Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis

doi:10.1136/bmj.322.7284.460

BMJ 2001;322:460-463 ( 24 February )

Papers

Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis

James A Kaye, epidemiologist, Maria del Mar Melero-Montes, epidemiologist, Hershel Jick, associate professor of medicine.

Boston Collaborative Drug Surveillance Program, Boston University School of Medicine, 11 Muzzey Street, Lexington, MA 02421, USA

Correspondence to: J A Kaye jkaye{at}narsil.com

Objective: To estimate changes in the risk of autismand assess the relation of autism to the mumps, measles, and rubella(MMR) vaccine.
Design: Time trend analysis of data from the UK generalpractice research database(GPRD).
Setting: General practices in the UnitedKingdom.
Subjects: Children aged 12 years or younger diagnosedwith autism 1988-99, with further analysis of boys aged 2 to 5years born 1988-93.
Main outcome measures: Annual and age specific incidence for firstrecorded diagnoses of autism (that is, when the diagnosis of autismwas first recorded) in the children aged 12 years or younger;annual, birth cohort specific risk of autism diagnosed in the2 to 5 year old boys; coverage (prevalence) of MMR vaccinationin the same birthcohorts.
Results: The incidence of newly diagnosed autism increasedsevenfold, from 0.3 per 10 000 person years in 1988 to 2.1 per10 000 person years in 1999. The peak incidence was among 3 and4 year olds, and 83% (254/305) of cases were boys. In an annualbirth cohort analysis of 114 boys born in 1988-93, the risk ofautism in 2 to 5 year old boys increased nearly fourfold overtime, from 8 (95% confidence interval 4 to 14) per 10 000 forboys born in 1988 to 29 (20 to 43) per 10 000 for boys born in1993. For the same annual birth cohorts the prevalence of MMRvaccination was over 95%.
Conclusions: Because the incidence of autism among 2 to5 year olds increased markedly among boys born in each year separatelyfrom 1988 to 1993 while MMR vaccine coverage was over 95% forsuccessive annual birth cohorts, the data provide evidence thatno correlation exists between the prevalence of MMR vaccinationand the rapid increase in the risk of autism over time. The explanationfor the marked increase in risk of the diagnosis of autism inthe past decade remainsuncertain.

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Rapid Responses:

Read all Rapid Responses

MMR vaccine: J K Anand
bmj.com, 24 Feb 2001 [Full text]
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