In February 1998, Andrew Wakefield published results of a small study, in which he described, for the first time, some specific changes in the ileum and colon of children with autism and suggested a possible relationship with the measles-mumps-rubella (MMR) vaccination. (1) This and subsequent publications by the same team have changed the way parents perceive autism and vaccination. The attack on Wakefield and his work by the vaccine authorities and the pro-vaccine lobby was prompt, massive and relentless. Two publications by a team from Finland are most often quoted. (2,3). In both, the authors describe the adverse events reported following the administration of some 3 million doses of MMR vaccine to about 1.8 million individuals during a national immunization campaign in Finland between 1982 and 1996. Children were immunized between 14 and 18 months of age and again at 6. Also receiving the vaccine were older children and selected groups of young adults, such as military recruits and nursing students (2,3,4). The main authors of the two publications in question were H. Peltola and A. Patja and both stated that there was no evidence for MMR vaccine-associated inflammatory bowel disease or autism in the 14-year study (the title of the Peltola paper).

Many criticized the study findings and its conclusions because:

1. Fewer than 200 individuals, those who had developed acute events within 3 weeks of vaccination, were followed for 14 years. The rest of the 1.8 million vaccine-recipients were not.
2. Both autism and inflammatory bowel disease (IBD) are chronic illnesses, which develop over months or years. No one ever claimed that they start within 21 days of vaccination.
3. Wakefield never contended that children who develop diarrhea immediately after vaccination, a known and accepted reaction, are those who will go on to develop IBD as young adults.
4. The Finnish study ended in 1996. Autism and IBD were never mentioned in connection with MMR vaccination prior to 1998
5. Peltola stated on BBC Radio-4 on January 13, 2001 that the study was not designed to look at IBD and autism
6. The vaccine manufacturer funded the study.

Obviously, this is not true.

Autism & Inflammatory Bowel Disease have increased in Finland in recent years.

Autism. M. Kielinen et al, in a study published in the Journal of European Child & Adolescent Psychiatry (5) described a significant rise in autism in the northern provinces of Oulu and Lapland, which represent 1/8 of the total population of Finland. The Kielinen study included all children born in the two provinces, between 1979 and 1994. Every single one of those children was eligible and must have received the MMR vaccine. The authors personally reviewed all records of children with autism to determine that they fulfilled the criteria of ICD-10 and DSM-IV. The cumulative incidence of autism was 12.2/10,000, a significant increase when compared to the previously reported incidence of 4.75/10,000 by Vinni and Timonen. The increase in the younger children, all born in the second half of the MMR campaign, was even more striking. In the 5 to 7 age group, the cumulative incidence was 20.7/10,000 or more than 1 in 500.

There is no reason to doubt that this increase is not occurring nationwide nor that it is less spectacular than in other European countries.

Inflammatory Bowel Disease. According to figures obtained from the Statistical Branch of the Social Insurance Institution of Finland, the number of patients entitled for special refunds because of Crohn’s and Ulcerative Colitis DOUBLED between 1992 and 2001, from 9 737 to 20 807. In the same period, the prevalence rate per thousand of the two conditions also doubled while the population of Finland only increased by 3%. (Table I)

Inflammatory Bowel Disease is most often diagnosed between the ages of 15 and 35. The older children, adolescents, nursing students and army recruits who received the MMR vaccine in Finland starting in 1982, reached that vulnerable age in the last ten years and figure in all likelihood, in the increasing statistics. No one is claiming that other causes of IBD do not exist because they certainly do. Nevertheless if the rates of Crohn’s Disease and Ulcerative Colitis continue to increase and accelerate in Finland in the next few years, when the younger vaccinees reach adulthood, then Peltola and his colleagues will owe the scientific community an explanation and the vaccine authorities will be accountable for endorsing their unwarranted conclusions.
 
 

Despite numerous attempts, I was unable to obtain accurate statistics on the incidence of autism in Finland before the publication of Autism and Inflammatory Bowel Disease in Finland: A Recent Increase. The last agency I contacted, The Social Welfare and Health Care Statistics in Finland or STAKES did not have any autism listing and a representative suggested that I contact Autismiliitto.

On November 11, 2002, a spokesperson for autismiliitto.fi informed me that she did not have accurate figures but that “we are estimated to have 10,000 autistic people in Finland and about 40,000 people with Asperger’s syndrome”.

Better and earlier diagnosis may have led to the identification of some of these cases, but it clearly cannot explain all of them. The thought that in Finland 1 of every 100 individuals may have an autistic spectrum disorder is frightening (50,000 cases in a population of slightly over 5 million). This would translate, in the US, to 2.88 million ASD cases. Taking into account the fact that the incidence is higher in children and younger adults and the well-known gender difference, one can only guess the affliction in young Finnish males.

The high ratio of Asperger’s Syndrome (AS) is also extremely relevant to the present controversy. Kielinen pointed out, in the study mentioned above, that in the Northern Provinces, there were more children recently with IQs above 70 than had been reported in earlier studies. Other investigators have reported a similar trend worldwide.

Children affected since birth and in early infancy, are usually more profoundly brain damaged than those who develop normally until their first birthday and then sink into autism in the second year of life, some after receiving the MMR vaccine.

Any official statistics on the incidence of Autism and Asperger’s Syndrome in Finland in the last 15 years will be greatly appreciated.

Meanwhile, Professor Peltola needs to answer two questions, specifically:
1 Why he claimed that there was no increase in autism in Finland during and following the national MMR vaccination campaign when clearly there has been one.
2. What he believes is the cause of this remarkable increase in Autistic Spectrum Disorders in Finland since the national massive vaccination campaign_

F, Edward Yazbak, MD, FAAP, Falmouth, Massachusetts
November 14, 2002

© 2002

References

1. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998; 351: 637­41

2. Peltola H, Heinonen OP, Valle M et al. The Elimination of Indigenous Measles, Mumps, and Rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med 1994; 331: 1397-402

3. Patja A, Davidkin I, Kurki T, Kallio MJT, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatric Infectious Disease Journal 2000;19(12):1127-1134.

4. Peltola H, Heinonen OP, Valle M, Paunio M, Virtanen M, Karanko V, Cantell K. The Elimination of Indigenous Measles, Mumps, and Rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med 1994; 331: 1397­402. )

5. Kielinen M, Linna S.-L, Moilanen I. Autism in Northern Finland; European Child & Adolescent Psychiatry 9:162-167 (2000)

November 2, 2002

© 2002 F. Edward Yazbak, MD, FAAP Falmouth, Massachusetts, USA