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Association of Autistic
Spectrum Disorder and the Measles, Mumps, and Rubella
Vaccine
A Systematic Review of
Current Epidemiological Evidence
Kumanan Wilson, MD, MSc, FRCP(C);
Ed Mills, DPH; Cory Ross, MSc, DPH,
CHE; Jessie McGowan, BMus, MLIS;
Alex Jadad, MD, DPhil, FRCP(C)
Arch Pediatr Adolesc Med. 2003;157:628-634.
Objective To systematically review the
evidence for and against the existence of an
association between autistic spectrum
disorder (ASD) and the measles, mumps, and rubella (MMR)
vaccine.
Study Design We conducted a systematic review
of the medical literature to identify all
controlled epidemiological articles examining
for an association between ASD and the MMR vaccine.
We extracted data from the articles on the
characteristics and objectives of the study
as well as evidence of an association.
Results Twelve articles met the inclusion
criteria. One study found no difference in
the rates of ASD and the MMR vaccine in
children who were vaccinated and those who were not. Six
studies examined for evidence of an increase in
ASD associated with an increase in the MMR
vaccine coverage, none of which showed
evidence of an association. Four studies examined if
a variant form of ASD was associated with the MMR
vaccine, none of which showed evidence of an
association. Eight studies attempted to
determine if there was a temporal association between
developing ASD and receiving the MMR vaccine.
Of these, 1 study identified an increase in
parental concern in the 6-month period following
vaccination with MMR in one of its analyses. The
results of all other studies showed no
association between ASD and the MMR vaccine.
Conclusions The current literature does not
suggest an association between ASD and the
MMR vaccine; however, limited epidemiological
evidence exists to rule out a link between a
rare variant form of ASD and the MMR vaccine. Given the
real risks of not vaccinating and that the
risks and existence of variant ASD remain
theoretical, current policies should continue
to advocate the use of the MMR vaccine.
From the Departments of Medicine and Health
Policy, Management, and Evaluation (Dr Wilson),
University of Toronto, and the Canadian College of
Naturopathic Medicine (Mr Mills and Dr Ross), Toronto
Ontario; Department of Public Health, University of
Oxford, Oxford, England (Mr Mills); Department of
Healthcare Management, Queen Margaret University
College, Edinburgh, Scotland (Dr Ross); the Institute of
Population Health, University of Ottawa, Ottawa, Ontario
(Ms McGowan); and the Centre for Global E-Health
Innovation, University of Toronto (Dr Jadad).
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