Vaccinations and Autism: One Pediatrician's Perspective

Medical Author: David Perlstein, MD, FAAP
Medical Editors: William C. Shiel, Jr., MD, FACP, FACR

When I was asked to write a Doctor's View about the Hannah Poling ruling, I hesitated initially, and then determined that it was one of my responsibilities as a pediatrician to give my opinions of the decision. Briefly, this is in response to the recent case in which the federal government ruled that Hannah Poling, a nine year old girl, was entitled to receive compensation from a federal vaccine injury fund after developing neurological delays, including signs and symptoms of autism, following administration of a number of vaccines in 2000. This decision added fire to the Blog-O-Sphere where it was seen as both a victory for anti-vaccine groups and as the Government's admission that vaccines are the cause of the increase in the incidence of Autism Spectrum Disorders. On March 6, 2008, after the Poling ruling, Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention, in response to a question about the government's ruling stated:

"Let me be very clear that government has made absolutely no statement about indicating that vaccines are a cause of autism. And that is a complete mischaracterization of the findings of the case and a complete mischaracterization of any of the science that we have at our disposal today."

First of all, as a general pediatrician working in the Bronx, and as a parent of children with medical and developmental problems, I can wholly appreciate the visceral nature of dealing with a child who is not "normal". I also want to be clear that, although I do not have child with autism, I recognize the challenges and emotional stress that is involved in raising a child with autistic features. I would like to personally praise Hannah's parents and especially her father Dr. Jon Poling, who has been adamant about his support of immunizing children against infectious diseases.

In an interview with WebMD, Dr. Poling stated "I want to make it clear I am not anti-vaccine. Vaccines are one of the most important, if not the most important advance, in medicine in at least the past 100 years." He did go on to say "Every treatment has a risk and a benefit. To say there are no risks to any treatment are not true...I don't think the case should scare people. Sometimes people are injured by a vaccine, but they are safe for the majority of people. I could say that with a clean conscience. But I couldn't say that vaccines are absolutely safe, that they are not linked to brain injury and they are not linked to autism."

I will not be using this forum to present claims for and against the vaccine-autism connection, but will use the rest of my allotted space to remind you all of the pre-vaccine era, and the risks inherent in decreasing our civilization's immunity to the well documented infectious killers of our recent history. The simplest way to deliver this information is by briefly sharing the CDC's mortality data regarding measles virus with some pertinent vaccine licensure history during the pre-vaccine era and after. I would also add that globally, we are still in the "pre-vaccine" era and that the annual number of deaths due to vaccine preventable diseases is staggering and unacceptable.

In 1971 the current MMR vaccine was licensed in the United States. During 1971-75 in the US, an average of 35 measles-related deaths were recorded each year; one death for every 1,000 cases with the majority of cases occurring in children under 1 year of age. In 1989 the current 2-dose schedule was recommended. During 1987-1992 in the US, there were 43 measles-related deaths annually (90% of deaths occurred in persons who had not been vaccinated against measles.) During 1993-1999, only one acute measles-related death in the US was reported to the CDC. This decrease in mortality is believed to be a direct result of immunization policies.

In 2008, most of us have antibodies to measles, and can neither contract nor spread the disease to those who do not; however globally measles is still a leading cause of vaccine-preventable death among children, with approximately 410,000 children under the age of five dying annually. In this country, most cases of measles are contracted out of the United States, or spread by an unimmunized visitor. If we are not held accountable, measles, as well as other vaccine preventable illnesses in the United States will once more re-emerge as common causes of infant and childhood deaths.

Measles is only one example. Vaccination programs against polio, diphtheria, pertussis, and most recently Streptococcal pneumonia have similar stories, all resulting in dramatic decreases in Morbidity and Mortality, especially in children.

In conclusion, I would like to reiterate that I believe that Dr. Poling is right on all counts. Studies thus far have not revealed a clear causal relationship between vaccines and autism; but this doesn't mean that the research should completely stop. I just want to be sure that there will also continue to be significant research and development in the field of vaccinations for the foreseeable future, so that we can one day hope to decrease the number of deaths and hospitalizations due to preventable infections.

"Primum non nocere" is commonly translated as "above all else, do no harm". This is the well known interpretation of the Hippocratic Oath that I took when I graduated from Medical School. I believe that vaccinating infants and children in order to protect them from the killers of yesterday is the right and noble thing to do, and by vaccinating children, I believe I currently am and will continue to be true to that Oath.

References: Centers for Disease Control and Prevention, Media Availability on Vaccine Safety, March 6, 2008. WebMD, Inc. "Dad in Autism-Vaccine Case Speaks Out," March 6, 2008.