Autism, Vaccination and Immigrants - Yet Another Clear Correlation by F. Yazbak, MD, FAAP

January 23, 2011

http://www.vaccinationnews.com/20110121AutismVaccinationImmigrantsYazbakFE

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Autism, Vaccination and Immigrants - Yet Another Clear

Correlation by F. Yazbak, MD, FAAP

Autism and Autistic Spectrum Disorders (ASD) seem more common among young

Somalis in Minnesota and among immigrant communities in several western

countries. At least as late as 2003, Ethiopian-born immigrants to Israel

had no recorded cases of autism. [That is correct: Not a single

one!]

***

The medical literature contains several reports of a higher prevalence of

autism among immigrant communities worldwide.

The earliest report I could find was published on March 6, 1976 in the

Australian Medical Journal. According to Haper and , relatively

more New South Wales children who had at least one foreign-born parent

whose native language was not English, carried a diagnosis of infantile

autism. The authors attributed the behavioral changes to environmental

stresses, adjustment difficulties and a confusing language environment

leading to de-compensation of an already vulnerable child.

Autism was a purely psychiatric disorder at the time. Just nine years

earlier, Bruno Bettleheim had published his widely read The Empty

Fortress: Infantile Autism and the Birth of the Self, where he

promoted his sad and offensive " refrigerator mother " theory of

autism.

Gillberg and Gillberg reported in 1996 that of 55 thirteen-year-old

children with autism they investigated, 15 (27%) were born to parents,

“at least one of whom had migrated to Sweden”. In several cases, the

affected child was the first born in Sweden after the mother’s arrival to

the

country.

[ii]

In 2006,

Maimburg and

Vaeth

[iii] reported results of a “population-based, matched case-control

study of infantile autism” in Denmark and stated that the risk of

infantile autism was increased with foreign citizenship.

Across the Atlantic in 2007, Canadian physicians were reporting similar

findings from Montreal to Vancouver and some complained that there was

“little research to understand

why.”

[iv]

At the time, I talked to a few informed parents in Montreal and reviewed

with them the local situation.

I was told that for years, the “mother tongue” of students in Montreal

schools was French 42%, Non-English 36% and English 22% and that most if

not all non-English-speaking immigrant children attended “French”

schools.

The parents also claimed that the city’s French schools enrolled a

significant number of children with Pervasive Developments Disorders and

provided me with school year 2001-2002 data from a “Special Needs School”

in a Montreal French School Board. Of the 185 students aged 4 to 13 in

that French school, 56 (30.3%) carried a diagnosis of Pervasive

Developmental Disorder (PDD).

The demographic data are illustrated in the following table.

Students in a “Special Needs School” in Montreal –

2001-2002

Mother-language French

Mother-language Creole (Haitian)

Mother-

language

“Other”

Total

No. of Students

85

39

61

185

Students with PDD

17

18

21

56

% with PDD in Group

20

46

34

30

Table I

The above data very strongly suggest that in Montreal French schools,

children of immigrants had a relatively higher prevalence of PDD than

French-Canadian-born children.

To please the genetic crowd, I will concede that Haitian, Arab and Asian

children are genetically different from French children. But it is also a

fact that they have different vaccination patterns.

As an example, the Regional Program of Vaccination for the Province of

Quebec

[v] states that Hepatitis B vaccination is recommended and available

free of charge to children whose families (or at least one parent)

immigrated from regions where hepatitis B is highly endemic. The lists of

hepatitis B-highly endemic countries that followed the above

recommendation included 47 countries from the Sub-Sahara, 18 from Asia, 4

from the Middle-East, 24 from the Pacific Islands, 5 from the region of

the Amazon in addition to Haiti and the Dominican Republic.

According to the Canada Communicable Disease Report of May 1, 2002,

" the only thimerosal-containing vaccine in routine use in the

infant immunization schedules of some Canadian jurisdictions is hepatitis

B

vaccine. "

[vi]

More recently, the Public Health Agency of Canada reported that “The

influenza vaccine and most hepatitis B vaccines are multi-dose vaccines,

which contain thimerosal as a preservative. For immunization of infants

against hepatitis B, parents or guardians in some provinces and

territories have the choice of a thimerosal-free vaccine.” [updated

12/2/2010]

[vii]

The Federal Canadian Immunization rules

[viii

] are in effect in all Canadian Provinces including the Province of

Quebec. Part 3 of the Canadian Immunization Guide exclusively deals with

“Immunization of Persons New to Canada”.

