Hi, I’m Wendy Zukerman, you’re listening to Science Vs from Gimlet. Today we’re revisiting our episode on Vaccines. Because... well…
<<The CDC says the number of measles cases being reported is close to the danger zone>>
<< There are now 704 cases in 22 states >>
<< That is the highest number since the disease was declared eradicated back in the US back in 2000>>
That’s right, the US measles outbreak just hit a peak — the number of cases is the highest it has been in the last 25 years. And this is so scary because measles is airborne … when you cough, when you breathe it can spread.. And that means it can spread fast. Last week in California,just one person with measles walked into a university library … and that led to more than 600 people being quarantined.
And in the US… in some communities, vaccination rates   have dropped so low that measles is starting to spread to people with vulnerable immune systems - like babies, who are too young to be vaccinated, and the elderly. 
With all this going on, we wanted to share an episode we did a while back on whether vaccines are safe. We first aired this episode two years ago, but.. the science still holds up. Here it is… Science Vs Vaccines.
<<This is the show that pits facts against tickling… >>
And that’s Heather Rogers… our reporter… and her little kiddo, Leo
<We’re sharing a microphone is that ok? You talk on your own microphone!>>
HR: He’s four years old
WZ: Oh my gosh!
HR: he’s got beautiful big eyes… and he likes stories
LR: Scary stories, funny stories, spooky stories
HR and he likes to snuggle in the morning
LR: I do!
WZ So is Leo vaccinated?
HR: He’s partially vaccinated…
Back when Leo was little… some people in Heather’s family had brought up questions around vaccines… and around that same time she heard some friends weren’t getting vaccines exactly as their pediatrician told them to.
HR I knew some parents who had spaced them out, I don’t want to give them all at once… and I was like is that smart should I have done that?
WZ: Wait, why?
So next time Heather took Leo in for his routine vaccination… she asked her doctor about it.
HR And I said can you tell me about the side effects and the doctor looked at me and kind of like scoffed. She said, Are you serious? It was very disorientating. Why do I feel like I did something wrong by asking.
WZ: So I have to be honest with you… I’m on the pediatrician’s side.
HR I would expect you to say that Wendy.
But the thing is, a lot of parents are worried about vaccines. So there’s this Pew survey that came out recently and it found that 43 percent of parents with young children think that vaccines come with a medium OR high risk .
WZ 43 percent
HR Yeah, getting close to half
Okay, so parents have questions. And as fears about vaccines grow, vaccine rates can drop. And we’ve seen the consequences of this in pockets of the US where diseases we thought we’d gotten rid of… have come back.
15 years after US health officials declared measles had been eliminated from our country the virus is back in the headlines.
Outbreak at Disney show it’s a small world after all.
<<Small world music starts>
Nearly 400 people became sick in ohio
 Measles once eradicated from the US is exploding in the somali community where many parents won’t vaccinate.
And so for parents who worry about the risks of vaccines… it can feel like they are stuck with a really hard choice… expose their kids to diseases… or potentially dangerous vaccines?
And for parents like Heather who just want to know the risks… she says it’s hard to get good information…
HR Y’know In doing this story ive gotten to talk to experts to researchers and i’ve been able to do things like - ok look, I have this question, what is the answer to this question? Like I’m a parent and I want an answer to this question. And a lot of parents don’t have the opportunity
So … today - Heather, and I and the team and Science Vs - we are going down the rabbit hole on childhood vaccines… to answer the following questions…
When it comes to vaccines there are lots of <<Spooky stories>> … But then there’s SCIENCE
Science Vs Vaccines is coming up after the break.
VACCINE AND AUTISM.
Welcome back. So today we’re talking about the risks -- and the benefits -- of vaccines. There are a couple of fairly common risks to vaccines … these are pretty minor … you can get a fever… some pain and stiffness in the joints… about 1 out of 20 kids who get the measles, mumps and rubella vaccine get a mild rash… and for other vaccines, it’s pretty rare, but some kids vomit.
But parents who are skeptical or really worried about vaccines… they often have bigger issues. They’re worried that vaccines will cause long term problems to their kids… so let’s dive into these issues.
A big worry right now is that vaccines can cause autism. And this fear really took off in 1998… Let me set the scene for you. … Monica Lewinsky had just become the world’s most famous intern, everyone was laughing at Cameron Diaz's hair in 'There's Something About Mary.' And THIS was the song of the summer
And some parents were freaking out… it felt like all of a sudden autism was everywhere.
