Vaccines Autism and Chronic Inflammation

To enlarge this document for easy viewing please click Fullscreen below.

Embedded Scribd iPaper - Requires Javascript and Flash Player
by barbara Loe Fisher
Barbara Loe Fisher is co-founder and president of the National Vaccine Information Center (www.NVIC. org), a non-profit founded in 1982 by parents of vaccine-injured children to prevent vaccine injuries and deaths through public education and defend the informed consent ethic. She has served on the National Vaccine Advisory Committee, Institute of Medicine Vaccine Safety Forum, FDA Vaccines & Related Biological Products Advisory Committee, Vaccine Policy Analysis Collaborative, and Consumers United for Evidence Based Healthcare – U.S. Cochrane Collaboration. She is the mother of three children.
he Great Denial of vaccine risks for the past three decades by vaccine makers, pediatricians, and government officials operating the mass vaccination system is the reason why more and more parents today question and do not trust doctors who tell them to give their children 69 doses of 16 vaccines from the day of birth through age 18, triple the numbers of vaccinations that children were given in the 1970s. When Harris Coulter and I coauthored DPT: A Shot in the Dark1 in 1985 exposing flaws in the mass vaccination system that allowed the highly reactive DPT vaccine to stay on the market unimproved for more than 40 years, we never imagined that those tragic flaws in the system would remain largely intact in 2009. I knew then that the alliance between industry, organized medicine, and the government was powerful. But it is only after a quarter century of witnessing the Great Denial of vaccine risks, and the refusal to do the credible science that will fully evaluate those risks, that the magnitude of that unchecked power has been fully revealed. Even as America celebrated the inauguration of a new president promising an unprecedented transparency and engagement by government with the people, there are new indications that the powerful and wealthy Vaccine Lobby is gearing up to use the government to minimize the significance of new reports of Gardasil vaccine risks;2 block efforts to conduct research into vaccine-related autism;3
ruin the reputations of researchers investigating vaccine-related injuries;4 and deny vaccine-injured children federal compensation5 while protecting vaccine manufacturers from liability for vaccine injuries and deaths.6 New attacks on freedom to investigate, freedom to speak, and freedom to publish in science are compromising truth in science. And one only has to look at the inappropriate influence of the pharmaceutical industry on the kinds of vaccine studies that get published in the medical literature7 to understand why good vaccine science is not being published and bad vaccine science is being used to cover up what will one day be acknowledged as an unprecedented iatrogenic epidemic of inflammation and chronic disease. What gives this tragic epidemic its special poignancy is that it is likely that many more vaccine deaths and injuries will have to occur before steps will be taken by those in power to end it. No matter what is done now by government, industry, and medical organizations fighting to protect the status quo and deny the reality of vaccine casualties, they cannot unring the bell that has been ringing in the U.S. since 1982. That bell, which tolls for children robbed of health by poorly regulated vaccines and one-size-fits-all vaccine policies that do not acknowledge biodiversity, will continue to ring louder and louder with each vaccine casualty despite attempts to silence it.
ISSUE 31 2009
 The question on the minds of many parents today is: Why are so many highly vaccinated children so sick and disabled? During the past quarter century, once prevalent childhood infectious diseases in America like whooping cough, measles, mumps, and chicken pox have been suppressed with the use of multiple vaccines, but now 1 in every 6 children8 becomes developmentally delayed while 1 in 150 or more children develops autism.9  Is there scientific evidence to suggest there could be an association between increased use of vaccines by America’s children and increases in chronic disease and disability among children? In a new book, Vaccines, Autism & Chronic Inflammation: The New Epidemic10 (which is an altered version of a chapter I wrote for Envisioning a Bright Future edited by Patricia Lemer) the evidence from the medical literature is presented to support a “Yes” answer to that question. Although the U.S. Court of Claims recently declined to award federal vaccine injury compensation to three children, who regressed into autism after vaccination, the several biological mechanisms being argued were confined to ones involving thimerosal (mercury) and MMR vaccine.11 Whether one agrees or disagrees about the quantity and quality of the scientific evidence demonstrating causation or lack of causation with regard to the specific biological mechanisms that were argued in these three cases, the fact remains that a causal relationship between vaccination and chronic brain and immune system dysfunction has been very well established in the medical literature for more than a century. Complications of Infections and Vaccination Similar A review of more than a century of medical literature reveals ample evidence that neurological and immune system dysfunction caused by infectious diseases are often identical to neurological and
ISSUE 31 2009
