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20-September-2008 09:55:52 - Thiomersal controversy The thiomersal controversy is between claims that thiomersal-containing vaccines TCVs cause or contribute to the development of autism and other brain development disorders,1 and mainstream medical opinion that no convincing scientific evidence supports these claims.23 Thiomersal, also spelled thimerosal, is an organomercury preservative used in vaccines since the 1930s to prevent bacterial and fungal contamination.4 In July 1999, following a review of mercury-containing food and drugs, the Centers for Disease Control CDC and the American Academy of Pediatrics AAP asked vaccine makers to remove thiomersal from vaccines as quickly as possible, and it was rapidly phased out of most U.S. and European vaccines.56 The precautionary principle assumes that there is no harm in exercising caution even if it later turns out to be unwarranted, but this 1999 action sparked confusion and controversy that has diverted attention and resources away from other efforts to find the causes of autism.2 Thousands of lawsuits have been filed in the U.S. to seek damages from alleged toxicity from vaccines, including those purportedly from thiomersal preservatives.7 The scientific consensus-including scientific and medical professional bodies and governmental agencies such as the Food and Drug Administration,4 the Centers for Disease Control and Prevention,8 and the World Health Organization9-rejects the hypothesis that exposure to thiomersal causes or contributes to autism or other neurological disorders. Contents 1 Background of controversy 1.1 Scientific background 1.2 Social and political background 2 Rationale for concern 3 Scientific consensus on controversy 4 Effects of the controversy 5 Court cases 6 Timeline 7 See also 8 References Background of controversy Scientific background After the FDA Modernization Act of 1997 mandated a review and risk assessment of all mercury-containing food and drugs, vaccine manufacturers responded to FDA requests to provide detailed information about the thimerosal content of their preparations in December 1998 and April 1999.10 Upon conclusion of this review, the FDA, in conjunction with the other members of the US Public Health Service USPHS, the National Institutes of Health NIH, CDC and Health Resources and Services Administration HRSA in a joint statement with the American Academy of Pediatrics AAP, concluded: Our review revealed no evidence of harm caused by doses of thimerosal found in vaccines, except for local hypersensitivity reactions. At the time of our review, vaccines containing thimerosal as a preservative could expose infants to cumulative mercury at levels that exceed EPA recommendations during the first 6 months of life. The clinical significance of this conclusion is not currently known; EPA guidelines contain as much as a 10-fold safety factor and such guidelines are meant to be starting points for the evaluation of mercury exposure. However, reducing exposure to thimerosal from vaccines is merited given the goal of reducing human exposure to mercury from all sources, the feasibility of removing thimerosal as a vaccine preservative, and the desirability of ensuring public confidence in the safety of vaccines.11 The FDA noted that while the vaccination schedule at that time might have exceeded EPA standards for mercury exposure during the first 6 months of life, it did not exceed those of the FDA, Agency for Toxic Substances and Disease Registry ATSDR, or WHO. The FDA also noted some difficulty interpreting toxicity of the ethylmercury in thiomersal because guidelines for mercury toxicity were based primarily on studies of methylmercury. Despite the lack of convincing evidence of toxicity of thiomersal, the USPHS and AAP determined that thiomersal should be removed from vaccines as a purely preventative measure and to increase public confidence in vaccines.4 Due to continued public concern, the Centers for Disease Control and the National Institutes of Health NIH asked the National Academy of Science's NAS Institute of Medicine IOM to establish an independent expert committee to review hypotheses about existing and emerging