PARENT: You ask anyone and they have autism in their classroom… https://youtu.be/EHjMFRAi18o?t=50s
And a really unnerving part of all this... is that no one knew ...and, in fact, we still don't know what causes autism. Some parents and even some scientists started wondering
What if these shots childhood diseases that are meant to protect your child - actually causing harm?
Soon… several theories cropped up as to how vaccines could cause autism… one that got a lot of attention was that the vaccine for Measles Mumps Rubella was the culprit. So, can it cause autism?
The person who first championed this idea was a British doctor by the name of Andrew Wakefield… and you might have heard of him...he’s since become a big campaigner against vaccines… Here he is speaking last year on - InfoWars, yes, the same show that called the Sandy Hook school shooting a hoax..
“[2 minutes in…] One in two children born in 2032 will have autism that is unacceptable. [ 5 minutes in] Whatever politicians say about me, it doesn’t matter, What matters is the future of this country and they children” https://youtu.be/f-u0UnOF5xU?t=5m00s
But that’s the Andrew Wakefield of today. Back in the late 1990s…
I don’t want to close my eyes…
Andrew was quite different. He was a gastroenterologist working at the Royal Free Hospital and School of Medicine in London. His research which connected the measles mumps and rubella vaccine to autism was being published in a prestigious journal, The Lancet, and it was being taken seriously… So let’s take a close look at it… . … Andrew and his colleagues studied 12 kids, some of whose parents said they got the autism soon after getting the vaccine.
Now specifically… he was looking at the kid’s guts, and found some of them had a bit of inflammation. From that, he thought. Haha!! That vaccine must have caused the inflammation - which then led to their autism.
Now even though this was a really small study, which - when you think about it - it didn’t prove anything really… Andrew drummed up a lot of media attention and started telling parents not to vaccinate their kids with Measles Mumps and Rubella vaccine, also called the MMR… here he is on ABC News
There is a great deal of evidence stacking up to suggest that the parents their contention that their child regressed after the MMR shot is correct. https://youtu.be/IhL6Sl2zhYo?t=2m4s
Scientists scrambled to figure out if Andrew was right… and that the Measles Mumps and Rubella shot could cause autism.… The first studies that put Andrew’s theory to the test, came out about a year later... and while that's fast in the world of science... it wasn’t fast enough…
<< Science takes time, and time was not on our side…>
DS if we would've had good solid data sooner i suspect that public concerns wouldn’t have grown as quickly as they did. And people might've been reassured by those data.
One of the first follow-up studies looked at every kid diagnosed with autism in a part of the UK .... almost 500 kids … and it found no link between those who got the Measles Mumps and Rubella vaccine and autism. Soon, more and more studies would come out -- involving well over a million children -- all showing no connection between getting the vaccine and kids getting autism.
DS Those studies were done by different investigators different scientists in different countries, using different methods and they were all negative.
Meanwhile… Andrew Wakefield’s original paper was retracted … it turned out that he had messed around with facts about the patients’ medical histories … and by 2011 an editorial in the British Medical Journal called the paper “fatally flawed both scientifically and ethically.” He lost his licence to practice medicine… and now Andrew goes on shows like InfoWars where the hosts says things like this:
Conclusion: Lots of work has been done looking for a connection between autism and the Measles Mumps and Rubella Vaccine. And none has been found.
But… that’s just one vaccine, and one theory. There’s another idea about how vaccines could be causing autism: Mercury. Mercury… is sometimes used as a preservative in vaccines… in a form called thimerosal. And in the mid to late 1990s
<<I don’t want to fall asleep….>>
Americans started getting really worried out about mercury.. The FDA was issuing warnings to pregnant women not to eat certain fish…There were moves to get mercury out of thermometers… Even Neil Degrasse Tyson even tried to stop Mercury from being a planet.
Ok we made up that one. But seriously… Officials wanted to rid the US of mercury… and that’s because mercury is a big deal because when people are exposed to a lot of it, it can damage their nervous system and brain…. Making people kooky, which is where the term Mad Hatter comes from. Hatters used to use mercury to make their hats.
But seriously Mercury exposure is serious. It can affect how people talk and move… which - to some -- sounded like the symptoms of autism. So could the little bit of mercury that’s used as a preservative in vaccines cause autism?
Amy Kalkbrenner a public-health researcher at the University of Wisconsin, Milwaukee…She looks at various things that might cause autism… from vaccines to pollution. And Amy says her mum saw this career coming…
She actually claims that pollution was an early word of mine so sometimes I do have to smile about that
WZ: Wait, so it was mama, dada, pollution?
That’s what my mum claims yeah.