It includes the following statements:

New immigrants, refugees and internationally adopted children may be

lacking immunizations and/or immunization records because of their living

conditions before arriving in Canada or because the vaccines are not

available in their country of origin.

Only written documentation of vaccination given at ages and intervals

comparable with the Canadian schedule should be considered valid.

Therefore health care providers in Canada who see persons newly

arrived in the country should make the assessment and updating of

immunizations a priority.

*****

Section 341 of the Illegal Immigration Reform and Immigrant

Responsibility Act of 1996 imposed certain vaccination requirements on

all persons seeking green cards in the United States. These requirements

apply to persons seeking to adjust their status to permanent residence in

the U.S. as well as to those who apply for immigrant visas to enter the

U.S.

Under “New Vaccination Criteria for U.S. Immigration” the CDC

[ix] presently lists vaccines for the following diseases as currently

required: Mumps, Measles, Rubella, Polio, Tetanus and diphtheria,

Pertussis, Haemophilus influenzae type B (Hib), Hepatitis A,

Hepatitis B, Rotavirus, Meningococcal disease, Varicella’ Pneumococcal

disease and Seasonal influenza.

The human papillomavirus (HPV) and zoster (Shingles) vaccines were

removed from the list of required vaccines for immigrant

applicants in December 2009.

After carefully reviewing the Canadian and United States vaccination

practices related to immigrants, the following is very evident:

Both countries take vaccination of immigrants very seriously

Immigrants and refugees will likely have a 100% compliance with US

vaccine requirements and Canadian “recommendations”

Improperly administered or poorly documented vaccinations WILL be

repeated as needed

The following is quite evident in most Western and developed

countries:

The present generation of children is the most vaccinated ever The present generation of young parents is also the most vaccinated

ever.

This is particularly relevant to this discussion where both immigrant

children and children born to immigrant parents in Canada, Israel and the

United States are discussed.

*****

In 2008, Somali parents in Minnesota were alarmed and devastated when

they started noticing disproportionally high rates of Autism Spectrum

Disorders (ASD) among their children when compared to their schoolmates

in preschool programs.

As expected, those parents asked a simple question: “Why was this

happening?

They also hoped to get an answer.

The situation attracted a lot of attention

[x] nationwide. Any mention of some relationship to vaccination among

immigrants was promptly squashed with the argument that many Somali

children born in Minnesota also had a high prevalence of autistic

disorders.

As of July 24, 2008 the Somali tragedy in Minnesota was still a mystery

[xi] and the Minnesota Department of Health was still “scrambling to

put together a " pre-pilot program " to assess autism in the

general population.” The DOH claimed that its failure to assess the

situation and come up with accurate statistics about autism among

immigrant children with autism was “in part because of laws restricting

access to school data.”

The Minnesota Department of Education on the other hand had no difficulty

stating that “in the Minneapolis' early childhood and kindergarten

programs, more than 12 percent of the students with autism reported

speaking Somali at home. According to Minneapolis school officials, more

than 17 percent of the children in the district's early childhood special

education autism program are Somali speaking.”

At the time, Somali-speaking students constituted almost 6 percent of the

district's total enrollment in early childhood/kindergarten special

education programs.

A special education official in the Minneapolis school district was

quoted as saying “I've been working to get somebody to look at this and

pay attention because it feels like this is too specific [to Somalis].

It's got to be preventable.” The same official also reported that she

knew of an apartment building in the city were almost every Somali family

has “at least one autistic child” and added “They're given more

[vaccines] then we get, and sometimes they're doubled up. Then their

children are given immunizations. In Somalia, their generations have not

received these immunizations, and then suddenly they're getting just a

wallop of them in the moms and then in the babies. That's certainly a

concern that's been expressed to me by the Somali population.”

On March 31, 2009, the MN Department of Health published “Minnesota and

the Somali Community - Report of Study.”