immunization safety concerns. In 2001 the committee reported: The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established and rests on indirect and incomplete information, primarily from analogies with methylmercury and levels of maximum mercury exposure from vaccines given in children, the hypothesis is biologically plausible. The committee also concludes that the evidence is inadequate to accept or reject a causal relationship between thimerosal exposures from childhood vaccines and the neurodevelopmental disorders of autism, ADHD, and speech or language delay.12 Social and political background The FDA actions prompted autism advocates to consider the possibility of thiomersal as a cause of autism. The indirect evidence included analogy with neurotoxic effects of mercury compounds, extrapolation from laboratory and animal studies, and comparisons between trends in vaccination and autism cases.13 This concept also gained support in the political sphere, with Rep. Dan Burton and Rep. David Weldon openly supporting this movement as well. A number of hearings were held in the Subcommittee on Human Rights and Wellness, Committee on Government Reform, chaired by Rep. Burton, on the topic of autism and vaccines. His staff concluded: Thimerosal used as a preservative in vaccines in sic likely related to the autism epidemic. This epidemic in all probability may have been prevented or curtailed had the FDA not been asleep at the switch regarding the lack of safety data regarding injected thimerosal and the sharp rise of infant exposure to this known neurotoxin. Our public health agencies' failure to act is indicative of institutional malfeasance for self-protection and misplaced protectionism of the pharmaceutical industry1 Rationale for concern Supporters of a link between thiomersal and autism cite several lines of reasoning for their concerns, including: Appeal for caution: precise thresholds for ethylmercury toxicity have not been fully studied, and methylmercury is a poor surrogate for studying the toxicity of thiomersal.414 In vitro tests: cultured cells in laboratory show adverse effects when exposed to ethylmercury.15 An in vivo study reported in 2004 that autoimmune disease-sensitive mice exposed to thiomersal had growth delay, reduced locomotion, exaggerated response to new stimuli, and uncommon neuronal structure in some brain areas. The exposure attempted to replicate the one-year schedule for U.S. infants in 2001, adjusted for weight and age.16 However, a similar 2007 study found no pervasive developmental neurotoxicity in the same mouse strain.17 Also, while the intervals between vaccination in human infants assure nearly complete clearance of the organic species from the brain and blood, significant accumulation would be expected for the accelerated schedule in the mouse pups.18 Unscientific reports that autism is rarer in the Amish community and other non-vaccinated groups. The reports are undercut by the fact that Amish genes may differ from those in the general community, that people in the Amish community have low exposures to many other potential hazards for example, pesticides and plastics and that increasingly, the Amish do receive at least some vaccinations.19 Epidemiologic data: epidemiologic studies all coauthored by Mark Geier examined population level correlation between thiomersal and autism.20 Concern that mercury might have synergistic effects with other metals and toxicants.21 Despite the 1999 recommendation by the USPSH and AAP, some vaccines continue to contain non-trace amounts of thiomersal, mainly in vaccines targeted against influenza and tetanus.22 Other products that may contain thimerosal include products derived from blood plasma such as RhoD Immune Globulin, pit viper antivenin and coral snake antivenin, as well as black widow spider antivenin.23 Scientific consensus on controversy The scientific consensus is reflected in another committee report commissioned by the CDC by the Institute of Medicine that follows up on the initial 2001 report. Since the 2001 report, the IOM committee took into account new data that had been published in the interim, including a number of large scale epidemiologic studies focusing