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Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study
Anders Hviid1, Jørgen Vinsløv Hansen1, Morten Frisch1
1Statens Serum Institut, Copenhagen, Denmark (A.H., J.V.H., M.F.).
Background:
The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake.
Objective:
To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination.
Design:
Nationwide cohort study.
Setting:
Denmark.
Participants:
657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013.
Measurements:
Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).
Results:
During 5 025 754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100 000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.
Limitation:
No individual medical charts were reviewed.
Conclusion:
The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.
Primary Funding Source:
Novo Nordisk Foundation and Danish Ministry of Health.
Insights
The measles, mumps, rubella (MMR) vaccine does not increase autism risk in children. This large study found no link between MMR vaccination and autism in any subgroup or time period, supporting vaccine safety.
Area of Science:
- Pediatric Health
- Vaccinology
- Epidemiology
Background:
- The link between the measles, mumps, rubella (MMR) vaccine and autism remains a public concern, impacting vaccination rates.
- Previous studies have investigated this association, but concerns persist regarding specific subgroups and timing of vaccination.
Purpose of the Study:
- To determine if the MMR vaccine elevates autism risk in children.
- To investigate potential increased risk in specific child subgroups or timeframes post-vaccination.
Main Methods:
- A nationwide cohort study in Denmark included 657,461 children.
- Danish population registries were utilized to link MMR vaccination status with autism diagnoses.
- Survival analysis using Cox proportional hazards regression assessed autism risk, adjusting for covariates.
Main Results:
- Over 5 million person-years of follow-up, 6,517 autism diagnoses occurred.
- The adjusted hazard ratio for autism in MMR-vaccinated vs. unvaccinated children was 0.93 (95% CI, 0.85-1.02).
- No increased autism risk was observed in subgroups based on sibling history, risk factors, or vaccination timing.
Conclusions:
- This study provides strong evidence that MMR vaccination does not increase autism risk.
- MMR vaccination is not associated with triggering autism in susceptible children or case clustering.
- The findings add significant statistical power to existing research on MMR vaccine and autism.
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