Background It has been suggested that vaccination against measles,mumps, and rubella (MMR) is a cause of autism.
Methods We conducted a retrospective cohort study of all childrenborn in Denmark from January 1991 through December 1998. Thecohort was selected on the basis of data from the Danish CivilRegistration System, which assigns a unique identification numberto every live-born infant and new resident in Denmark. MMR-vaccinationstatus was obtained from the Danish National Board of Health.Information on the children's autism status was obtained fromthe Danish Psychiatric Central Register, which contains informationon all diagnoses received by patients in psychiatric hospitalsand outpatient clinics in Denmark. We obtained information onpotential confounders from the Danish Medical Birth Registry,the National Hospital Registry, and Statistics Denmark.
Results Of the 537,303 children in the cohort (representing2,129,864 person-years), 440,655 (82.0 percent) had receivedthe MMR vaccine. We identified 316 children with a diagnosisof autistic disorder and 422 with a diagnosis of other autistic-spectrumdisorders. After adjustment for potential confounders, the relativerisk of autistic disorder in the group of vaccinated children,as compared with the unvaccinated group, was 0.92 (95 percentconfidence interval, 0.68 to 1.24), and the relative risk ofanother autistic-spectrum disorder was 0.83 (95 percent confidenceinterval, 0.65 to 1.07). There was no association between theage at the time of vaccination, the time since vaccination,or the date of vaccination and the development of autistic disorder.
Conclusions This study provides strong evidence against thehypothesis that MMR vaccination causes autism.
Source Information
From the Danish Epidemiology Science Center, Department of Epidemiology and Social Medicine, Århus, Denmark (K.M.M., M.V., P.T., J.O.); the Danish Epidemiology Science Center, Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark (A.H., J.W., M.M.); and the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta (D.S.).
Address reprint requests to Dr. Madsen at the Danish Epidemiology Science Center, Department of Epidemiology and Social Medicine, Vennelyst Blvd. 6, DK-8000, Aarhus C, Denmark, or at kmm{at}dadlnet.dk.
Ashwell, G.
(2009). Autism and Asperger's syndrome. InnovAiT
2: 651-656
[Abstract][Full Text]
Kilburn, K. H, Thrasher, J. D, Immers, N. B
(2009). Do terbutaline- and mold-associated impairments of the brain and lung relate to autism?. Toxicol Ind Health
25: 703-710
[Abstract]
Gilger, M. A., Redel, C. A.
(2009). Autism and the Gut. Pediatrics
124: 796-798
[Full Text]
Alverson, B.
(2009). Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure. Arch Pediatr Adolesc Med
163: 396-396
[Full Text]
Li, J., Vestergaard, M., Obel, C., Christensen, J., Precht, D. H., Lu, M., Olsen, J.
(2009). A Nationwide Study on the Risk of Autism After Prenatal Stress Exposure to Maternal Bereavement. Pediatrics
123: 1102-1107
[Abstract][Full Text]
Offit, P. A., Moser, C. A.
(2009). The Problem With Dr Bob's Alternative Vaccine Schedule. Pediatrics
123: e164-e169
[Abstract][Full Text]
Baird, G, Pickles, A, Simonoff, E, Charman, T, Sullivan, P, Chandler, S, Loucas, T, Meldrum, D, Afzal, M, Thomas, B, Jin, L, Brown, D
(2008). Measles vaccination and antibody response in autism spectrum disorders. Arch. Dis. Child.
93: 832-837
[Abstract][Full Text]
Clarke, C. E.
(2008). A Question of Balance: The Autism-Vaccine Controversy in the British and American Elite Press. Science Communication
30: 77-107
[Abstract]
Schultz, S. T., Klonoff-Cohen, H. S., Wingard, D. L., Akshoomoff, N. A., Macera, C. A., Ming Ji,
(2008). Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: The results of a parent survey. Autism
12: 293-307
[Abstract]
Montiel-Nava, C., Pena, J. A.
(2008). Epidemiological findings of pervasive developmental disorders in a Venezuelan study. Autism
12: 191-202
[Abstract]
Elliman, D., Bedford, H.
(2007). MMR: where are we now?. Arch. Dis. Child.
92: 1055-1057
[Full Text]
Duggan, C. P., Westra, S. J., Rosenberg, A. E.