on the relationship between thiomersal and autism in a number of countries including the US, Sweden, Denmark, and the UK. The committee noted, in response to those who cite in vitro or animal models as evidence for the link between autism and thiomersal: However, the experiments showing effects of thimerosal on biochemical pathways in cell culture systems and showing abnormalities in the immune system or metal metabolism in people with autism are provocative; the autism research community should consider the appropriate composition of the autism research portfolio with some of these new findings in mind. However, these experiments do not provide evidence of a relationship between vaccines or thimerosal and autism. In the absence of experimental or human evidence that vaccination either the MMR vaccine or the preservative thimerosal affects metabolic, developmental, immune, or other physiological or molecular mechanisms that are causally related to the development of autism, the committee concludes that the hypotheses generated to date are theoretical only.24 Based on an exhaustive review of the scientific literature, the committee concludes: Thus, based on this body of evidence, the committee concludes that the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.24 bold in original This committee felt so strongly about this conclusion that they state: The committee concludes that much more research must be conducted on autism. However, research should be directed towards those lines of inquiry most supported by the current state of knowledge. The vaccine hypotheses are not currently supported by the evidence.24 Three large-scale controlled observational studies have been reported on this issue; none have found an association between thiomersal-containing vaccines TCVs and autism.13 A study from Denmark noted no decrease in autism rates despite cessation of TCVs25 and a UK study found that TCVs actually had a protective effect with respect to autism.26 Because the Danish and UK studies involved only diphtheria-tetanus-pertussis DTP or diphtheria-tetanus DT vaccines, they are less relevant for the higher thiomersal exposure levels that occurred in the U.S.13 For the U.S., a study based on the Vaccine Safety Datalink found no association between TCVs and autism.27 Some smaller studies have also found no association between TCVs and autism2829 and a study found no association between thimerosal and the neurological signs of autism.30 Another smaller study also found a protective effect: it reported a significantly lower prevalence of autism spectrum disorders among children exposed to thimerosal 5.95 per 1,000 versus 8.27 per 1,000.31 The research of Mark Geier, the main source of epidemiologic data used by supporters of a link between thiomersal and autism, has received considerable criticism,32 including charges of not presenting methods and statistical analyses to others for verification,33 improperly analyzing data taken from Vaccine Adverse Event Reporting System,3324 as well as either mislabelling or confusing fundamental statistical terms in his papers.24 Further evidence of the position of the scientific consensus includes the rejection of a causal link between thimerosal and autism by the main scientific and medical professional bodies including the American Medical Association,34 the American Academy of Pediatrics,35 the American College of Medical Toxicology,36 the National Academy of Sciences,24 the Food and Drug Administration,4 Centers for Disease Control and Prevention,8 the World Health Organization,9 the Public Health Agency of Canada,37 and the European Medicines Agency.38 Effects of the controversy In July 1999 the CDC and the AAP asked vaccine makers to remove thiomersal from vaccines as quickly as possible, and asked doctors to delay the birth dose of hepatitis B vaccine in children not at risk for hepatitis. The CDC and the AAP followed the precautionary principle, which assumes that there is no harm in exercising caution even if it later turns out to be unwarranted, but their action sparked confusion, controversy and some harm. About 10% of hospitals suspended the use of hepatitis B vaccine for all newborns, and one child born to a Michigan