A jab separated the twins

Twin brothers Aleksander and Ivan Radulovic look like two peas from the same pod. They are handsome nine-year-olds growing up in a loving family on the outskirts of London. When they were born, both weighing a sturdy seven pounds at St Mary's Hospital, Paddington, on 20 July 1993, their parents could hardly tell them apart and carried them home joyously to begin a normal, happy childhood.

A year later, both healthy boys were booked in by their mother, Rebecca, for routine development tests at their local health centre. Their eyesight was checked, their hearing monitored and they were pronounced to be thriving. If anything, Ivan was more advanced than his brother. He was beginning to talk, had already taken his first step, and was so close to his sibling that the two would suck each other's fingers.

When, soon afterwards, Rebecca and her husband, Dusko, took the twins with their four-year-old sister Jovana out to a restaurant and Ivan called out to the waiter, "more food, please", it was a wonderful moment. Their little boy was obviously going to be clever. Eight years on, they look back at that family occasion, one of the last they would enjoy without worry, with a mixture of nostalgia and incomprehension.

For on 19 August 1994, when Ivan and Aleksander were 13 months old, they had their MMR vaccinations. The boys were given the jabs by the same doctor, on the same day and the vaccine almost certainly came from exactly the same batch. Today, Aleksander is playing the violin and excels in his class at Greenwood Primary. Ivan, in contrast, can hardly string a few words together, will not sit still for two minutes at a time, is autistic and attends a special school. The twins who, although not identical, share the same genes and upbringing, could not be more different.

"Not much had been written about the MMR when I took the twins for their jabs, so I didn't give the matter a second thought," says Rebecca today at the family's stylishly decorated semi in Northolt, Middlesex. "Before the inoculation, the boys both did all the right things at the right time. Of the two, Ivan developed just that bit faster than his brother. He did, however, seem to have a weaker immune system and caught more colds."

In retrospect, Rebecca realises Ivan began to deteriorate soon after the MMR vaccination. At the time she subconsciously tried to ignore it. But by the following summer, when he was two, his condition could not be ignored. "He had stopped being interested in what his brother was doing. Instead, he would sit in the garden and endlessly pick up dirt from the cracks. He had almost stopped talking, whereas Aleksander was by then chattering away in sentences."

"We will never know if the MMR caused Ivan's condition," adds Rebecca, 47, a former receptionist, who gave up work to look after her son. "If Ivan had been a slow developer from the beginning we probably wouldn't have thought so. But he was very advanced and sailed through his one-year-old developmental test. He suddenly stopped developing after his MMR vaccination, and you have to ask yourself why? But then we look at Aleksander, who is good at English, plays the violin and loves tennis, and we wonder again."

The debate over the triple vaccine against mumps, measles and rubella, first introduced in 1988, has been an emotive one. The National Autistic Society states that there are a staggering 500,000 diagnosed cases of autism in this country while research undertaken by the Medical Research Council in 2001 found that one in 166 children under eight years olds has the condition.

The Government, however, insists that there is no cause for alarm. Only today, a new survey by Government scientists of toddlers in the Thames Valley says the MMR vaccination does not overload - and therefore harm - toddlers' immune systems. Other medical experts explain that the marked increase in the condition is the result of better diagnosis.

None the less, more than 2,000 affected families have banded together to take action against the manufacturers of the MMR vaccine, and eight test cases are due to be heard this October in the High Court.

There is no doubt that the decision of whether or not to give a child the MMR vaccination is one of the most important a parent can make. The plight of the Radulovic family highlights the dilemma in the most poignant way. London doctor Richard Halvorsen, who has watched autism numbers grow, said: "It is not a proven fact, but we do see that sometimes the children developing autism after having the MMR vaccine have been more susceptible to things like recurring colds in the past."

Children with autism are hyperactive, obsessional, difficult to control and inevitably dramatically change the lives of their families. "It's very difficult for us to go on family outings," says Dusko, 45, a law graduate from Montenegro in former Yugoslavia, who came for a holiday here in 1983, stayed and then married Rebecca, who is English.

