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Measles and Autism in Minnesota: False Prophets and Real Problems

Measles is in the news again.

As of this writing, 51 children and 3 adults in Minnesota have come down with measles in the past month, of which 3 had been vaccinated. So far, the scale of this outbreak falls within familiar patterns of recent years, including the much-hyped 2015 Disneyland outbreak – the U.S. has averaged about 125 cases per year over the past two decades. However this cluster is unique in that it began in the tightknit Somali-American community of Cedar-Riverside in Minneapolis.  Forty-seven of the 54 reported cases – 87% – are Somali-American.

Somali-Minnesotans share another distinction: the unusually high autism prevalence in their community. One in 32 children (3% of the population) is 1.5 times the statewide prevalence of 1 in 48, and more than double the national rate of 1 in 68.  Even more troubling, autistic Somali-Americans have 3 to 5 times greater risk for intellectual disabilities than their Minnesotan peers in other groups.  Public health officials have downplayed the significance of these findings, pointing to the statistically comparable rate of 1 in 36 among white Minnesotans. However, a similar 2010 Swedish study reinforced the distinction, reflecting autism prevalence 3 to 4 times higher among Somalis in Stockholm than that of other ethnic groups.

This striking autism prevalence among Somali-Americans mirrors the steep rise in prevalence across the U.S. and other industrialized nations, but defies the common explanation of “better diagnosis.” Somali-American parents have witnessed a first-generation shift from a culture in which there is no known autism, for which there is no word for autism in the spoken language, to a reality in which no family is untouched by this epidemic. As Somali-American parents have observed staggering rates of regressions and neurological impairments among their kids, vaccination uptake in their community has declined in recent years. Community leaders reached out to advocacy organizations for support in exercising their parental right to choose individualized vaccination plans appropriate for their children’s medical histories. This action has sparked unprecedented backlash from public health officials and media outlets.

Vaccine safety advocates recall the panicked and impugning tone of the 2015 Disney measles coverage, and this year’s reporting is tediously familiar. But coverage of the 2017 outbreak in Hennepin county has acquired new elements of condescension and paternalism: Lena Sun of the Washington Post declares "Anti-vaccine activists sparked the state's worst measles outbreak in decades," opening with the foreboding specter of a young mother “getting advice from friends,” who have apparently been fomenting “a discredited theory…fanned by meetings organized by anti-vaccine groups.” Sun proceeds to invoke the pharmaceutical industry’s most convenient and reviled villain, Dr. Andrew Wakefield, and misquotes him out of context. Other outlets followed suit, some with comedic hyperbole.

In fact, the work detailed in the 1998 Lancet paper co-authored by Wakefield and 12 others was fully exonerated during co-author Dr. John Walker-Smith’s trial in 2012, in a scathing decision which declared “the finding of serious professional misconduct and the sanction of erasure are both quashed.” The results of that paper have been replicated numerous times, and the causal association between thimerosal and aluminum adjuvants and the brain injuries which cause symptoms of autism are well established. Large court settlements have been awarded to victims of vaccine-induced brain injuries resulting in autism.

The frenzy reached a crescendo this past Monday when the Boston Herald called for the revival of public execution by hanging. It’s one thing, the Herald admonished, when elites in Hollywood don their “fashionable” anti-vaxism atop designer gowns at the Oscars – but “it’s another thing when anti-vaccine activists start preying on vulnerable people, particularly within immigrant communities.” Presumably “immigrant communities” are less capable than other parents of making sound evidence-based decisions, so the vile anti-vaccine interlopers must be dispatched via the hanging rope.

The Somali-American community of Cedar-Riverside sought out Dr. Wakefield to address the consistent pattern of their children’s regressions following the MMR vaccine, after their concerns had been categorically denied and ignored by public health institutions and care providers. The parents pursued comprehensive information to properly weigh the risks and benefits of wild measles infection against risks and benefits of strict compliance with the CDC vaccination schedule.

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