[xii] Only one statement was highlighted in “Bold” character:

“This study did not attempt to identify possible causes or risk

factors for ASD.”

The following paragraph was the only mention of the Somali issue in

the 2-page report:

" Administrative prevalence of Somali children, ages 3 and 4, who

participated in the MPS ECSE ASD programs was significantly higher than

for children of other races or ethnic backgrounds. This is consistent

with what families and others observed. Because of the study’s

limitations, it is not proof that more Somali children have autism than

other children; however, it does raise an important question of why

Somali children are participating in this program more than other

children.”

On January 15, 2011, the Minnesota Autism Spectrum Disorder Task Force

that included two state senators and two state representatives in

addition to delegates from several agencies and professional

organizations issued an “Interim Report "

[xiii] in which the Somali tragedy was discussed in the following

sentence: “However, a Minnesota Department of Health and CDC report

showed that Somali American children enrolled in Minneapolis Public

Schools had an administrative prevalence of up to seven times

higher.”

*****

The Israeli Paradox

For those who do not know the terribly sad story of the Jews in Ethiopia,

I would like to suggest “History of Ethiopian Jews”, a remarkable review.

[xiv]

Page 2 of the review is particularly relevant to the present

discussion.

It is unlikely that vaccines or medications ever reached the poor

Ethiopian Jews who had been isolated for years under atrocious conditions

and were waiting to be secretly evacuated to Israel, in the dark of the

night. Certainly their concerned saviors could not care less whether they

were vaccinated and had completed, signed and stamped “Yellow

cards”.

For their part, the government and social organizations looking after the

refugees during their first months in Israel had plenty to do treating

their diseases, improving their health and nutrition, providing them with

much needed psychological support and “relocating ” them in general.

Whether or not the refugees were “up to date” vaccination-wise was

certainly NOT a priority: These new citizens had in all likelihood

survived all the infectious diseases that Israel had vaccines

for.

*****

I recently discovered a remarkable Israeli “File Review Study” by

Kamer, Zohar et al

[xv] that was published in 2003 and that I somehow had missed all

these years.

For accurate reporting, the authors reviewed a national Israeli registry

of 1,004 Jewish children who were diagnosed with PDD. (Arab children were

not included)

They also examined relevant data available from the Israeli National

Bureau of Statistics and found that those Jewish children born in the

years 1983–1997 and living in Israel at the time belonged to four

distinct groups:

Group 1: Native Israelis of non-Ethiopian extraction: 1,198,300

Group 2: Native Israelis of Ethiopian extraction: 15,600

Group 3: Immigrants of non-Ethiopian extraction: 110,300

Group 4: Children born in Ethiopia: 11,800

Data related to the prevalence of Pervasive Developmental Disorders among

those groups are summarized in Table II.

PDD Prevalence among Jewish children in Israel

1983-1997

Born Abroad

Israeli-born

Ethiopian

Other

Total

Ethiopian

Other

Total

PDD

0

59

13

991

1,004

Total

11,800

110,300

122,100

15,600

1,098,300

1,113,900

Rate/10,000

0

5.3

4.8

8.3

9.0

Table II

There were significant differences in PDD prevalence between

Israeli-born children and immigrant children. But unlike the situation in

Canada and the United States, the estimated prevalence of PDD among

first-generation Ethiopian children in Israel at the time was 0 (Zero)

per 10,000 while among Israeli-born children who were not of Ethiopian

origin, the estimated prevalence was 9 per 10,000.

Not to belabor the point, not a single immigrant child of the 11,800 born

in Ethiopia and living at the time in Israel carried a diagnosis of PDD.

Native Israeli children had a higher prevalence of PDD than foreign born

children. Among the children who were born in Israel, those born to

non-Ethiopian parents had a higher prevalence of PDD when compared to

those children who were born to Ethiopian parents.

A genetic immunity to autism among the Ethiopians is unlikely because:

1. Autism does occur in Ethiopia

2. Children of Ethiopian extraction born in Israel do develop autism

Trying to explain every aspect of the paradox is not easy.

