusually eventful meeting even apart from the historic visit by President Obama (see Original article: Obama Seeks M.D.'s Help to Reform Health Care). Other resolutions included one on parity for mental illness and substance abuse in health system reform, accurate estimation of American health care costs for comparison with other countries, and physician suicide (see Original article: Health Reform Must Include Parity, Substance Abuse Coverage, AMA Says; Original article: AMA Opposes Single Payer, but Is Open to Public Option; and Original article: High Physician Suicide Rate Triggers AMA Study).

The house's overwhelming support of the section council's resolution regarding vaccines and autism reflected a growing alarm about the trend among some parents to refuse routine childhood immunizations for their children.

“The Institute of Medicine and the CDC [Centers for Disease Control and Prevention] have done comprehensive studies and have not found any type of relationship between vaccines and autism,” said child psychiatrist Louis Kraus, M.D., during hearings on the resolution. “Our resolution asks the AMA to reaffirm policy and continue ongoing efforts to assist physicians and other health care workers in communicating to parents, policymakers, and the media that existing scientific evidence overwhelmingly shows that vaccines do not cause autism and that decreasing rates of vaccination will lead to a resurgence of vaccine-preventable diseases and death.”

Kraus, who is medical director for the Easter Seals Therapeutic Schools in Chicago for children with autism, added that it was a common occurrence for parents of a child with autism to decide not to get vaccinations for other offspring because of something they have seen on a television talk show or read on the Internet.

“There are tens of thousands of children not being vaccinated secondary to dogma,” he said.

Physicians from several specialties testified that this trend has led to spikes in the incidence of potentially deadly but preventable diseases, such as measles, by diminishing “herd immunity”—the phenomenon by which virtually universal protection against disease can be guaranteed when a large enough majority of individuals are immunized, even if 100 percent of the people are not. Herd immunity typically requires inoculation of 95 percent of the population, and even small increases in the portion of the unvaccinated population increase the risk to the whole.

“The inoculation rate in England has reportedly fallen below 80 percent, which has led to a rapid increase in the incidence of measles,” including at least two confirmed deaths, said David Fassler, M.D., a child psychiatrist and vice chair of the Section Council on Psychiatry.

He cited a May 7 New England Journal of Medicine article reporting that 1 in 20 children not vaccinated against pertussis ultimately contracts the illness, compared with 1 in 500 vaccinated children. “Put another way, the unvaccinated children were 23 times more likely to get whooping cough,” said Fassler, who is also APA secretary-treasurer.

Michael Butera, M.D, an alternate delegate from the Infectious Disease Society, testified to “the largest outbreak of measles in the last 20 years” in the affluent La Jolla section of San Diego in the early part of the year. A February 2008 edition of the CDC's “Morbidity and Mortality Weekly Report,” reporting on that outbreak, documented 12 cases of measles among unvaccinated children there.

And Carol Berkowitz, M.D., a delegate from the American Academy of Pediatrics, told physicians at the meeting that she had recently spoken to a group of mothers in an affluent neighborhood of west Los Angeles where 3 of 11 mothers had refused routine vaccinations for their children.

Also widely supported was the section council's resolution seeking a reassessment of guidelines concerning lead levels in children. As a result of the motion, the AMA's Council on Science and Public Health will review and update its 1994 report on children and lead and generate screening recommendations, taking into account existing recommendations from the American Academy of Pediatrics and the CDC.

In testimony on the resolution, Fassler told physicians that an elevated blood lead level, as defined by the CDC, was 30 mcg/dl in the early 1980s. That was lowered to 25 mcg/dl in 1985, and then to 10 mcg/dl in 1990.

“However, subsequent research has clearly demonstrated that even this level of lead exposure can have significant and lasting repercussions on physical development and cognitive functioning,” Fassler said. “We now know that blood lead levels below 10 mcg/dl are inversely associated with children's IQ scores. Lead levels as low as 3 mcg/dl have also been shown to be associated with decreased height and delayed puberty.”

The New England Journal of Medicine article, “Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases,” is posted at<http://content.nejm.org/cgi/content/abstract/360/19/1981>. The CDC report, “Outbreak of Measles—San Diego, California, January—February 2008,” is posted at<www.cdc.gov/mmwr/preview/mmwrhtml/mm57e222a1.htm>.▪