BMJ 2002;325:1134 ( 16 November )

News

MMR vaccine is not linked with autism, says Danish study

Janice Hopkins Tanne, New York

A Danish study of more than half a million children showed no link between measles, mumps, and rubella (MMR) vaccination and autism.

In a commentary accompanying the study, which was published in the New England Journal of Medicine (2002;347:1477-82)[Abstract/Free Full Text], Dr Edward Campion, senior deputy editor, wrote, "This careful and convincing study shows that there is no association between autism and MMR vaccination."

Lead author Dr Kreesten Meldgaard Madsen, an epidemiologist and expert on infectious diseases at the Danish Epidemiology Science Centre in Aarhus, told the BMJ that the study showed that the risk of autism was similar in children who were vaccinated and children who were not.

The study reviewed records of 537303 children born in Denmark between January 1991 and December 1998, representing almost 100% of children born in that period. Of these children 440655 had been vaccinated. Records were retrieved from three sources: the unique identification number assigned to each child at birth; MMR vaccination data reported to the National Board of Health by general practitioners, who give all MMR vaccinations and are reimbursed for their reports; and diagnoses of autism recorded in the Danish Psychiatric Central Registry. Only specialists in child psychiatry diagnose autism and related conditions.

The study considered the children's sex, weight and gestational age at birth, and age at diagnosis of autism or of a related disorder; the socioeconomic status of the parents; and the mother's education.

The authors found that "There was no increase in the risk of autistic disorder or other autistic-spectrum disorders among vaccinated children as compared with unvaccinated children (adjusted relative risk of autistic disorder, 0.92; 95% confidence interval, 0.68 to 1.24; adjusted relative risk of other autistic-spectrum disorders, 0.83; 95% confidence interval, 0.65 to 1.07)."

In addition, the authors found no association between the development of autistic disorder and the age at vaccination, the interval since vaccination, or the calendar period at the time of vaccination.

Children were vaccinated at 15 to 17 months, and catch up vaccination was given to older children when the vaccine was introduced in 1987. Almost all children were vaccinated before the age of 3 years. The mean age at diagnosis for autism was 4 years, 3 months, and for autistic spectrum disorders 5 years, 3 months.

Although MMR vaccination was introduced in Denmark in 1987, the rise in autism began only in the mid-1990s. "If it [MMR vaccination] caused autism, we would see a greater risk [soon] after its introduction," Dr Madsen said, but the study did not show that. Autism is increasing, perhaps because of better diagnosis, but there is no link to MMR vaccination, he said.

The retrospective nature of the study may be its strength, Dr Madsen told the BMJ. Recall bias, such as when parents whose children are given a diagnosis of autism recall events that occurred around the time of the diagnosis, was absent. In this study, data on vaccination were recorded separately from data on diagnosis.

MMR vaccination protects children against disease, Dr Madsen said. "Measles kills one in 3000 children, even in developed countries. It causes encephalitis in one in 2000 and pneumonia in one in 20. People tend to forget."

---

© BMJ 2002
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Rapid Responses:

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bmj.com, 16 Nov 2002 [Full text]

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