I do propose that Jewish Ethiopian immigrants to Israel, both infants and

adults, probably received no vaccinations in Ethiopia in the rural

distant areas where they lived. Their immigration journey was hasty, at

night and cloaked with secrecy unlike Somali refugees who stayed in

pre-immigration camps for relatively long periods of time waiting to come

to the United States and certainly available for “catch-up measures.”

The Ethiopian infants may also have been older when they started their

pediatric vaccinations in Israel.

Group 3 included children of non-Ethiopian origin who came to Israel in

the 1990s. These children had more PDD than Ethiopians but less that

“Native Israelis”. A plausible explanation could be that many if not most

children from that group came from post-USSR countries, where vaccination

programs were limited when compared to those of Israel.

Conclusions

There has been a continuing barrage of attacks on Dr.

Wakefield and on anyone who dares to say that a vaccine–autism connection

has not as yet been properly ruled out.

It is evident that the CDC and its supporters have not done, and will

never propose to do, a vaccinated v unvaccinated study, the only way to

rule out such a connection.

A thorough discussion of the subject requires attention to the child’s

and his or her mother’s vaccination profiles.

In this review, I have shown that Autism and Autism Spectrum Disorders

seem to be more prevalent among children of immigrants in some western

countries.

The fact that such disorders have not been reported among Israeli

children born in Ethiopia, and in all likelihood differently vaccinated,

speaks for itself.

Similarly, the fact that children born in Israel to women of Ethiopian

origin (who may have had different vaccination profiles) are relatively

less likely to carry a diagnosis of PDD than children born to

non-Ethiopian and Israeli mothers is also worth noting.

This review is as close as anyone can get to an unvaccinated v vaccinated

study without undertaking such a study and a Zero PDD count among

Ethiopian-born children in Israel should be convincing enough that the

issue is by no means settled, as some would like us to believe.

References

i

Haper J,

S. Infantile autism: the incidence of national groups in a

New South Wales survey. Med J Aust. 1976 Mar

6;1(10):299-301.

ii

Gillberg IC,

Gillberg C. Autism in immigrants: a population-based study from

Swedish rural and urban areas. J Intellect Disabil

Res. 1996 Feb;40 ( Pt 1):24-31.

iii

Maimburg RD,

Vaeth M. Perinatal risk factors and infantile autism.

Acta Psychiatr Scand. 2006

Oct;114(4):257-64.

iv

http://www.cbc.ca/health/story/2007/06/06/autism-immigrants.html

Accessed 01/14/11

v

http://www.santepub-mtl.qc.ca/mdprevention/fiches/immunisation/paysendemiciteVHB.pdf

Accessed 01/15/11

vi

http://dsp-psd.pwgsc.gc.ca/Collection/H12-21-28-9.pdf Accessed

01/19/11

vii

http://www.phac-aspc.gc.ca/im/q_a_thimerosal-eng.php Accessed

01/19/11

viii

http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-11-eng.php

Accessed 01/11/11

ix

http://www.cdc.gov/immigrantrefugeehealth/laws-regs/vaccination-immigration/revised-vaccination-immigration-faq.html#whatvaccines

Accessed 01/11/11

x

http://www.nytimes.com/2009/04/01/health/01autism.html Accessed

01/16/11

xi

http://www.minnpost.com/stories/2008/07/24/2687/a_mysterious_connection_autism_and_minneapolis_somali_children

Accessed 01/17/11

xii

http://www.health.state.mn.us/ommh/projects/autism/reportfs090331.pdf

Accessed 01/17/11

xiii

http://archive.leg.state.mn.us/docs/2011/mandated/110065.pdf Accessed

01/17/11

xiv

http://www.jewishfederations.org/page.aspx?id=791 & page=1 Accessed

01/17/11

xv

Kamer A,

Zohar AH,

Youngmann R,

Diamond GW,

Inbar D,

Senecky Y. A prevalence estimate of pervasive developmental disorder

among Immigrants to Israel and Israeli natives. Soc

Psychiatry Psychiatr Epidemiol. 2004

Feb;39(2):141-5.

F. Yazbak MD, FAAP

Falmouth, Massachusetts

Date:

January 21, 2011

Sheri Nakken, former R.N., MA, Hahnemannian

Homeopath

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