An excellent study was published on Tuesday in the Journal of the American Medical Association that should permanently lay to rest the oft-repeated claims of links between autism and the MMR vaccine given to children to protect against measles, mumps and rubella. I’ll share the abstract here…
Importance Despite research showing no link between the measles-mumps-rubella (MMR) vaccine and autism spectrum disorders (ASD), beliefs that the vaccine causes autism persist, leading to lower vaccination levels. Parents who already have a child with ASD may be especially wary of vaccinations.
Objective To report ASD occurrence by MMR vaccine status in a large sample of US children who have older siblings with and without ASD.
Design, Setting, and Participants A retrospective cohort study using an administrative claims database associated with a large commercial health plan. Participants included children continuously enrolled in the health plan from birth to at least 5 years of age during 2001-2012 who also had an older sibling continuously enrolled for at least 6 months between 1997 and 2012.
Exposures MMR vaccine receipt (0, 1, 2 doses) between birth and 5 years of age.
Main Outcomes and Measures ASD status defined as 2 claims with a diagnosis code in any position for autistic disorder or other specified pervasive developmental disorder (PDD) including Asperger syndrome, or unspecified PDD (International Classification of Diseases, Ninth Revision, Clinical Modification 299.0x, 299.8x, 299.9x).
Results Of 95 727 children with older siblings, 994 (1.04%) were diagnosed with ASD and 1929 (2.01%) had an older sibling with ASD. Of those with older siblings with ASD, 134 (6.9%) had ASD, vs 860 (0.9%) children with unaffected siblings (P < .001). MMR vaccination rates (≥1 dose) were 84% (n = 78 564) at age 2 years and 92% (n = 86 063) at age 5 years for children with unaffected older siblings, vs 73% (n = 1409) at age 2 years and 86% (n = 1660) at age 5 years for children with affected siblings. MMR vaccine receipt was not associated with an increased risk of ASD at any age. For children with older siblings with ASD, at age 2, the adjusted relative risk (RR) of ASD for 1 dose of MMR vaccine vs no vaccine was 0.76 (95% CI, 0.49-1.18; P = .22), and at age 5, the RR of ASD for 2 doses compared with no vaccine was 0.56 (95% CI, 0.31-1.01; P = .052). For children whose older siblings did not have ASD, at age 2, the adjusted RR of ASD for 1 dose was 0.91 (95% CI, 0.67-1.20; P = .50) and at age 5, the RR of ASD for 2 doses was 1.12 (95% CI, 0.78-1.59; P = .55).
Conclusions and Relevance In this large sample of privately insured children with older siblings, receipt of the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.
A brief explanation of the data…a relative risk ratio less than 1.00 suggests that the risk of autism is lower than what would be expected by random chance, while relative risk >1.00 suggests a greater than expected risk. In this study, the statistics suggest that in kids with older siblings with autism who received both recommended doses of the MMR vaccine, rates of autism approached the statistical threshold of being significantly lower than the rate in siblings who were unvaccinated. The authors had some interesting observations about this finding that were discussed at some length in the paper.
So…why bring this up here? Because what church leaders communicate to their congregations really matters, and the medical consequences of measles are potentially very serious for the young children we minister to.
We just finished a blog series about attitudes regarding mental illness and the church and it’s pretty obvious that skepticism in large pockets of the church about recommendations from the medical community run pretty deep…and from where I sit, some of that skepticism…especially when people in the medical and scientific community operate from a very different worldview…is well-deserved. But there’s a point at which blind rejection of good science jeopardizes our ability to credibly communicate our witness to the world outside our Christian cocoon. We become as easy to dismiss as people who wear tinfoil hats and reinforce the perception among outsiders that one needs to check their brain at the door in order to come to church.
There’s a real possibility that you have kids in your church with a chronic medical condition that precludes them from getting the MMR vaccine. Kids who are being treated for cancer, kids who are HIV-positive (3.2 million children worldwide, according to the Kaiser Family Foundation) and kids receiving high doses of oral steroids are unable to take the vaccine. They depend upon “herd” immunity from infections that are potentially fatal for those with compromised immune systems. When large numbers of families forego immunization, vulnerability to outbreaks increases.
One such outbreak occurred at Eagle Mountain International Church in Texas in 2013. In that church, 21 people contracted measles, 16 of whom had never been vaccinated, including all of the children who developed measles. The story received national scrutiny from major media, including Fox News, NPR, USA Today, the Washington Post and ABC News. From the Fox News story…
Although church officials were quick to act after the outbreak — including hosting clinics in August where 220 people received immunization shots — and have denied they are against medical care or vaccinations, people familiar with the ministry say there is a pervasive culture that believers should rely on God, not modern medicine, to keep them well.
“To get a vaccine would have been viewed by me and my friends and my peers as an act of fear — that you doubted God would keep you safe, you doubted God would keep you healthy. We simply didn’t do it,” former church member Amy Arden told The Associated Press.
What are our “take home” points…
- The finding that the MMR vaccine doesn’t cause autism is as close to “settled science” as we can get in modern medicine. Additional money spent researching this topic would represent extraordinarily poor public policy and stewardship of research money better spent determining the causes of autism and studying interventions to limit the functional impact of the condition.
- If I were a parent of a child with a vulnerable immune system, I’d be very concerned about bringing my child to church if I had concerns that many of the kids present in the children’s ministry were unvaccinated.
- If I were a pastor or an elder at a church in an area shown to have low immunization rates or families involved with adopting orphans from Sub-Saharan Africa (where HIV-positive status is endemic), I’d have to consider a policy of asking (if not requiring) families who are regular attenders to provide vaccination information as part of the children’s/youth ministry registration process. Obviously, we don’t want to create unnecessary barriers to families attending church, but we also need to maintain safe ministry environments for the kids we serve. One alternative might be to offer kids with immune system vulnerabilities classes/activities with kids who have been vaccinated. Note: On a statewide basis, Ohio, West Virginia and Colorado currently have the lowest MMR immunization rates according to the CDC, while some neighborhoods and private schools in affluent areas of Los Angeles have immunization rates comparable to those found in South Sudan!
While it’s critical to not allow controversies to divide us (and to continue to welcome families opposed to vaccines at church) we need to maintain ministry environments that are safe for all kids. Where significant numbers of kids go unvaccinated, other kids with medical conditions that preclude vaccination are exposed to risk.
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Key Ministry has assembled a helpful resource on the topic of Asperger’s Disorder and Spiritual Development. This page includes the blog series Dr. Grcevich and Mike Woods developed for Key Ministry, links to lots of helpful resources from other like-minded organizations, and Dr. Grcevich’s presentation on the topic from the 2012 Children’s Ministry Web Summit. Click here to access the page!