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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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