"Ivan runs away if we take our eyes off him for a second and he just can't sit still. It's like having a permanent, very active three-year-old. We have read that the MMR vaccine can have a far greater effect on children who are weaker and thus more vulnerable, but who knows?"

Rebecca, faced with a child who had changed so dramatically, had no idea what to do. "I didn't have a clue what was wrong with him but felt certain that our GP would cure it." Instead, their doctor immediately referred Ivan to a consultant community paediatrician in Ealing for various tests.

The official diagnosis of Ivan's autism did not come through for three months. It was a chance remark during a speech-therapy session that first alerted Rebecca to Ivan's problem. The therapist, who was trying to persuade the boy to talk again, mentioned the word autism to Rebecca. "I burst into tears,' she says. "I cried every day for a whole year afterwards. I was going through a form of bereavement at losing my son. I'm largely over that. Instead, we try to concentrate on helping him become independent. He is now beginning to dress himself."

Having a disabled child can severely affect a marriage, but Dusko and Rebecca are determined to stay together and seem close. "I have tried to be optimistic for Rebecca," Dusko says. "It is one of the reasons why I have stayed as a mini-cab driver rather than retrain as a British lawyer. I work nights so that I can be around as much as possible during the day to help her. It is very important that we don't let ourselves be affected when little things go wrong between us. We have more important things to think of."

Rebecca then adds: "Until about two years ago, Ivan would only sleep for one or two hours at night. It was absolutely exhausting, but I had to get used to it. Fortunately, Aleksander has become a very deep sleeper and, though they share a bedroom, he rarely wakes up when Ivan starts shouting or babbling. Now, luckily, Ivan seems to have a sleepless night only about once a fortnight."

When Ivan is not at school there is little chance of getting any rest. "He has wild, endless energy," says Dusko. "Sometimes he runs round and round the table non-stop for what seems like hours. If you take your eyes off him for a minute he can start smashing up things. Now that he is older he is always trying to open the front door and run off. Also if he wants something, he will ask for it a thousand times. It's hard not to be driven mad."

The most difficult and heartbreaking thing of all, perhaps, has been having the direct comparison of what Ivan so easily could have been. "For many years we couldn't help but compare Ivan and Aleksander all the time," admits Rebecca. "But there is now such a vast difference between them that we try not to." She pauses and her eyes fill with tears. "But it breaks our hearts when Aleksander says to me: 'I wish Ivan wasn't autistic. I want him to come and play football with me.' Luckily he gets on so well with his sister."

Aleksander was told from a very young age that his brother was ill, well before he could understand that the reason why Ivan behaved as he did was because he was autistic. "It's been hard for him," admits his father. "Sometimes we would punish him for something he did, but not punish Ivan when he did something similar, and explain that Ivan could not help it.

"Jovana, too, has been affected. She used to say we loved the boys more than her because Ivan needed a lot of attention, and so did Aleksander when Ivan broke one of his favourite toys. Luckily they both love him. We do too. He has such a cheeky face and grin."

Each day Ivan is brought home from his school for autistic children and always arrives back first. He comes into the room like a tornado, instantly switching on the television, then tearing across the sitting room into the kitchen.

"His routine is always the same," explains his father. "The television has to be on all the time, even though he barely watches it. He then starts eating almost non-stop. The only reason he doesn't get fat is because of the huge amount of energy he burns running around. He always looks out of the window for Aleksander to return. They don't play together but he likes him to be here."

Aleksander arrives at the house about 15 minutes later. He gives both his parents a hug and then sits quietly by his father. Although he and his brother look so incredibly similar, the contrast in their behaviour could not be more marked. It is unbearably moving to watch.

"Our main worry is Ivan's future," continues Rebecca in-between leaping up and chasing after Ivan. " People have told us to put him into an institution, but unless he becomes a danger to himself or others it would break my heart to do so. It is not his fault that he is the way he is."

Fortunately, neither parent feels guilty about letting him have the vaccination. "How could we?" Dusko asks. "We did so with the very best of intentions." "But," adds Rebecca quietly, "I would never do it again. I'd tell our friends to give their babies separate injections. It only costs £100 and it's a very cheap way to get peace of mind."