immune system dysfunction caused by vaccines created using those same lab-altered viruses and bacteria. A host/ disease or host/vaccine interaction causes inflammation, which is acute at first and becomes chronic rather than resolving and leaving the host with good health. In both cases, the end result is unresolved inflammation leading to immune-mediated brain dysfunction of varying degrees of severity, which is the same profile many have observed in children with autism spectrum disorders.12,13 Researchers have found evidence of chronic inflammation in the brains of patients with autism, particularly in the cerebellum. Autistic brains have been observed to be in “a chronic state of specific cytokine activity.” The suggested biological mechanisms responsible for the observed brain inflammation included chronic disease or an external environmental source.14 Beginning with smallpox vaccine, which was the first attempt to prevent an infectious disease by injecting a portion of a microorganism associated with the disease into human beings, the most feared complication of both smallpox and smallpox vaccination was brain inflammation.15 In the early 1930s, virologist Thomas Rivers studied the brain damaging effects of rabies vaccine and provided the first evidence that immune
cells can attack the brain.16 Acute brain inflammation, whether it follows infectious disease17,18,19 or vaccination, can become chronic and result in various kinds of mild to severe neurological dysfunction manifested by learning disabilities, ADD/ADHD, seizure disorders, autism, mental retardation, and other developmental delays. The association between vaccination and the development of autistic behaviors in previously healthy children was first reported in 1985 in DPT: A Shot in the Dark in which Harris Coulter and I documented never-before-reported case histories of DPT vaccine-related brain inflammation and permanent brain damage in previously healthy children. These cases were considered by an Institute of Medicine (IOM) Committee preparing a landmark report Adverse Effects of Pertussis and Rubella Vaccines in 1991.20 Vaccines Can Cause Acute and Chronic Brain and Immune Dysfunction The 1991 IOM Committee examining the evidence for and against a causal relationship between DPT vaccine and neurological dysfunction concluded that “the evidence is consistent with a causal relation” between DPT vaccine and acute encephalopathy, encephalitis, or encephalomyelitis. (In that same report, | THE AUTISM FILE 35
the IOM concluded that the “evidence is consistent with a causal relation” between rubella vaccine and acute and chronic arthritis, an autoimmune disorder involving inflammation of the joints.) In 1994, another IOM Committee went further after re-analyzing the landmark 1981 prospective, case-controlled British National Childhood Encephalopathy Study (NCES)21 and concluded in a report entitled DPT Vaccine and Chronic Neurological Dysfunction that: The NCES data are consistent with the possibility that some children without underlying brain or metabolic abnormalities might experience serious acute neurologic illness within 7 days after receiving DPT and that acute illness could have chronic nervous system sequelae. The NCES data are also consistent with the possibility that some children with underlying brain or metabolic abnormalities (which foster a “triggering” by DPT of an acute neurologic illness) might go on to develop chronic nervous system dysfunction due to a DPT-triggered acute illness. Therefore, the Committee concludes that the balance of evidence is consistent with a causal relation between DPT and the forms of chronic nervous system dysfunction described in the NCES in those children who experience a serious acute neurologic illness within 7 days after receiving DPT vaccine….the estimated excess risk ranged from 0 to 10.5 per million immunizations.22 Although the word “autism” did not appear in the NCES, the types of DPT-induced chronic neurological dysfunction that were listed in that study of neurological dysfunction in children were described as “neurologic, motor, sensory, educational, behavioral and selfcare dysfunctions” such as severe febrile and non-febrile convulsions, tremor, gross and fine motor incoordination,
muscle weakness, abnormal tendon reflexes, hyperactive behavior, unsociable behavior, vision and hearing losses. It is worth noting that the original 1981 NCES found that “the risk of a serious neurological disorder within 14 days after measles vaccine in previously normal children irrespective of eventual clinical outcome is 1 in 87,000 immunizations” while the NCES authors found that “the attributable risk of a serious neurological disorder within seven days after DTP vaccine in previously normal children irrespective of eventual clinical outcome is 1 in 110,000 immunizations.” A 1994 IOM Committee examining the medical literature concluded in the report Adverse Events Associated with Childhood Vaccines that “the evidence establishes a causal relation between measles vaccine and death from measles vaccine-strain viral infection.”23 In 1998, CDC officials published a study of cases of brain inflammation within 15 days of MMR or measles vaccination that ended in death or permanent brain injury, including “mental regression and retardation, chronic seizures, motor and sensory deficits, and movement disorders.” The authors noted a clustering of cases with signs and symptoms of brain inflammation (such as seizures) occurring on days 8 and 9 after MMR or measles vaccination and concluded that “a causal relationship between measles vaccine and encephalopathy may exist.”24 In 1999, a study was published in Clinical Infectious Diseases in which the authors state, “we believe that the present report is the first to clearly demonstrate that severe neurological disease can be caused by the vaccine strain of measles virus.”25 Multiple Vaccines, Genetic Vulnerability and Brain and Immune Dysfunction The possibility that genetically vulnerable
A healthy, mature immune system requires an equal balance of cellular and humoral immune system responses. A disruption in this balance can lead to development of allergy and autoimmune disorders, including neuroimmune disorders.