So to find out if that type of mercury, thimerosal in vaccines was linked to autism Amy combed through a raft of studies. One followed nearly half a million kids some of who got vaccines with thimerosal others who got vaccines without it. And? The researchers found that there was no difference in autism rates between the groups. And Amy found the same result in studies over and over again.
AK Long story short is that there is not evidence that vaccines containing thimerosal were associated with autism.
And Amy says that it’s important to know that the form of mercury used in vaccines -- thimerosol -- is actually less dangerous than the mercury that’s in fish… or in thermometers. So the science on this one is settled.
The research is good, it’s decent enough to say that we’re not showing associations and it's time to move on.
And another thing: these days Mercury isn’t even in most childhood vaccines. It was taken out of them while America was freaking out over mercury…more than a decade ago…. Now while mercury is still in the influenza vaccine - parents can ask their doctor for a version without it.
But Amy says she can understand why this idea that vaccines cause autism is so hard to shake.
AK: When you are heartbroken, that your child is suffering and is disconnected from you, and you are doing everything you can not only to help your child but to understand what happened here. I can say definitively NO, it’s not your fault..
Conclusion: The idea that mercury causes autism has been studied over and over again… and there is very convincing evidence that it doesn’t.
Next question: is it safe for kids to get a lot of vaccines at once? Kids these days get vaccinated for … Hepatitis B, measles, mumps, rubella, diphtheria, pertussis, tetanus, chickenpox, polio, and more … by the time they’re 2 years old. And some parents are worried that this is just too many vaccines.  In fact, this is what Donald Trump was talking about on the Campaign Trail…
<<I had my children taken care of over a long period of time, over 2 or 3 years. The same exact amount. You take this little beautiful baby and you pump i mean it looks just like it’s meant for a horse and not for a child.>>
Ok… so these syringes might look scary: But the important question is this: could having a lot of different vaccines over a short period of time be harmful to kids?
There are fears… that … again all of these vaccines could be causing autism… And on this particular scientific question: there actually aren’t a lot of studies.... one study that we did find looked at the immune response to vaccines of about 1000 young kids -- and from that it suggested there was no link between how many vaccines a kid got and whether that kid developed autism. And to Daniel Salmon, our professor at Johns Hopkins University, he says that while more research is always good… the idea that kids getting too many vaccines are now causing autism just kind of feels like the latest claim in a debate that won’t die…
DS part of what's happened with autism, it's a bit of a whack-a-mole game. The first theory was that it was the MMR vaccine and when the evidence became compelling that it wasn't the MMR vaccine then people said oh it's not the MMR vaccine it's the preservative thimerosal. And then people said it was the number of vaccines given at once.
But… Heather, our reporter, had heard about risks other than autism that parents were worried about…Like all these vaccines were just too much for a baby’s immune system to handle... which could mean that it increases a kid’s risk of getting allergies or asthma. We got Heather to look into it. So Heather,
WZ: What did you find on this questions?
HR: So what I find was a big 2013 report from the Institute of Medicine which looked into this. It said that… while each new vaccine gets thoroughly tested individually… these vaccines aren’t necessarily tested together with all the other vaccines.
WZ: That’s surprising, I’ve got to say…
HR: Yeah it is… There have been a few quite large studies    testing to see if getting a lot of vaccines increases the risk of asthma or allergies in kids, and what they’re finding is that vaccines don’t cause these things…
WZ: Yes, so while there are some unknowns here -- about the safety of all of these vaccines -- parents have to weigh those risks against the possibility that their kid won’t be protected from a potentially really horrible disease…
<<Don’t be fooled by measles. For centuries measles has disguised itself as a harmless childhood disease>>>
And that’s coming up after the break... plus… another concern: that vaccines are causing seizures.
So far we’ve found no evidence of a link between autism and vaccines despite a lot of research looking into it… but what about the idea that vaccines can cause seizures… According to the Centres for Disease Control and Prevention, this is one of the most common concerns about vaccines that parents have… And we’ll tell you right up front that, yes, vaccines can cause seizures..
And here’s how likely that is, for two of the most common childhood vaccines: About 1 person out of every 3000 who get the Measles Mumps and Rubella vaccine will have a seizure -- that’s coming from the CDC... And the chance of getting seizures from another common childhood vaccine - DTaP, which protects you from diphtheria, tetanus, and whooping cough is even rarer… 1 in 14,000 people.
Professor Scheffer’s office…
Ingrid’s a busy lady…
Hi Ingrid Scheffer
Hi this is Wendy
In more than 20 years researching epilepsy… Ingrid has seen a lot of patients.
in my office here I’m looking at a wall full of patient's faces… beautiful children, some very sick, some thankfully not sick.
