Lack of Association of Measles, Mumps, and Rubella Vaccination with Autism
Abstract & Commentary
Synopsis: A study of all children born in Denmark from 1991-1998 showed no association between vaccination with measles, mumps, and rubella (MMR) vaccination and autism.
Source: Madsen KM, et al. N Engl J Med. 2002;347: 1477-1482.
A retrospective cohort study of all 537,303 children born in Denmark from 1991-1998 showed that 440,655 (82%) received the MMR vaccine. In this cohort, 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorder were identified from national psychiatric registers of all patients and outpatient clinics in Denmark. The relative risk of autistic disorder among vaccinated children compared with unvaccinated children was 0.92 (95% CI, 0.68-1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95% confidence interval, 0.65-1.07). No association was found between dates of vaccination, the child’s age at the time of vaccination, interval since vacation, or date of vaccination and development of autistic disorder.
Comment by Hal B. Jenson, MD, FAAP
In 1998, Wakefield and colleagues1 reported 12 children with "developmental regression," including 9 with autism, where the parents associated onset of symptoms with MMR vaccination in 8 of the 12 children, with measles infection in 1 child, and otitis media in another. One of the 8 children had delays noted before MMR vaccination, although subsequent regression was also observed. This report, coupled with the ability of measles virus to cause encephalitis and its association with subacute sclerosing panencephalitis, launched concern that measles vaccination may be causally associated with autism. Since that time there has been much public and political attention to this issue. The available evidence to date has not supported the association between MMR vaccination and autism, but the data have been relatively weak, based on case-series and cross-sectional studies. This objective analysis of more than half a million children in a defined population, including about one-fifth who had not received the vaccine, provides conclusive and convincing scientific evidence against the hypothesis that MMR vaccination causes autism.
These unsubstantiated accusations against vaccines are not harmless. Some parents will elect that their children go without vaccination. Unfortunately, it is the children who will suffer the consequence of disease and associated complications and sequelae. Unsupported claims often contribute to generating legal actions, which are costly for all parties. Medical and scientific resources are diverted from other important projects to pursue rumors and innuendo. Even convincing scientific data may not end the misperceptions by some since rigorous objective scientific studies, such as this report, that negate the original misperceptions usually receive much less publicity and attention than the more dramatic, but unsupported, initial claims. The spillover may affect public acceptance of other licensed vaccines, which expands the deleterious effects. Inaccurate adverse publicity in developed countries also affects vaccine acceptance in developing countries. Such unsubstantiated claims have emerged as an additional liability that may affect interest in developing new vaccines.
Dr. Jenson is Chair of
the Department of Pediatrics and Director of the Center for Pediatric Research
at Eastern Virginia Medical School and Children’s Hospital of the King’s
Daughters, Norfolk, VA.
Reference
1. Wakefield AJ, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637-641.
A study of all children born in Denmark from 1991-1998 showed no association between vaccination with measles, mumps, and rubella (MMR) vaccination and autism.
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