children may develop neurological dysfunction after repeated atypical manipulations of the immune system with multiple vaccines in early childhood is an hypothesis I first presented to the Institute of Medicine Immunization Safety Review Committee in January 2001. I stated: There is a compelling argument to be made that the dramatic increase in chronic brain and immune dysfunction in children, especially the rising number of reports of regression in previously healthy children, is due to an early exposure that is being experienced by all children but which is harming an expanding minority of them…. Many biological responses are at least partially under genetic control. If, for example, adverse responses to vaccination are tied to the genes responsible for predisposition to autoimmunity and immune-mediated neurological dysfunction, then it is possible that the addition of more doses of vaccines to the routine schedule in the past two decades has affected more and more children with that genetic predisposition…26 Therefore, when all children were exposed only to DPT and polio vaccine in the early 1960s, a tiny fraction of the genetically susceptible responded adversely. But with the addition of measles, mumps, and rubella to the routine schedule in 1979, and then HIB, hepatitis B, and chicken pox in the late 1980s and 1990s, far more of the genetically susceptible have been brought into the adverse-responder group. This hypothesis could not be examined by the IOM in their 2002 report on Multiple Immunizations and Immune Dysfunction. After reviewing evidence in the medical literature, the IOM Immunization Safety Review Committee stated that: The committee was unable to address the concern that repeated exposure of a [genetically] susceptible child to multiple immunizations over the developmental period may also produce atypical or non-specific immune or nervous system injury that could lead to severe disability or death (Fisher, 2001). There are no epidemiological studies to address this. Thus, the committee recognizes
ISSUE 31 2009
with some discomfort that this report addresses only part of the overall set of concerns of some of those most wary about the safety of childhood immunization.27 The Hygiene Hypothesis The hygiene hypothesis, first proposed in 1989 by researcher D.E. Strachen, suggests that the reduction of early childhood infections in technologically advanced countries due to improved living conditions and sanitation, widespread vaccination, and antibiotic use in the 20th century has caused an increase in chronic allergic and autoimmune diseases in children.28 Strachen theorized that preventing children from being naturally challenged by exposure to certain viral and bacterial infections during childhood, when the immune system is maturing and learning how to successfully respond to viruses and bacteria in the environment, could weaken the immune system and make it more susceptible to immune dysfunction. In 2005, researchers at the University of Illinois at Chicago conducted a study relating asthma, hay fever, and eczema and vaccination status. Working with the National Vaccine Information Center membership, researchers anonymously identified 515 never vaccinated, 423 partially vaccinated and 239 completely vaccinated children. They concluded that parents of unvaccinated children were 11 times less likely to report asthma for children with no family history of the disease and no exposure to antibiotics in infancy. Parents of unvaccinated children were 10 times less likely to report hay fever among children with no family history of hay fever. Eczema was also reported significantly less in unvaccinated children.29 Unvaccinated children also appear to have a lower incidence of autism, according to a 2005 investigation by UPI reporter Dan Olmsted, who looked at an unvaccinated Amish population in Lancaster, Pennsylvania. If the CDC’s 2005 calculation that one in 166 children was autistic is correct, Olmsted calculated that at least 100 children in Lancaster should have autism. He found only three: a girl adopted from China, an Amish child
Vaccine developers of preventive and therapeutic vaccines continue to have trouble developing safe and effective vaccines which mimic the complex interplay between innate and adaptive immunities involved in the stimulation of the immune system during the natural disease process.