mother infected with hepatitis B virus died of it. The notion that thiomersal causes autism caused some parents to have their children treated with chelation therapy; about 10,000 autistic children in the U.S. receive mercury-chelating agents every year, and in August 2005 a 5-year-old autistic boy died from an arrhythmia caused by injection of the chelating agent EDTA. The notion has also diverted attention and resources away from efforts to determine the causes of autism.2 Court cases Further information: Vaccine court From 1988 until 2008-01-08, 5,263 claims relating to autism were made to the U.S. court that oversees compensation. One claim was compensated, and 350 were dismissed; the rest are pending.39 In the one autism-related case, the government conceded that the child had a pre-existing mitochondrial disorder with autism-like symptoms aggravated by simultaneous immunizations against nine diseases, two of which contained thiomersal.4041 Timeline 1930s - first added to vaccines and other products as a bactericide.42 Mid-1980s - used as a preservative in virtually all whole-cell DPT vaccines, which were routinely administered four times each to children before eighteen months of age, starting at two months. Late 1980s - Hib vaccines are recommended for administration to children at eighteen months. They contain thiomersal. Early 1990s - In the USA three doses of Hepatititis B vaccine at that time containing Thiomersal are recommended for infants under six months of age, beginning on the day of birth; four doses of Hib are recommended within an eighteen month period, beginning at age two. Late 1990s - three of the vaccines included in Vaccination schedules for children between six and eighteen months of age contain thiomersal. 1999 - The American Academy of Pediatrics requests removal of thiomersal from all pediatric vaccines. 2001 - Thiomersal is no longer used in routine childhood vaccines in the U.S.5 2001 - The Institute of Medicine, citing insufficient evidence, is unable to prove or disprove any link between thiomersal and autism. However, they conclude that a causal connection between thiomersal and autism is biologically plausible.4 2002 - The USA Centers for Disease Control CDC and the USA Food and Drug Administration FDA state that: although thiomersal was to be discontinued in some paediatric vaccines, they would not be recalling any unused stocks, as there is no proof that low doses of thiomersal is dangerous, and that the change was purely cautionary. 2004 - The Institute of Medicine, based on new information from epidemiological studies undertaken since its 2001 report, rejects the hypothetical causative link between thiomersal and autism.4 2005 - Robert F. Kennedy, Jr. authored an article in the June, 2005 Rolling Stone, alleging connections between thimerosal in vaccines and autism.43 2006 - Some vaccines provided by the World Health Organization for children in developing countries contain the same amounts of thiomersal as vaccines used previously for American children. Current vaccination schedulescitation needed give these in a shorter time period.citation needed 2006 - In the latest review by the WHO committee, the conclusion previously reached was reaffirmed that there is no evidence of toxicity in infants, children or adults exposed to thiomersal in vaccines.44 2007 - In February, the U.S. National Institute of Mental Health NIMH halted an experiment that gave the chelating agent DMSA to children with autism whose blood had detectable but nontoxic mercury or lead. The experiment, by Susan Swedo, head of autism research at NIMH, had begun in September 2006 but was halted after a 2007 report showed that chelating agents could cause cognitive problems in rats; Swedo decided that NIMH's limited resources were better focused on a different experiment involving minocycline in children with regressive autism. Critics said the chelation experiment posed a risk to children for what is sure to be no medical gain for them; proponents said the therapy is in broad use and the experiment would provide scientific evidence about any benefits or dangers.45 2007 - Theresa and Michael Cedillo, the parents of 12-year-old Michelle Cedillo asked a federal court, the so-called vaccine court, Monday June 11, to find that their child's autism was caused by common childhood vaccines. 