Sri Wardhani Kusumawati wrote:
> Mumpung masalah imunisasi ini sedang hangat dibicarakan......
> Rabu, 14 Juni 2000
> (dari satumed.com)
> Salah satu vaksin yang paling ditakutkan oleh
> masyarakat adalah kombinasi vaksin measles, mumps and Rubella (MMR) atau
> vaksin kombinasi untuk penyakit campak, gondongan dan campak jerman.
dihapus..
> Salah satu kekhawatiran orang tua adalah bahwa vaksin
> ini berhubungan dengan timbulnya autisme tetapi beberapa penelitian telah
> menunjukkan tidak adanya hubungan antara vaksinasi dan autisme.
Rekan-rekan,
terus terang, sampai sekarang saya agak ragu dengan vaksin MMR. Ella mestinya
sudah divaksin tgl 15 ini, tapi karena kebetulan baru pulih dari flu-batuk
nya, saya putuskan utk. menunda seminggu lagi. Saya belum pernah ketemu ada
pernyataan di Indonesia bahwa MMR bebas dari risiko autism. Ada rekan2 yg.
tahu dimana harus cari info ?
Aduuh... bayangkan gimana kalo anakku yg. lucu itu jadi autistik ?
Penjelasan dari CDC yg. saya paste di bawah ini sih sangat...meyakinkan. Tapi
itu kan dari pemerintahnya. Sejauh mana pemerintah (Amerika) bisa jujur utk.
suatu produk yg. (seandainya benar) berside-effect jelek, tapi sudah keburu
disetujui...? Sementara banyak badan2 / peneliti swasta (di LN) yg. menyatakan
ada hubungan MMR dgn. autisme...
Gimana dong, ya...?
Rien.
---------------------
MMR Vaccine and Autism
1. Does the MMR vaccine cause autism?
CDC believes that the current scientific
evidence does not support the hypothesis that
MMR, or any combination of vaccines, cause
the development of autism, including
regressive forms of autism. A suspected link
between MMR vaccine and autism has been
suggested by researchers and some parents of
children with autism. Often symptoms of
autism are first noted by parents as their
child begins to have difficulty with delays
in speaking after age one. MMR vaccine is
first given to children at 12 to 15 months of
age. Therefore, children an apparent onset of
autism within a few weeks after MMR
vaccination may simply be an unrelated chance
occurrence.
An extensive study of the evidence was
recently conducted in the United Kingdom. The
British Committee on Safety of Medicines
convened a "Working Party on MMR Vaccine" to
conduct a systematic review of reports of
autism, gastrointestinal disease, and similar
disorders after receipt of MMR or
measles/rubella vaccine. The National
Childhood Encephalopathy Study (NCES) was
examined to see if there was any link between
measles vaccine and neurological events. The
researchers in England found no indication
that measles vaccine contributes to the
development of long-term neurological damage,
including educational and behavioral deficits
(Miller et al 1997). A more recent
epidemiological study also found no
association between MMR vaccine and autism
(Taylor et al. 1999). This study compared
rates of autism between children who received
the MMR vaccine and children who did not. The
results found no difference in rates of
autism between the two groups.
2. What about the study by Dr. Andrew
Wakefield, of the Royal Free Hospital in the
United Kingdom?
Current scientific evidence does not support
the hypothesis that the MMR vaccine, or any
combination of vaccines, causes the
development of autism, including regressive
forms of autism. This includes the research
conducted by Dr. Wakefield.
The Wakefield Study
This study was conducted in 1998 and looked
at whether the existence of the measles virus
from the MMR vaccine could cause bowel
disease and, in turn, cause autism. The
authors reviewed reports of 12 children with
bowel disease and regressive developmental
disorders, mostly autism. In 9 of the cases,
the child's parents or pediatrician
speculated that the MMR vaccine had
contributed to the behavioral problems of the
children in the study.
This study was reviewed by an expert
committee from the UK Medical Research
Council (MRC). The Council concluded there is
no evidence to link the MMR vaccine with
autism. On April 3, 2000 the MRC issued a new
report confirming its earlier conclusion; MMR
has not been linked with inflammatory bowel
disease in autism. A copy of this research
report can be found in the appendix and is
also available at the MRC web site,
http://www.mrc.ac.uk
Limitations of Dr. Wakefield's Study
1. The study used too few cases to make any
generalizations about the causes of autism;
only 12 children were included in the study.
Further, the cases were selected by
researchers and may not be representative of
many cases of autism.
2. There were inadequate groups of control
children. As a result, it is difficult to
determine whether the bowel changes were
similar to changes in normal children, or to
determine if the rate of vaccination in
autistic children was higher than in the
general population.
3. The study did not identify the time period
during which the cases were identified.
4. In at least 4 of the 12 cases behavioral
problems appeared before the onset of
symptoms of bowel disease; that is, the
effect preceded the proposed cause. It is
unlikely, therefore, that bowel disease or
the MMR vaccine triggered the autism.
3. Would it be safer to separate the MMR
vaccine into its individual components--in
other words, give children three separate
shots, at different times (e.g., six months
or one year apart), instead of one combined
shot? Why do we have to use the combined
vaccine?