She told us that when a child has a seizure from a vaccine, while it’s rare, it can be frightening
IS The baby starts going stiff often with jerking down one side...So they have loss of consciousness they go often a terrible gray blue color. Ah and the parent looks at their child and thinks their child is dying.
The main reason that vaccines can cause seizures is because when our immune system ramps up to respond to the little bit of virus or bacteria in the vaccine… it can cause a fever… And fevers, any kind of fever, can actually trigger a seizure.
IS Still doesn't stop it being terrifying for the mum and dad. But it's not a problem, thank goodness
And… in the 1970s a lot of doctors thought that too.. Reports were being published of rare cases where kids who were totally healthy would get a seizure soon after getting vaccinated, and developed severe epilepsy and permanent brain damage. Doctors even had a name for this: “vaccine encephalopathy”… in other words: brain damage caused by vaccines..
IS Vaccine encephalopathy was rare but was certainly diagnosed around the world
WZ So the pronunciation of enkephalopathy, encephalopathy?
IS Heheh, so in the US you say encephalopathy, in Australia and England, encephalopathy, but thankfully we all understand each other
WZ Oh man, how do they have the same word!?
IS Potato potato? Tomato tomato… what do you need…
And when Ingrid told us this… it really got us thinking: Who says patato?
More to the point… through the 1990s… as doctors were diagnosing the rare patient with vaccine encephalopathy… epilepsy researchers were working out that there were different types of epilepsy, some really severe, and critically, they were finding out that these could be caused by your genetics. This is where Ingrid and her colleagues thought...
IS Hey maybe vaccine encephalopathy isn't due to the vaccine at all
That is. Maybe these kids had a genetic mutation which gave them epilepsy. By the early 2000s
the specific genes for a very severe type of epilepsy, Dravet syndrome, had been identified. And now Ingrid could test her idea!! She did genetic tests on 14 of her patients who were diagnosed with “vaccine encephalopathy” and she was searching for that Dravet’s syndrome gene. She found it in 11 of the patients.
IS We put together all of the pieces of the puzzle and showed that it really had been a misdiagnosis. These children has Dravet syndrome and they were destined to have Dravet syndrome.
So Dravet's syndrome accounted for 11 of the 14 kids Ingrid looked at. What about the other three? Well Ingrid thinks they had some other kind of genetic epilepsy, tied to a gene that we haven't discovered yet. Now, that is speculative, but new genes that lead to epilepsy are being discovered fairly regularly.
And while Ingrid’s was a small study…. Since then other research has backed up her idea. And it’s not just Dravet syndrome…researchers have found that other kids previously diagnosed with vaccine encephalopathy - actually had other types of epilepsy, such as Doose’ or West’s Syndrome,  .
WZ So when you say vaccine encephalopathy, then does that condition exist?
IS I don’t really think it does. I don’t think vaccine encephalopathy exists.
WZ How can you be so confident since we don’t have two views of history… how can you be so sure?
IS It would be an experiment that would be very hard to do. Because if you don’t vaccinate a child you put them at risk for a range of nasty diseases. But we also know of families where two siblings where one hasn't been vaccinated and they still have Dravet's syndrome. So i guess they’ve given us that answer.
Now… this isn’t totally cut and dry. The Institute of Medicine published a huge report on the adverse effects of vaccines in 2012...  and they weren’t prepared to rule out that vaccine encephalopathy exists… now that’s partly because not all kids who have ended up with severe epilepsy soon after their first vaccination have a genetic diagnosis… But overall their assessment has lined up with Ingrid’s - that in most cases where there are adverse reactions they come from a pre-existing condition.
Heather was in on the interview, and she told Ingrid… that some people… particularly those in the anti-vaccination community -- don’t buy that there are a bunch of different types of epilepsy…They’re still convinced that vaccines are to blame.
HR: I talked to a woman, she’s a pretty big, a well-known anti-vaccine activist. She said to me these scientists are making up all of these epilepsy to explain away the effects of vaccines. What would you...What’s your response to that?
IS Oh my gosh really? That's tragic. I think that's absolutely tragic. Because [sigh] these disorders have existed since time immemorial, that these children and adults with severe epilepsy, many seizure types and intellectual disability were around. There are nothing new about these disorders. When I trained they were thought to be acquired, very old fashion thinking, you got a bump on your head. Now with the new genetics we actually can find the new mutations, so I think it would be tragic that we would make up diseases, it undermines our whole life’s work
But for Ingrid… there’s one more thing that’s really important here. She says while vaccines aren’t causing the epilepsy, but they could be triggering a child’s first seizure. … You see, from what we know about epilepsy… seizures get sparked by something… it could be a fever, an infection, flickering lights, stress.
