sumber : www.cdc.gov

[Centers for Disease Control and Prevention]

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 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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_/)(\_     |~          Salam,
 /~~\    o'  |~        Rien.
/_  _\      o'
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