There is no scientific research or data to
indicate that there is any benefit to
separating the MMR vaccine into its
individual components. This idea is not based
on any published evaluation of the effect(s)
it may have on children. In fact, splitting
the MMR vaccine into three separate doses may
be harmful because it would expose children
unnecessarily to potentially serious
diseases. For instance, if rubella vaccine
were delayed, 4 million children would be
susceptible to rubella for an additional six
to 12 months. This would potentially allow
otherwise preventable cases of congenital
rubella syndrome (CRS) to occur. Infection of
pregnant woman with "wild" rubella virus is
one of the few known causes of autism. Thus,
by preventing infection of pregnant women,
rubella vaccine also prevents autism.
4. Should a younger sibling, or a child of
someone who suffered autism be vaccinated
with MMR or other vaccines?
Current scientific evidence does not support
the hypothesis that MMR, or any combination
of vaccines, cause the development of autism,
including regressive forms of autism.
While family history may need to be
considered in specific circumstances, no
contraindications to vaccination exist solely
on this basis. Genetic susceptibility to
severe events is worthy of further research.
A younger sibling or the child of someone who
suffered a vaccine adverse event usually can,
and should, safely receive the same vaccine.
This is especially true since the large
majority of adverse events after vaccination
are local reactions and fever, which do not
represent a contraindication.
Due to the general safety of vaccines, and
the rarity of serious vaccine adverse events,
it is extremely difficult to study whether a
subgroup (e.g., family members) are actually
at increased risk compared with the general
population. The one exception is an increased
risk of neurologic events--primarily febrile
seizures--after vaccination with DTP vaccine
and measles-containing vaccines (MCV). The
risk increases if any of these have
previously occurred in immediate family
members. Considering the rare occurrence of
these events after DTP and MCV vaccination,
the generally benign outcome of febrile
convulsions, and the risk of pertussis and
measles to unvaccinated people and the
general population, the Advisory Committee on
Immunization Practices concluded that a
history of convulsions in siblings or parents
should not be a contraindication to pertussis
or measles vaccination. Special care in the
prevention of post-vaccination fever may be
warranted in children with a family history
of seizures, however. Oral polio vaccine
(OPV) is contraindicated when there is a
family member with immune-deficiency since
OPV can spread to family contacts.
5. Should we delay vaccination until we know
more about the negative effects of vaccines?
There is no convincing evidence that vaccines
such as MMR and hepatitis B cause long term
health effects. On the other hand, we do know
that people will become ill and some will die
from the diseases these vaccines prevent.
Discontinuing a vaccine program based on
unproven theories would not be in anyone's
best interest. Isolated reports about these
vaccines causing long term health problems
may sound alarming at first. However, careful
review of the science reveals that these
reports are isolated and not confirmed by
scientifically sound research. Detailed
medical reviews of health effects reported
after receipt of vaccines have often proven
to be unrelated to vaccine but related to
other health factors. Because these vaccines
are recommended widely to protect the health
of the public, research into any theory about
their safety is important to follow and
further investigate. Several studies are
currently underway to further investigate
whether suggested long term effects are real
or false signals.
6. I have heard that measles virus was found
in specimens from intestines of children with
autism? Have these data been reviewed by
other scientists?
The recently released finding has not yet
been published in a scientific journal. This
means that it has not been reviewed by other
medical experts, before and after
publication, to assure the methods of the
study are sound. No other laboratories have
had similar findings. Such tests should be
repeated by several laboratories to ensure
accurate results. Several renowned measles
laboratories have offered to duplicate the
tests in order to validate the results. This
is a typical procedure that is followed in
medical research.
7. What if multiple laboratories confirmed
the presence of measles virus in specimens
from the intestines of children with autism?
Would that indicate that measles causes
autism?
Even if measles virus were consistently shown
to be present in intestinal specimens of
children, this would not conclusively
indicate that measles causes autism. It is
possible that the measles virus persists in
the intestines of children with autism, i.e,
the measles virus in the intestine is a side
effect of autism, not a cause. In addition,
in order to implicate measles virus as a
cause of autism, it would be important to
show that measles virus is not present in the
bowel of healthy children who are of the same
age as the autistic children and have the
same history of measles infection and the
same vaccination status. Also, there is no
scientific evidence to show how intestinal
inflammation with measles virus would cause
the chronic neurological and behavioral
difficulties seen with autism.
8. What if measles virus is shown to be
associated with autism? Would that mean we
should stop vaccinating against measles?
If measles virus is shown to be associated
with autism, it would be most likely that the
wild measles virus would be a greater cause
of autism than vaccine virus. Therefore, it
is likely that in preventing wild measles
virus infections, we also would be reducing
the total number of cases of autism. People
infected with wild type measles virus develop
severe infections. Vaccination exposes the
child to a weaker measles virus and prevents
the complications of these severe infections.
As an example, a severe degenerative
infection of the brain (sub-acute sclerosing
panencephalitis or SSPE) can occur following
wild - type measles virus infection. Vaccine
virus does not cause this severe degenerative
infection and vaccination programs in the
United States have virtually eliminated such
complications by controlling measles.
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