who had been vaccinated and developed autism shortly afterwards, and another child whose vaccination status was unclear.30 Good Health: A Balancing Act Humans and infectious microbes have coexisted for as long as humans have walked the earth, and the human immune system has developed an efficient way of dealing with viral and bacterial infections. When infected with a micro-organism, the body’s first line of defense is for the cellular or “innate” part of the immune system to mount an inflammatory response. This response then signals the humoral or “learned” part of the immune system to produce anti-inflammatory chemicals and antibodies that resolve inflammation, so that healing can take place and establish future resistance to re-infection. A healthy, mature immune system requires an equal balance of cellular and humoral immune system responses. A disruption in this balance can lead to development of allergy and autoimmune disorders, including neuroimmune disorders.31,32,33 Vaccination attempts to fool the body into believing it has come in contact with the real microorganism that causes infection. But vaccination does not exactly mimic the natural infection progress and often bypasses cellular immunity in favor of humoral immunity.34 Most live-virus and killedbacterial vaccines are injected into the body, whereas in the natural disease process, microorganisms enter the body primarily through the mucous membranes of the respiratory and gastrointestinal tracts, where the inflammatory immune response to the challenging microorganism begins. Because vaccine developers do not fully understand the biological mechanisms involved in the immune response to natural infection or vaccination, the achievement of vaccineinduced mucosal (cellular) immunity has been elusive.35,36 Vaccine developers of preventive and therapeutic vaccines continue to have trouble developing safe and effective vaccines which mimic the complex interplay between innate and adaptive immunities involved in the stimulation of the immune system during the natural disease process.37 Newborn infants do not mount a rapid or strong antibody response to vaccination, which is an atypical manipulation of the immune system with lab-altered
viruses and bacteria.38 “Babies are born with a very immature cellular immune system,” says Lawrence Palevsky, MD, a New York pediatrician and co-founder of the Holistic Pediatric Association. “Childhood viral infectious diseases like measles, mumps, and chicken-pox initially stimulate the cellular part of the immune system, which leads to the production of the signs of inflammation - fever, redness, swelling, and mucus. This cellular immune response stimulates the humoral part of the immune system to produce anti-inflammatory chemicals and antibodies that assist in recovery from these illnesses. The natural process helps the cellular and humoral immune systems to mature.”39 In other words, this natural “exercise” of the immune system can make it stronger and better able to maintain good health. When the immune system does not function normally, as in many children with autism spectrum disorders, it may become “stuck” on inflammation and lead to chronic illness. The elimination of most natural experience with infectious disease in early childhood, through mass use of multiple vaccines, may disrupt the balance of cellular and humoral immunity, thus causing children to be susceptible to developing chronic inflammation and chronic illnesses, including autism. Those children genetically predisposed to inflammatory conditions, such as autoimmune disorders or allergies, may be at special risk when they are additionally subjected to atypical manipulation of the immune system with multiple vaccines in early childhood. Chronic Inflammation: At the Root of Most Chronic Disease Many scientists are now concluding that persistent inflammation is at the root of most chronic brain and immune system disorders40,41 and that genetic variations in the population make some individuals genetically vulnerable to inflammatory disease.42,43 The dramatic increase in autism, learning disabilities, and other developmental delays in American children during the past three decades
Since the early 1980s, there has been a doubling or tripling of the numbers of children suffering from autism and other forms of brain and immune system dysfunction at the same time that the numbers of doses of vaccines have tripled, and vaccination rates are at an all time high.
has been accompanied by similar increases in autoimmune disorders. Many American children today, including those with autism, have food and environmental allergies, gluten, and/or casein intolerance, inflammatory bowel disorders, asthma, and other signs of immune dysfunction. Unresolved inflammation may play an important role in the development and persistence of autism in children, and genetic factors that predispose children to autoimmunity may be very important in the development of autism in some children. Researchers have found that mothers of autistic children and family members often have a history of autoimmune disorders, such as thyroid disease, rheumatoid arthritis, and other illnesses marked by chronic inflammation.44 Conclusion Since the early 1980s, there has been a doubling or tripling of the numbers of children suffering from autism and other forms of brain and immune system dysfunction at the same time that the numbers of doses of vaccines have tripled, and vaccination rates are at an all time high. It is possible that, when children are prevented from having any experience with viral and bacterial infections in childhood and are repeatedly subjected to atypical manipulation of the immune system from vaccination, they may become more vulnerable to chronic inflammation leading to chronic illness and disability, including regressive autism. Children, who are genetically vulnerable to immune mediated chronic inflammation, may be at special risk for vaccine-induced neuroimmune dysfunction. The biological mechanisms involved in the type of injury they will suffer are likely dependent upon the individual vaccines or combination of vaccines given and on the child’s individual genetic profile. Additives such as mercury, aluminum, and other toxins in vaccines can cause harm on their own and may contribute to chronic inflammation that leads to neuroimmune dysfunction. There is an urgent need for methodologically sound, basic science research into the biological mechanisms for vaccine-induced brain and immune dysfunction at the cellular and molecular level. Pathological profiles must be developed to separate out what is and is not vaccine-induced to identify which children are more vulnerable than others for suffering harm from vaccination so they can be identified and their lives spared and to find ways to address neuroimmune dysfunction so affected children can begin to heal. Most importantly, there needs to be a re-examination of what constitutes good health and a recognition that some experience with infections in early childhood may be necessary for normal immune and brain development. Individual and public health is not measured simply by an absence of infectious disease as chronic disease can be more devastating and costly over the long run. Attempting to prevent all infections with the use of multiple vaccines in childhood and throughout life may play a significant role in the mysterious rise in chronic disease and disability, including autism, that has developed over the past quarter century. With several hundred vaccines in development in more than 2,000 clinical trials worldwide45 and calls in the U.S. for more vaccine mandates and no exemptions,46 a re-examination of what “good health” really means is a matter of great urgency.