IS If they hadn't been vaccinated at that point the next fever or viral illness would have triggered their first seizure. So there's no way you can avoid that even if you put your baby in a bubble and made sure they avoided all infections. It would still happen.
Conclusion: In rare cases, kids do have seizures after a vaccine. These are scary, but best we can tell ... they’re harmless. And there is very little evidence that vaccines cause epilepsy … the science suggests these diseases are due to genetic conditions.
Now there’s a very different condition that we want to tell you about that can be caused by vaccines. And that’s an infection in the brain. Now the name of this infection sounds a lot like encephalopathy, but it’s called encephalitis. These cases are so rare that we only mention this is because the anti-vaccination community make it sound like the condition is WAY more common than it really is. of the millions and millions of kids who have gotten vaccinated against measles … that big Institute of Medicine report found three cases… three cases of babies who got permanent brain damage from the vaccine… it’s believed the measles virus, which is in a weakened form in the vaccine, somehow got into the kid’s brain’s…
Any risk of brain damage to a kid is absolutely scary for parents. But they also have to compare that tiny tiny risk… one out of millions… to the risk we haven't told you about yet... and that’s what happens if you don't get vaccinated. And this is really what convinced Heather... as she was doing the research for this episode
HR: It was very simple
HR: When I found out that measles kills one or two for every thousand people who get it, I was like, oh my god, I compared that to the data was finding on the injuries that people can possibly get from the vaccines, and those pale in comparison to the bad, bad things if Leo got one of these diseases. I was like - forget it! - get the vaccines…
And that’s just one disease we vaccinate for… but we also vaccinate for Pertussis -- or Whooping cough -- which leads to bouts of debilitating coughing and kills 1 out of every 100 people who get it. Or… Diphtheria, a bacterial infection that can kill 1 in every 10 people who get it. Or tetanus, which causes severe muscle contractions, can make it so hard to breathe that up to 2 in 10 people who get it will die. And even with better medicine and hygiene… these are the stats right now. These diseases are still pretty scary.
So when it comes to Science Vs Vaccines... do they stack up?
First up... Do vaccines cause autism? No. [ba-bow] There are large population studies that have looked at the measles mumps and rubella vaccine as well as the preservative thimerosal... All of the well-done studies show no relationship between vaccines and autism.
And while there is less research about kids getting a lot of vaccines at once -- the evidence we have, says that this is safe too.
Next. Can vaccines cause seizures? Yes, but it’s rare. And although they might be scary for parents, as best as science can tell these seizures don’t cause long-term harm.
And…finally. Are the risks of vaccines higher than the risks of the diseases themselves? No. Really… we know this. And the answer is No.
And the thing is… although the risk of getting some of these diseases -- like measles -- is pretty low right now... that’s because so many people get vaccinated. As less and less people get the shots - your chances of getting these diseases go up. In fact a study published this year found that if there is just a 5% drop in the number of kids getting the MMR vaccine - it could lead to 3 times more kids getting measles each year.
Next week we’ll be back with a brand new episode … the Placebo effect… does your mind have the power to heal you?
<<LB: All of a sudden there’s absolutely nothing. >>
WZ: Absolutely Nothing?
i'm talking about gone. nothing at all. no symptom at all
This episode has been produced by Heather Rogers, Me - Wendy Zukerman, and Shruti Ravindran. Production help from Rose Rimler. Our senior producer is Kaitlyn Sawrey. We’re edited this week by Blythe Terrell and Annie-Rose Strasser. Fact checking by Michelle Harris, with help from Rose Rimler. Sound design by Martin Peralta. Music written by Bobby Lord. For this episode we also spoke with Dr. Saad Omer, Dr. Neal Halsey, Dr. Paul Offit, Dr. Frank DeStefano , and Prof. Alison Buttenheim. And an extra thanks to Ivona Stamatoska, Reese and Walter Ludwig, The Zukerman Family, Joseph Lavelle Wilson and - of course! - Leo Rogers.
Hi I’m Leo Rogers and you’re listening to Wendy VS
Good rebrand buddy
 The highest number of actively quarantined people, 628, was connected to Cal State Los Angeles, where a single measles patient created hundreds of possible exposures by visiting a campus library, officials said. That number includes at least 106 staff members, according to the university.
 Other countries with high immunization rates also suffering from large outbreaks in 2019:
 NANCY MESSONNIER (CDC): The recent outbreak started through what we call importation. … 44 cases so far this year were directly imported from other countries. Among the 44 internationally imported measles cases over 90% were in people who are unvaccinated or whose vaccination status was unknown.
