http://bmj.com/cgi/content/abstract/322/7284/460

 

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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@narsil.com

Objective: To estimate changes in the risk of autism and assess the relation of autism to the mumps, measles, and rubella (MMR) vaccine.
Design: Time trend analysis of data from the UK general practice research database (GPRD).
Setting: General practices in the United Kingdom.
Subjects: Children aged 12 years or younger diagnosed with autism 1988-99, with further analysis of boys aged 2 to 5 years born 1988-93.
Main outcome measures: Annual and age specific incidence for first recorded diagnoses of autism (that is, when the diagnosis of autism was first recorded) in the children aged 12 years or younger; annual, birth cohort specific risk of autism diagnosed in the 2 to 5 year old boys; coverage (prevalence) of MMR vaccination in the same birth cohorts.
Results: The incidence of newly diagnosed autism increased sevenfold, from 0.3 per 10 000 person years in 1988 to 2.1 per 10 000 person years in 1999. The peak incidence was among 3 and 4 year olds, and 83% (254/305) of cases were boys. In an annual birth cohort analysis of 114 boys born in 1988-93, the risk of autism in 2 to 5 year old boys increased nearly fourfold over time, from 8 (95% confidence interval 4 to 14) per 10 000 for boys born in 1988 to 29 (20 to 43) per 10 000 for boys born in 1993. For the same annual birth cohorts the prevalence of MMR vaccination was over 95%.
Conclusions: Because the incidence of autism among 2 to 5 year olds increased markedly among boys born in each year separately from 1988 to 1993 while MMR vaccine coverage was over 95% for successive annual birth cohorts, the data provide evidence that no correlation exists between the prevalence of MMR vaccination and the rapid increase in the risk of autism over time. The explanation for the marked increase in risk of the diagnosis of autism in the past decade remains uncertain.

 

© BMJ 2001

This article has been cited by other articles:

• Smeeth, L., Hall, A. J, Rodrigues, L. C, Huang, X., Smith, P. G, Fombonne, E., Edwardes, M., Baltzan, M., Yazbak, F E., Kaye, J. A, Melero-Montes, M. d. M., Jick, H. (2001). Measles, mumps, and rubella (MMR) vaccine and autism. BMJ 323: 163-163 [Full text]  
• Heussler, H., Polnay, L., Marder, E., Standen, P., Lyn U, C., Butler, N. (2001). Prevalence of autism in early 1970s may have been underestimated. BMJ 323: 633-633 [Full text]  
• Fombonne, E., Chakrabarti, S. (2001). No Evidence for A New Variant of Measles-Mumps-Rubella-Induced Autism. Pediatrics 108: e58-58 [Abstract] [Full text]  
• Heller, T., Heller, D., Pattison, S., Heller, T. (2001). Ethical debate: Vaccination against mumps, measles, and rubella: is there a case for deepening the debate? How safe is MMR vaccine? Validity of the evidence Dealing with uncertainty GP's response. BMJ 323: 838-840 [Full text]  
• Kemp, C. (2001). AAP panel finds no link between ASD, MMR vaccine. AAPNews 18: 197-c-204 [Full text]  

Rapid Response responses to this article:

Read all Rapid Response responses

MMR vaccine

JK Anand

bmj.com, 23 Feb 2001 [Response]

Autism - Could it be drug induced?

Mary Reid

bmj.com, 23 Feb 2001 [Response]

MMR could still be the cause of some autism.

Peter Allmark

bmj.com, 23 Feb 2001 [Response]

What's next?

Michel Odent

bmj.com, 26 Feb 2001 [Response]

The Effect of Improved Case Ascertainment on Autism / MMR studies

Dr A J Ferraro

bmj.com, 26 Feb 2001 [Response]

Another Seriously Flawed Study?

John P. Heprtonstall

bmj.com, 27 Feb 2001 [Response]

Re: What's next?

Mary Reid

bmj.com, 1 Mar 2001 [Response]

Response to Rapid Responses

James A Kaye

bmj.com, 2 Mar 2001 [Response]

Re: Response to Rapid Responses

John P. Heptonstall

bmj.com, 4 Mar 2001 [Response]

Public disquiet remains

Christine Miller

bmj.com, 7 Mar 2001 [Response]

Re: Re: Response to Rapid Responses

James A Kaye

bmj.com, 7 Mar 2001 [Response]

Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners

Dr Nicola Ellis

bmj.com, 7 Mar 2001 [Response]

'Social' causes for changes in incidence of autism. Were other childhood disorders on the increase?

Ronan Ryan; Bernadette Purcell

bmj.com, 10 Apr 2001 [Response]

Re: 'Social' causes for changes in incidence of autism. Were other childhood disorders on the increa

Lisa Blakemore-Brown

bmj.com, 11 Apr 2001 [Response]

Autism: Changes in diagnosis or increase in prevalence- Evidence from the 1970 cohort

Helen Heussler

bmj.com, 14 May 2001 [Response]

MMR is the open door

Karen Montrose

bmj.com, 26 May 2001 [Response]

The numbers don't match

Adrian Thewlis, B.E.

bmj.com, 21 Aug 2001 [Response]

Re: The numbers don't match

James A. Kaye

bmj.com, 31 Aug 2001 [Response]

Correlation with other vaccinations

Russell Welch

bmj.com, 9 Nov 2001 [Response]

How was the "MMR Prevalence" estimated?

Ulf C Brånell

bmj.com, 10 Feb 2002 [Response]

Related letters in BMJ:

Measles, mumps, and rubella (MMR) vaccine and autism

Liam Smeeth, Andrew J Hall, Laura C Rodrigues, Xiangning Huang, Peter G Smith, Eric Fombonne, Michael Edwardes, Marc Baltzan, F Edward Yazbak, James A Kaye, Maria del Mar Melero-Montes, and Hershel Jick
BMJ 2001 323: 163. [Letter]

Prevalence of autism in early 1970s may have been underestimated

Helen Heussler, Leon Polnay, Elizabeth Marder, Penny Standen, Chin Lyn U, and Neville Butler
BMJ 2001 323: 633. [Letter]

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BMJ 2001 322: 0. [Full text]  

 

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