2007 - Mike Enzi, the ranking member on the United States Senate Committee on Health, Education, Labor, and Pensions, issued a report assessing allegations about thimerosal and autism. The report substantiated allegations that there were shortcomings in the Institute of Medicine's conflict screening procedures, that thimerosal is used in third-world childhood vaccines, and that late-1990s EPA mercury guidelines were inappropriate for vaccines and caused many individuals to conclude that ethyl mercury can be linked to autism. Several other allegations were not substantiated.46 2008 - A study found that autism rates for children in California increased each quarter from January 1995 through March 2007, despite the removal of all but trace amounts of thiomersal from childhood vaccines since the 1999 national recommendation.47 The study analyzed data from the California Department of Developmental Services database, which had been systematically used by proponents of the thimerosal hypothesis to argue that the rising number of children accessing these services was linked to increased use of thimerosal in vaccines.48 2008 - A study that examined the ethylmercury from thiomersal in vaccines found that the half-life of blood mercury after vaccination averages 3.7 days for newborns and infants, much shorter than the 44 days for methylmercury. The shorter half-life suggests that thiomersal in vaccines is not as risky as was feared, and that a new risk assessment is needed.49 2008 - U.S. presidential candidate John McCain says, It's indisputable that autism is on the rise amongst children, the question is what's causing it. And we go back and forth and there's strong evidence that indicates that it's got to do with a preservative in vaccines.50 See also 2000 Simpsonwood CDC conference David Kirby journalist Generation Rescue Leuprolide Mercury poisoning MMR vaccine controversy References ^ a b Burton D 2003. Mercury in medicine report PDF. Congressional Record 149: E1011-30. ^ a b c Offit PA 2007. Thimerosal and vaccines-a cautionary tale. N Engl J Med 357 13: 1278-9. doi:10.1056/NEJMp078187. PMID 17898096. ^ Doja A, Roberts W 2006. Immunizations and autism: a review of the literature. Can J Neurol Sci 33 4: 341-6. PMID 17168158. ^ a b c d e f g Thimerosal in vaccines. Center for Biologics Evaluation and Research, U.S. Food and Drug Administration 2007-09-06. Retrieved on 2007-10-01. ^ a b Baker JP 2008. Mercury, vaccines, and autism: one controversy, three histories. Am J Public Health. doi:10.2105/AJPH.2007.113159. PMID 18172138. ^ Thimerosal in vaccines: frequently asked questions FAQs. Center for Biologics Evaluation and Research, U.S. Food and Drug Administration 2007-06-07. Retrieved on 2008-07-22. ^ Autism cases in vaccine court: Sugarman SD 2007. Cases in vaccine court-legal battles over vaccines and autism. N Engl J Med 357 13: 1275-7. doi:10.1056/NEJMp078168. PMID 17898095. U.S. Court of Federal Claims 2007-09-28. Vaccine Program/Office of Special Masters Omnibus Autism Proceeding. Retrieved on 2007-11-24. ^ a b Centers for Disease Control 2007-01-08. Mercury and Vaccines Thimerosal. Retrieved on 2007-07-22. ^ a b World Health Organization 2006-07-01. Thiomersal and vaccines: questions and answers. Retrieved on 2007-07-22. ^ American Academy of Pediatrics 1999-09-01. Joint Statement of the American Academy of Pediatrics and the US Public Health Service USPHS. Retrieved on 2007-07-22. ^ Ball LK, Ball R, Pratt RD 2001. An assessment of thimerosal use in childhood vaccines. Pediatrics 107 5: 1147-54. doi:10.1542/peds.107.5.1147. PMID 11331700. ^ Immunization Safety Review Committee, Board on Health Promotion and Disease Prevention, Institute of Medicine 2001. Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders. Washington, DC: National Academy Press. ISBN 0-309-09008-3. ^ a b c DeStefano F 2007. Vaccines and autism: evidence does not support a causal association. Clin Pharmacol Ther 82 6: 756-9. doi:10.1038/sj.clpt.6100407. PMID 17928818. ^ Burbacher TM, Shen DD, Liberato N, Grant KS, Cernichiari E, Clarkson T 2005. Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal. Environ Health Perspect 113 8: 1015-21. PMID 16079072. ^ In vitro tests: James SJ, Slikker W III, Melnyk S, New E, Pogribna M, Jernigan S 2005. Thimerosal neurotoxicity is associated with glutathione depletion: protection with glutathione precursors. Neurotoxicology 26 1: 1-8. doi:10.1016/j.neuro.2004.07.012. PMID 15527868. Baskin DS, Ngo H, Didenko VV 2003. Thimerosal induces DNA breaks, caspase-3 activation, membrane damage, and cell death in cultured human neurons and fibroblasts. Toxicol Sci 74 2: 361-8. doi:10.1093/toxsci/kfg126. PMID 12773768. Ueha-Ishibashi T, Oyama Y, Nakao H et al. 2004. Effect of thimerosal, a preservative in vaccines, on intracellular Ca2+ concentration of rat cerebellar neurons. Toxicology 195 1: 77-84. doi:10.1016/j.tox.2003.09.002. PMID 14698570. ^ Hornig M, Chian D, Lipkin WI 2004. Neurotoxic effects of postnatal thimerosal are mouse strain dependent. Mol Psychiatry 9 9: 833-45. doi:10.1038/sj.mp.4001529. PMID 15184908. ^ Berman RF, Pessah IN, Mouton PR, Mav D, Harry J 2008. Low level neonatal thimerosal exposure: further evaluation of altered neurotoxic potential in SJL mice. Toxicol Sci 101 2: 294-309. doi:10.1093/toxsci/kfm265. PMID 17977901. ^ Clarkson TW, Magos L 2006. The toxicology of mercury and its chemical compounds. Crit Rev Toxicol 36 8: 609-62. doi:10.1080/10408440600845619. PMID 16973445. ^ Olmsted D 2007-07-18. The age of autism: the last word, UPI. Retrieved on 2007-07-23. ^ Geier studies: Geier DA, Geier MR 2006. A meta-analysis epidemiological assessment of neurodevelopmental disorders following vaccines administered from 1994 through 2000 in the United States. Neuro Endocrinol Lett 27 4: 401-13. PMID 16807526. Geier DA, Geier MR 2006. An assessment of downward trends in neurodevelopmental disorders in the United States following removal of Thimerosal from childhood vaccines. Med Sci Monit 12 6: CR231-9. PMID 16733480. Geier DA, Geier MR 2006. An evaluation of the effects of thimerosal on neurodevelopmental disorders reported following DTP and Hib vaccines in comparison to DTPH vaccine in the United States. J Toxicol Environ Health A 69 15: 1481-95. doi:10.1080/15287390500364556. PMID 16766480. Geier DA, Geier MR 2006. Early downward trends in neurodevelopmental disorders following removal of thimerosal-containing vaccines. J Am Phys Surg 11 1: 8-13. Geier DA, Geier MR 2007. A prospective study of mercury toxicity biomarkers in autistic spectrum disorders. J Toxicol Environ Health A 70 20: 1723-30. doi:10.1080/15287390701457712. PMID 17885929. Young HA, Geier DA, Geier MR 2008. Thimerosal exposure in infants and neurodevelopmental disorders: an assessment of computerized medical records in the Vaccine Safety Datalink. J Neurol Sci. doi:10.1016/j.jns.2008.04.002. PMID 18482737. ^ Mutter J, Naumann J, Schneider R, Walach H, Haley B 2005. Mercury and autism: accelerating evidence? PDF. Neuro Endocrinol Lett 26 5: 439-46. PMID 16264412. Retrieved on 2007-08-15. ^ Institute for Vaccine Safety 2007-07-12. Thimerosal Content in Some US Licensed Vaccines. Retrieved on 2007-07-23. ^ Food and Drug Administration 2004-09-09. Mercury in Plasma-Derived Products. Retrieved on 2007-07-23. ^ a b c d e f Immunization Safety Review Committee, Board on Health Promotion and Disease Prevention, Institute of Medicine 2004. Immunization Safety Review: Vaccines and Autism. Washington, DC: The National Academies Press. ISBN 0-309-53275-2. ^ Hviid A, Stellfeld M, Wohlfahrt J, Melbye M 2003. Association between thimerosal-containing vaccine and autism. JAMA 290 13: 1763-6. doi:10.1001/jama.290.13.1763. PMID 14519711. ^ Andrews N, Miller E, Grant A, Stowe J, Osborne V, Taylor B 2004. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. Pediatrics 114 3: 584-91. doi:10.1542/peds.2003-1177-L. PMID 15342825. ^ Verstraeten T, Davis RL, DeStefano F et al. 2003. Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics 112 5: 1039-48. PMID 14595043. ^ Heron J, Golding J, ALSPAC Study Team 2004. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. Pediatrics 114 3: 577-83. doi:10.1542/peds.2003-1176-L. PMID 15342824. ^ Madsen KM, Lauritsen MB, Pedersen CB et al. 2004. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics 112 3: 604-6. doi:10.1542/peds.112.3.604. PMID 12949291. ^ Thompson WW, Price C, Goodson B et al. 2007. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med 357 13: 1281-92. doi:10.1056/NEJMoa071434. PMID 17898097. Lay summary - NNii 2007. ^ Fombonne E, Zakarian R, Bennett A, Meng L, McLean-Heywood D 2006. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics 118 1: e139-50. doi:10.1542/peds.2005-2993. PMID 16818529. ^ Allen A 2007-05-28. Thiomersal on trial: the theory that vaccines cause autism goes to court, Slate. Retrieved on 2008-01-30. ^ a b Parker SK, Schwartz B, Todd J, Pickering LK 2004. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 114 3: 793-804. doi:10.1542/peds.2004-0434. PMID 15342856. Erratum 2005 Pediatrics 115 1, 200. doi:10.1542/peds.2004-2402. PMID 15630018. ^ American Medical Association 2004-05-18. AMA Welcomes New IOM Report Rejecting Link Between Vaccines and Autism. Retrieved on 2007-07-23. ^ American Academy of Pediatrics 2004-05-18. What Parents Should Know About Thimerosal. Retrieved on 2007-07-23. ^ Kurt TL 2006. ACMT position statement: the Iom report on thimerosal and autism PDF. J Med Toxicol 2 4: 170-1. PMID 18072140. ^ National Advisory Committee on Immunization 2007. Thimerosal: updated statement. An Advisory Committee Statement. Can Commun Dis Rep 33 ACS-6: 1-13. PMID 17663033. ^ European Medicines Agency 2004-03-24. EMEA Public Statement on Thiomersal in Vaccines for Human Use. Retrieved on 2007-07-22. ^ National Vaccine Injury Compensation Program statistics reports. Health Resources and Services Administration 2008-01-08. Retrieved on 2008-01-22. ^ Stobbe M, Marchione M 2008-03-07. Analysis: vaccine-autism link unproven, Associated Press. Retrieved on 2008-06-06. ^ Honey K 2008. Attention focuses on autism. J Clin Invest 118 5: 1586-7. doi:10.1172/JCI35821. PMID 18451989. ^ Mercury and vaccines thimerosal. Centers for Disease Control and Prevention 2007-06-05. Retrieved on 2007-10-01. ^ Deadly Immunity : Rolling Stone ^ Statement on thiomersal World Health Organization, July 2006 ^ Stokstad E 2008. Stalled trial for autism highlights dilemma of alternative treatments. Science 321 5887: 326. doi:10.1126/science.321.5887.326. PMID 18635766. ^ Enzi MB 2007. Thimerosal and autism spectrum disorders: alleged misconduct by government agencies and private entities PDF. Retrieved on 2007-10-04. ^ Schechter R, Grether JK 2008. Continuing increases in autism reported to California's developmental services system: mercury in retrograde. Arch Gen Psychiatry 65 1: 19-24. doi:10.1001/archgenpsychiatry.2007.1. PMID 18180424. Lay summary - Associated Press 2008-01-07. ^ Fombonne E 2008. Thimerosal disappears but autism remains. Arch Gen Psychiatry 65 1: 15-6. doi:10.1001/archgenpsychiatry.2007.2. PMID 18180423. ^ Pichichero ME, Gentile A, Giglio N et al. 2008. Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines. Pediatrics 121 2: e208-14. doi:10.1542/peds.2006-3363. PMID 18245396. Lay summary - University of Rochester Medical Center 2008-01-30. ^ Tapper J 2008-02-29. John McCain enters the autism wars, ABC News. Retrieved on 2008-03-03. v d e Vaccines, Vaccination, Immunization, and Inoculation see also artificial induction of immunity Development Adjuvants Cancer vaccines DNA vaccination HIV Live vector vaccine Models Timeline Trial Administration Global: GAVI Policy Schedule Vaccine injury USA: ACIP VAERS VSD Vaccine court Vaccines live Anthrax BCG tuberculosis Flu MMR MMRV PolioOPV Rotavirus Smallpox Varicella Yellow fever Inactivated/toxoid inactivated virus: Flu HAV PolioIPV inactivated bacteria/toxoid: DTwP conjugate: Hib PCV Other subunit: Anthrax DTaP HPV recombinant DNA: HBV other: Anthrax PPV Controversy General A-CHAMP MMR NCVIA Pox party Safe Minds Thiomersal See also List of vaccine topics Epidemiology Eradication of infectious diseases Retrieved from http://en..org/wiki/Thiomersal_controversy Categories: Vaccination | Autism | Toxicology | Medical controversiesHidden categories: All articles with statements | Articles with statements since February 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 27 July 2008, at 16:32
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