 “Forty-four cases were directly imported from other countries, and 9 out of 10 of those individuals were in unvaccinated persons. All 40 were old enough to get vaccinated,” said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. … The national public health agency also added that the majority of cases were imported from other countries.
KAPLOVITZ: “Most at threat are, of course, are people who are not immunized, obviously, which sometimes are the littlest children in the community and, say, probably the kids who are a year younger. People who are immunocompromised. You're talking about some of the elderly, also, you know, where their immune systems aren't necessarily working as well.”
 HERD IMMUNITY SCIENCE LIT
half of mothers pregnant with their first child had concerns about childhood vaccinations and less than
three quarters had made a decision about childhood vaccinations.
 Coverage among children aged 5-6 years has exceeded 95% each school year since 1980 for DTP; polio; and measles, mumps, and rubella vaccines (CDC, unpublished data, 1998).
 In 1998, measles reached a provisional record low number of 89 cases with no measles-associated deaths
 The incidence of autism rose 7- to 8-fold in California from the early 1990s through the 2009. “Since 1985, non-US studies have reported higher rates of autism”
Wakefield and colleagues1 postulated that measles, mumps, and rubella (MMR) vaccination might be causally linked with autism. Although there is no scientific evidence to support this claim,24 neither are there robust data on the prevalence of autism in children born before and after the introduction of MMR vaccine to the UK in 1988.
Even though ASD can be diagnosed as early as age 2 years, Most children are not diagnosed with ASD until after age 4 years
 Developmental disability; signs typically appear during early childhood and affect a person’s ability to communicate, and interact with others…. delayed learning of language; difficulty making eye contact or holding a conversation
 Dan: Two - that Mercury, which was used as a preservative in some vaccines, does it.
 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11096-0/abstract: Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another.
 Measles virus18, 19 and measles vaccination20 have both been implicated as risk factors for Crohn's disease and persistent measles vaccine-strain virus infection has been found in children with autoimmune hepatitis.2
 Here's andrew, right after the paper was released, telling people to not vaccinate with MMR:
On 28 February 1998, Andrew Wakefield, a British gastroenterologist, and colleagues  published a paper in The Lancet that described 8 children whose first symptoms of autism appeared within 1 month after receiving an MMR vaccine.
 https://iaomt.org/TestFoundation/nolinkmmr.htm: The age at diagnosis was found to be independent of whether MMR vaccine was given, or in those vaccinated, whether the vaccine was given before or after 18 months of age--the earliest age at diagnosis of core or atypical autism. The proportion of core and atypical cases vaccinated by the end of the second year of life was similar to that in the same birth cohorts in the North East Thames region. None of these analyses suggest a causal association between MMR vaccination and autism.
 See footnotes 12-17.
 This study looked at almost 498 kids with autism. This one looked at 473 kids with autism. This study had 537,303 children. In this study 1294 cases and 4469 controls (5,763 kids) were included. This study looked at 535,544 kids. And this study re-analyzed Wakefield’s data and didn’t get the same findings.
 look here for other studies: http://www.vaccinesafety.edu/vs-autism.htm
 “The Lancet completely retracted the Wakefield et al. paper in February 2010, admitting that several elements in the paper were incorrect, contrary to the findings of the earlier investigation. Wakefield et al. were held guilty of ethical violations (they had conducted invasive investigations on the children without obtaining the necessary ethical clearances) and scientific misrepresentation (they reported that their sampling was consecutive when, in fact, it was selective). This retraction was published as a small, anonymous paragraph in the journal, on behalf of the editors.”
 Also see this: http://www.bmj.com/content/342/bmj.c5347
 OK’d by Dan
 The human health effects from exposure to low environmental levels of elemental mercury are unknown. Very high mercury vapor concentrations can quickly cause severe lung damage. At low vapor concentrations over a long time, neurological disturbances, memory problems, skin rash, and kidney abnormalities may occur.
 Widespread and predictable misinterpretation of this conservative, precautionary directive, coupled with a public already concerned by a proposed but unsubstantiated link between vaccination and autism, understandably provoked concern among parents, which led to the birth of several antimercury advocacy groups.
 Study is cite #10
 Children in our cohort contributed person-time to follow-up from 1 year of age or January 1, 1991, whichever occurred last, until a diagnosis of autism, other autistic-spectrum disorder, tuberous sclerosis, Angelman syndrome, fragile X syndrome or congenital rubella, possible death, disappearance or emigration, 11 years of age, or until December 31, 2000, whichever occurred first
 This one looked at in utero and infant exposure in just over 1,000 kids - no association.
