Thursday, 25 February 2016

Does rubella (german measles) cause autism?

Rubella rash @ NHS Choices
"Rubella might still cause autism, even in vaccinated populations."

That was one of the points raised in the '2015 reappraisal' document published by Jill Hutton [1] (open-access) covering a topic that has quite a long history with autism in mind (see here).

Rubella, also called german measles, a previously common childhood disease characterised by a rash, high temperature and cold-like symptoms, has in many parts of the world almost been entirely eradicated as a consequence of vaccination and other health measures. Here in Blighty (UK), our public health agency has even recently announced that it will soon halt screening for rubella in pregnant women as a result of the decline of the disease (see here). That screening was carried out following some potentially pretty serious complications to the unborn child known to be associated with maternal contraction of the disease. Sounds familiar doesn't it?

Anyhow, Hutton takes readers through the main points of the research linking rubella or rather congenital rubella syndrome (CRS) and autism down the years. Stella Chess, the first person to talk about rubella (CRS) and autism [2] (at least in the peer-reviewed domain) gets a pretty big shout-out throughout the article, alongside the overlap between CRS and autism from various different perspectives (behavioural, physiological, genetic). Drawing also on literature around the topic of vaccination and autism (see here), discussions also turn to the quite important group of children with autism who do not seem to display the appropriate immunological response to rubella infection/vaccination as per that discussed by Libbey and colleagues [3] for example. The idea being that antibody titers normally showing whether a vaccination has 'worked' in terms of conferring protection against a disease, were lower or none existent in some children on the autism spectrum and potentially indicates some type of immune dysfunction. Similar things have been talked about in other research papers (see here).

Hutton also discusses an important feature of the literature intersecting with migration and autism (see here) and how some: "Foreign born mothers (from the developing world, without vaccinations) are less likely to be immune or again more likely to be susceptible to rubella" and what potential effect this might have on cases of CRS and autism. During the times I've discussed the topic of autism and migration, I've tended to labour the point about how different foods, different exposures and in particular, different levels of vitamin D *might* be part and parcel of the effect noted in cases (see here). The Hutton discussions have been food for thought for me particularly in light of other findings [4].

"The thought that vaccination has wiped out rubella is falsely reassuring and has managed to wipe out most rubella research, but unfortunately rubella lingers." I was also interested in this statement and how, on the back of those previous findings about how a certain kind of immune system might react, or rather not react, to vaccination (assuming complete vaccine coverage), there may be quite a bit more scope for further research with at least some autism in mind. I know this has the potential to take us back into some quite heated discussions but if we are learning anything about the plural autisms (see here) it is that exposure to viral infection in particular, seems to have some important links to at least some types of autism (see here and see here).

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[1] Hutton J. Does Rubella Cause Autism: A 2015 Reappraisal? Front. Hum. Neurosci. 2016. 1 Feb.

[2] Chess S. Autism in children with congenital rubella. J Autism Child Schizophr. 1971 Jan-Mar;1(1):33-47.

[3] Libbey JE. et al. Are there altered antibody responses to measles, mumps, or rubella viruses in autism? J Neurovirol. 2007 Jun;13(3):252-9.

[4] Bahta L. & Ashkir A. Addressing MMR Vaccine Resistance in Minnesota's Somali Community. Minn Med. 2015 Oct;98(10):33-6.

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ResearchBlogging.org Hutton, J. (2016). Does Rubella Cause Autism: A 2015 Reappraisal? Frontiers in Human Neuroscience, 10 DOI: 10.3389/fnhum.2016.00025