ISSUE 31 2009
Coulter HL, Fisher BL. DPT: A Shot in the Dark. New York: Harcourt Brace Jovanovich. 1985 aspx 2 National Vaccine Information Center. An Analysis by the National Vaccine Information Center of Gardasil and Menactra Adverse Event Reports to the Vaccine Adverse Events Reporting System (VAERS), February 2009. Downloads/NVICGardasilvsMenactraVAERSReportFeb-2009u.aspx 3 Age of Autism. TACA: IACC Rescinds Vaccine Research Initiatives. January 16, 2009. http:// 4 Child Health Safety. U.S. Federal Court, US Justice Department & The Sunday Times – More Questions than Answers. February 17, 2009. http://childhealthsafety.wordpress. com/2009/02/17/more-questions-thananswers/ 5 Freking K, Neergaard L. Court says vaccine is not to blame for autism. Associated Press. February 12, 2009 ap/article/ALeqM5i5qHH2OdrDMQkErloXqYDHZAcHwD96A5PR00 6 Fisher BL. Vaccine Injury Compensation: A Failed Experiment in Tort Reform. Advisory Commission on Childhood Vaccines. November 18, 2008. December-2008/Vaccine-Injury-CompensationA-Failed-Experiment-i.aspx 7 Jefferson T et al. Relation of study quality, concordance, take home message, funding, and impact in studies of influenza vaccines: systematic review. BMJ 2009; 338-b354. http://www.nvic. org/Downloads/Jeffersonetal-BMJ2009.aspx 8 Centers for Disease Control. Morbidity and Mortality Weekly Report: Percentage of Children Aged 5-17 Years Ever Having Diagnoses of ADHD or Learning Disability by Sex and Diagnosis – U.S., 2003. November 4, 2005. mmwr/preview/mmwrhtml/mm5443a8.htm 9 Centers for Disease Control. Morbidity & Mortality Weekly Report: Prevalence of Autism Spectrum Disorders --- Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2002. mmwrhtml/ss5601a2.htm 10 Fisher BL. Vaccines, Autism & Chronic Inflammation: The New Epidemic. PB Industries, Inc. 2008. books.aspx 11 U.S. Court of Claims. Autism Decisions & Background Information. February 12, 2009 http:// 12 Jyonouchi H, Geng L, Ruby A, ZimmermanBier B. Dysregulated innate immune responses in young children with autism spectrum disorders: their relationship to gastrointestinal symptoms and dietary intervention. Neuropsychobiol 2005;51:77-85.