 This one looked at in utero exposure to thimerosal in 810 kids and found risk of autism was unassociated.
 http://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/thimerosaland https://www.fda.gov/ohrms/dockets/ac/02/briefing/3872_advisory%207.pdf and http://www.nhs.uk/chq/Pages/854.aspx?CategoryID=87
 AK == OK
 All vaccines routinely recommended for children 6 years of age and younger in the U.S. are available in formulations that do not contain thimerosal.
 Dan: is causing autism has been studied over and over, and the evidence is very convincing that MMR vaccine and thimerosal in vaccines did not cause autism.
 “In summary, the evidence of an association between autism and the overall immunization schedule is limited both in quantity and in quality and does not suggest a causal association.”
 256 children, 187 (73%) met the stricter criteria for AD and 49 (19%) met the criteria for ASD with regression.
 We found no evidence indicating an association between exposure to antibody-stimulating proteins and polysaccharides contained in vaccines during the first 2 years of life and the risk of acquiring ASD, AD, or ASD with regression. … The other one found getting a lot of vaccines didn’t affect a kid’s intelligence or memory by the time they were 7 years old.
 “In summary, the evidence of an association between autism and the overall immunization schedule is limited both in quantity and in quality and does not suggest a causal association.”
 Although each new vaccine is evaluated in the context of the overall immunization schedule that existed at the time of review of that vaccine, elements of the schedule are not evaluated once it is adjusted to accommodate a new vaccine. Thus, key elements of the entire schedule—the number, frequency, timing, order, and age at administration of vaccines—have not been systematically examined in research studies… “The committee found no significant evidence to imply that the recommended immunization schedule is not safe.”
 Few studies have attempted more global assessments of entire sequence of immunizations or variations in the overall immunization schedule
 (Thomson et al., 2010): 620 allergy-prone children enrolled in 1989 and monitored from birth to 6 years of age. All data, including immunizations (diphtheria and tetanus toxoids and pertussis vaccine or diphtheria and tetanus toxoids absorbed [DT], oral poliovirus [OPV] vaccine, and measles, mumps, rubella [MMR] vaccine). “There was no relationship between cumulative immunizations and asthma. Administration of DT in the first year of life but not the second year of life was associated with asthma and eczema.”
 Benke et al. (2004) studied 4,500 young adults enrolled in a study in Australia in 1992. Looked at vaccines including MMR, DTP, OPV, the hepatitis B [HepB] vaccine, and BCG). Atopy was measured directly by a skin test. Overall, this study found no significant association between cumulative vaccinations and asthma
 Study of over 29,000 children found no relationship between age at the time of the first immunization with DTP or MMR and asthma or eczema and no relationship between the total number of immunizations and allergic diseases.
 Gruber and colleagues (2003) conducted a prospective investigation of atopy among 7,609 infants born in Germany in 1990 and monitored to age 5 years. The objective was to determine prospectively if the number (percentile) of childhood immunizations was associated with atopy in 5-yearolds who had been identified to be a high-risk cohort (at least two family members had atopy and a detectable immunoglobulin E concentration of >0.9 kU/L at birth). Overall, the study reported a negative correlation between atopy and the cumulative number of vaccine doses received, including pertussis vaccine.
 Regarding asthma and current US schedule “No evidence is available from studies that have directly examined the current immunization schedule (most studies enrolled children in the 1990s, and most were not conducted in the United States), but no studies suggest harm (e.g., an accelerated or increased likelihood of the development of asthma or atopic diseases).” But also says “The findings from the research that has been conducted are reassuring, however. No data have demonstrated harm (an increased risk of atopy) from immunizations.”
 No consistent relationship could be demonstrated between DTP immunization and susceptibility to infectious diseases.” “Our study confirms that the MMR vaccine does not increase the risk of invasive bacterial or viral infection in the 90 days after the vaccination and does not support the hypothesis that there is an induced immune deficiency due to overload from multi-antigen vaccines.”
 The committee has a high degree of confidence in the epidemiologic evidence based on seven studies with validity and precision to assess an association between MMR vaccine and febrile seizures; these studies consistently report an increased risk.
 The reports of vaccine-induced encephalopathy caused serious public alarm (Kulenkampff et al., 1974) . “This controversy was first ignited by a study published in 1974 suggesting neurological complications associated with the pertussis vaccine . (Another paper 1978s)
 In 1981, when the reports of the NCES were published, almost the entire medical profession believed that pertussis vaccine could, on rare occasions, cause permanent brain damage in children.
