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Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism (2001)

Chapter: Appendix D: Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism

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Suggested Citation:"Appendix D: Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism." Institute of Medicine. 2001. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: The National Academies Press. doi: 10.17226/10101.
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APPENDIX D

Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism

Jane S. Durch and Kathleen R. Stratton, Institute of Medicine Staff

In October 1998, the Institute of Medicine's Vaccine Safety Forum held an open meeting to hear about emerging research on the newly published hypothesis that Measles-Mumps-Rubella (MMR) vaccine might be related in some way to autism. Researchers were invited to present their data and ideas to the Forum members and to other participants. Several research ideas were suggested by the participants, and these are summarized below.

The discussions highlighted several considerations in pursuing research on a possible vaccine-autism link. It was stressed that a clear case definition will be essential for many types of studies. An argument was made to resist focusing only on childhood disintegrative disorders or regressive autism cases until the full spectrum of the disorder is better understood. Care was also urged in ensuring that case definitions not be biased by prior assumptions about cause. Because diagnosis depends on observation of behavior, studies will also need to rely on well-trained observers to apply standard, validated assessment instruments.

Expertise from a variety of disciplines will be needed to address the questions related to autism and vaccine use. Some activities are already under way. A 5-year, $27 million international collaborative research program supported by the National Institutes of Health is focusing on the neurobiology and genetics of autism. The Metropolitan Atlanta Birth Defects Study has added school-based surveillance for autism and other conditions classified as pervasive developmental disorders. More than 400 cases have been identified between 1995 and 1998. In addition, a multidisciplinary panel has been established to conduct more detailed follow-up studies of autism cases reported to VAERS.

Other suggestions by workshop participants included a formal study of the effectiveness of the intravenous immunoglobulin treatment being given to some children with autism. If the treatment is effective, further study might shed addi-

Suggested Citation:"Appendix D: Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism." Institute of Medicine. 2001. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: The National Academies Press. doi: 10.17226/10101.
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Page 86

tional light on the mechanisms that produce autism. Cross-national studies were also mentioned because autism rates seem to be similar across countries that have differing immunization levels and practices. To gain a better understanding of the basic neuroanatomy and neurochemistry of the autistic brain, systematic and more frequent postmortem examinations should be encouraged. In addition, new technologies, such as noninvasive imaging, have the potential to provide better information on brain function and structure.

Research studies might also explore whether identifiable features of genetics, immune function, or other factors predispose some children to an adverse vaccine reaction and whether the brain can be protected in such children. For example, animal models point to changes in brain vulnerability as neonates age, so the effect of changes in the timing of immunization might be studied. It was noted that although the idea of finding markers for genetic susceptibility is appealing, such tools might be hard to use because of the cost of screening all children.

Suggested Citation:"Appendix D: Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism." Institute of Medicine. 2001. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: The National Academies Press. doi: 10.17226/10101.
×
Page 85
Suggested Citation:"Appendix D: Research Needs and Opportunities Related to the Measles-Mumps-Rubella Vaccine and Autism." Institute of Medicine. 2001. Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Washington, DC: The National Academies Press. doi: 10.17226/10101.
×
Page 86
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Immunization is widely regarded as one of the most effective and beneficial tools for protecting the public's health. In the United States, immunization programs have resulted in the eradication of smallpox, the elimination of polio, and the control and near elimination of once-common, often debilitating and potentially life-threatening diseases, including measles, mumps, rubella, diphtheria, pertussis, tetanus, and Haemophilus influenza type b.

Along with the benefits of widespread immunization, however, have come concerns about the safety of vaccines. No vaccine is perfectly safe or effective, and vaccines may lead to serious adverse effects in some instances. Furthermore, if a serious illness is observed after vaccination, it is often unclear whether that sequence is coincidental or causal, and it can be difficult to determine the true nature of the relationship, if any, between the vaccination and the illness. Ironically, the successes of vaccine coverage in the United States have made it more difficult for the public to weigh the benefits and complications of vaccines because the now-controlled diseases and their often-serious risks are no longer familiar. However, because vaccines are so widely used-and because state laws require that children be vaccinated before entering daycare and school, in part to protect others-it is essential that safety concerns be fully and carefully studied.

Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism, the first of a series from the Institute of Medicine (IOM) Immunization Safety Review Committee, presents an assessment of the evidence regarding a hypothesized causal association between the measles-mumps-rubella (MMR) vaccine and autism, an assessment of the broader significance for society of the issues surrounding the MMR-autism hypothesis, and the committee's conclusions and recommendations based on those assessments.

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