1 13
Blaylock RL. The central role of excitotoxicity in autism spectrum disorders. JAMA 2003; 6:10-22. Vargas DL, Nascimbene C, Krishnan C, Zimmerman AW et al. Neuroglial activation and neuroinflammation in the brain of patients with autism. Annals of Neurology, 57, 1:2004, 67-81. Isselbacher KJ, Braunwald E et al, eds. 1994. Harrison’s Principles of Internal Medicine. Thirteenth Edition. New York: McGraw-Hill. Rivers TM, Sprunt DH, Berry GP. Observations on attempts to produce acute disseminated encephalomyelitis in monkeys. J Exp. Med. 1933;58:39-53. Lidin-Janson G, Strannegard O. Two cases of Guillain-Barre syndrome and encephalitis after measles. British Med J 1972; 2:572. Lurie LA, Levy S. Personality changes and behavior disorders of children following pertussis. JAMA 1942;120:890-4. Russell R, Donald JC. The neurological complications of mumps. British Med J 1958; 27-30. Institute of Medicine. Adverse Effects of Pertussis and Rubella Vaccines. Washington, D.C.: National Academy Press, 1991. Alderslade R, Bellman MH et al. The National Childhood Encephalopathy Study: a report on 1000 cases of serious neurological disorders in infants and young children from the NCES research team. In: Whooping Cough: Reports from the Committee on the Safety of Medicines and the Joint Committee on Vaccination and Immunisation, Department of Health and Social Security, London: Her Majesty’s Stationery Office. 1981. Institute of Medicine. DPT Vaccine and Chronic Nervous System Dysfunction: A New Analysis. Washington, D.C.: National Academy Press, 1994. Institute of Medicine. Adverse Effects Associated with Childhood Vaccines: Evidence Bearing on Causality. Washington, D.C.: National Academy Press, 1994. Weibel RE, Casserta V, Benor DE, Evans G. Acute encephalopathy followed by permanent brain injury or death associated with further attenuated measles vaccines: a review of claims submitted to the national vaccine injury compensation program. Pediatr 1998 Mar; 101(3):383-7.
Enriquez R, Addington W, Davis F, Freels S, et al. The relationship between vaccine refusal and self-report of atopic disease in children. J Allergy Clin Immunol 2005 Apr; 115:737-44. Olmsted D. The Age of Autism: The Amish anomaly. The Washington Times 2005 April 18, 2005. Heine H, Lien E. Toll-like receptors and their function in innate and adaptive immunity. Int Arch Allergy Immunol 2003;130:180-92. Park H, Zhaoxia L, Yang XO, Chang SH, et al. A distinct lineage of CD4 T cells regulates tissue inflammation by producing interleukin 17. Nature Immunol 2005; 6:1133-41. Vojdani A, Erde J. Regulatory T cells, a potent immunoregulatory target for CAM researchers: the ultimate antagonist (I). Evid Based Complement Alternat Med 2006; 3(1):25-30. Rook GA, Zumia A. Gulf war syndrome: is it due to a systemic shift in cytokine balance towards a Th2 profile? The Lancet 1997; 349:1831-3. Thalhamer J, Leitner W, Hammerl P, Brtko J. Designing immune responses with genetic immunization and immunostimulatory dna sequences. Endocrine Regulations 2001; 35:143-66. McKenzie BS, Corbett AJ, Johnson S, Brady JL, et al. Bypassing luminal barriers, delivery to gut address in by parenteral targeting elicits local IgA responses. Int Immunol 2004;16(11):1613-22. Biragyn A. Defensins - non antibiotic use for vaccine development. Current Protein Peptide Science 6 2005:53-60. Siegrist CA. Neonatal and early life vaccinology. Vaccine 2001; 19(25-26):3331-46. Fisher BL. In the Wake of Vaccines. Mothering Magazine 2004 Sept/Oct: 44. Gorman C, Park A. Inflammation is a secret killer: the surprising link between inflammation and asthma, heart attacks, cancer, Alzheimer’s and other diseases. Time Magazine 2004 Feb 23. Wellen KE, Hotamisligil GS. Inflammation, stress and diabetes. J Clin Invest 2005;115:1111-9. Moffatt MF, Cookson W. Genetics of asthma and inflammation: the status. Curr Opin Immunol 1999; 11:606-9. Zhong F, McCombs C. An autosomal screen for genes that predispose to celiac disease in the western counties of Ireland. Nature Genetics 1996; 14:329-33. Pruessner HT. Detecting celiac disease in your patients. Am Fam Physician 1998 Mar.1; 57(5). U.S. National Institutes of Health. Directory of World Clinical Trials. ct2/results?term=vaccines Fisher BL. Attacks on Vaccine Exemptions Increase (commentaries 2007-2009). +on+vaccine+exemptions+increase
Bitnun A, Shannon P. Measles inclusion-body encephalitis caused by the vaccine strain of measles virus. Clinical Infectious Diseases 1999; 29:855-61. Fisher BL. Statement for Immunization Safety Review Committee, Institute of Medicine. January 11, 2001. institutemedicine/iomimmunization.aspx Institute of Medicine. Multiple Immunizations and Immune Dysfunction. Washington, D.C.: National Academy Press. 2002.
28 Strachen DP. Hay fever, hygiene, and household size. Br Med J 1989:299: 1259-60.
ISSUE 31 2009