 It is not well defined but it is MORE than just epilepsy – it is severe epilepsy with a slowing in development (encephalopathy means disease of the brain) and is more than just seizures. (Email Ingrid sent Heather)
 De novo mutations in the sodium-channel gene SCN1A cause severe myoclonic epilepsy of infancy.
 “Our results suggest that in most cases, genetic or structural defects are the underlying cause of epilepsy with onset after vaccination, including both cases with preexistent encephalopathy or benign epilepsy with good outcome”
 A later study that Ingrid did, with 29 children who reported severe epilepsies soon after getting vaccinated. She found 8 probably had Dravet’s and 21 were diagnosed with other forms of epilepsy… like Doose, West and Lennox-Gastaut syndrome. There were 31 kids in that study who got an epilepsy that Ingrid couldn’t diagnosed but she says they probably have a genetic condition for an epilepsy that we haven’t discovered yet. This study of 23 kids found 65 percent had known underlying causes.
 The committee has limited confidence in the epidemiologic evidence, based on two studies that lacked validity and precision, to assess an association between diphtheria toxoid–, tetanus toxoid–, or acellular pertussis–containing vaccine and encephalitis or encephalopathy…. Conclusion 10.2: The evidence is inadequate to accept or reject a causal relationship between diphtheria toxoid–, tetanus toxoid–, or acellular pertussis–containing vaccine and encephalopathy. AND. The committee has limited confidence in the epidemiologic evidence, based on three studies that lacked validity and precision to assess an association between MMR vaccine and encephalitis or encephalopathy.
A study of more than 2 million children, found that neither the DPT nor MMR vaccines were associated with an increased risk of swelling of the brain. Several well-designed studies have since been conducted that show no evidence of an association between the whole-cell diphtheria–pertussis–tetanus vaccine and encephalopathy. Subsequent large-scale studies have failed to show an association. E.g. One patient with encephalitis/encephalopathy was reported out of 10.56 million doses of DPT.
 These predispositions can exist for a number of reasons— genetic variants (in human or microbiome DNA), environmental exposures, behaviors, intervening illness, or developmental stage, to name just a few. [IOM]
 The committee assesses the mechanistic evidence regarding an association between diphtheria toxoid or tetanus toxoid vaccine and seizures as lacking. AND. The committee has limited confidence in the epidemiologic evidence, based on three studies that lacked validity and precision to assess an association between MMR vaccine and encephalitis or encephalopathy.
“ What remains is to determine the underlying mechanism—how does the malfunctioning protein interact with the presumed immune response to vaccination to trigger a seizure or the onset of epilepsy?”
 Before genetic testing was feasible, permitted 2 important conclusions. Permanent neurologic injury is highly unlikely to follow diphtheria, pertussis (whooping cough), and tetanus (DPT) immunizations. Largest estimates suggest a frequency of <3 per million vaccinations.32 During the same time period,
children not immunized against pertussis developed encephalopathy 6 times more frequently than those immunized.32 Studies also have indicated that pertussis vaccination does not alter the natural history of Dravet syndrome or the eventual intellectual outcome.26,33 The bottom line was clear: DPT was safer than no DPT. (This review says 0.22 of million get encephalitis)
 The committee identified five publications reporting measles inclusion body encephalitis after the administration of measles or MMR vaccine. But, of the five - two got the measles infection another way - this one: “inconsistent with the well-established vaccine virus genotype (vaccine genotype is genotype A).” .. these complications include mumps meningitis, cerebellar ataxia, transverse myelitis and poliomyelitis-like disease, cranial nerve palsies, hydroencephalitis, and encephalitis, which occurs in less than 0.3 percent of cases, but is responsible for more than 50 percent of mumps-related fatalities ..PAGE 117: The committee assesses the mechanistic evidence regarding an association between MMR vaccine and encephalitis as weak based on knowledge about the natural infection and three cases.
 Poon et al. (1998) described a 2-year-old boy, diagnosed with human immunodeficiency virus (HIV), presenting with generalized convulsive seizures lasting 40 minutes 9 months after receiving a measles, mumps, and rubella vaccine.
 Measles is so contagious that 90% of the people who come in contact and aren’t immune will catch the disease.
 AK-fine, Dan: There are large population studies that have looked at the measles
mumps and rubella vaccine, thimerosal as a preservative in vaccines, and multiple vaccines at once and autism. All of these well-done studies show no relationship between vaccines and autism. The benefits of vaccines clearly outweigh the risks of vaccinating.
 AK graph is fine
 A 5% decline in MMR vaccine coverage in the United States would result in an estimated 3-fold increase in measles cases for children aged 2 to 11 years nationally every year