(2007). Case 23-2007 -- A 9-Year-Old Boy with Bone Pain, Rash, and Gingival Hypertrophy. NEJM
357: 392-400
[Full Text]
Woo, E. J., Ball, R., Landa, R., Zimmerman, A. W., Braun, M. M., VAERS Working Group, Center for Biologics Evaluati,
(2007). Developmental regression and autism reported to the Vaccine Adverse Event Reporting System. Autism
11: 301-310
[Abstract]
Dover, C. J, Le Couteur, A.
(2007). How to diagnose autism. Arch. Dis. Child.
92: 540-545
[Abstract][Full Text]
Kolevzon, A., Gross, R., Reichenberg, A.
(2007). Prenatal and Perinatal Risk Factors for Autism: A Review and Integration of Findings. Arch Pediatr Adolesc Med
161: 326-333
[Abstract][Full Text]
MacDonald, P.F.
(2007). The MMR vaccine controversy winners, losers, impact and challenges. British Journal of Infection Control
8: 18-22
[Abstract]
Atladottir, H. O., Parner, E. T., Schendel, D., Dalsgaard, S., Thomsen, P. H., Thorsen, P.
(2007). Time Trends in Reported Diagnoses of Childhood Neuropsychiatric Disorders: A Danish Cohort Study. Arch Pediatr Adolesc Med
161: 193-198
[Abstract][Full Text]
State, M. W.
(2006). A surprising METamorphosis: Autism genetics finds a common functional variant. Proc. Natl. Acad. Sci. USA
103: 16621-16622
[Full Text]
Friedlander, A. H., Yagiela, J. A., Paterno, V. I., Mahler, M. E.
(2006). The neuropathology, medical management and dental implications of autism.. Journal of the American Dental Association
137: 1517-1527
[Abstract][Full Text]
Barbaresi, W. J., Katusic, S. K., Voigt, R. G.
(2006). Autism: A Review of the State of the Science for Pediatric Primary Health Care Clinicians.. Arch Pediatr Adolesc Med
160: 1167-1175
[Abstract][Full Text]
Marks, S., Ciliska, D., Jull, A.
(2006). Evaluation of studies of treatment harm. Evid. Based Nurs.
9: 100-104
[Full Text]
D'Souza, Y., Fombonne, E., Ward, B. J.
(2006). No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells From Children With Autism Spectrum Disorder. Pediatrics
118: 1664-1675
[Abstract][Full Text]
Fombonne, E., Zakarian, R., Bennett, A., Meng, L., McLean-Heywood, D.
(2006). Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations. Pediatrics
118: e139-e150
[Abstract][Full Text]
Wright, J. A., Polack, C.
(2006). Understanding variation in measles-mumps-rubella immunization coverage--a population-based study. Eur J Public Health
16: 137-142
[Abstract][Full Text]
Shattuck, P. T.
(2006). The Contribution of Diagnostic Substitution to the Growing Administrative Prevalence of Autism in US Special Education. Pediatrics
117: 1028-1037
[Abstract][Full Text]
Hanley, J. A., Csizmadi, I., Collet, J.-P.
(2005). Two-Stage Case-Control Studies: Precision of Parameter Estimates and Considerations in Selecting Sample Size. Am J Epidemiol
162: 1225-1234
[Abstract][Full Text]
Steiner, J. F.
(2005). The Use of Stories in Clinical Research and Health Policy. JAMA
294: 2901-2904
[Full Text]
Ozonoff, S., Williams, B. J., Landa, R.
(2005). Parental report of the early development of children with regressive autism: The delays-plus-regression phenotype. Autism
9: 461-486
[Abstract]
Baley, J. E., Leonard, E. G.
(2005). The Immunologic Basis for Neonatal Immunizations. NeoReviews
6: e463-e470
[Full Text]
Bauch, C. T
(2005). Imitation dynamics predict vaccinating behaviour. Proc R Soc B
272: 1669-1675
[Abstract][Full Text]
Hviid, A., Wohlfahrt, J., Stellfeld, M., Melbye, M.
(2005). Childhood Vaccination and Nontargeted Infectious Disease Hospitalization. JAMA
294: 699-705
[Abstract][Full Text]
Larsson, H. J., Eaton, W. W., Madsen, K. M., Vestergaard, M., Olesen, A. V., Agerbo, E., Schendel, D., Thorsen, P., Mortensen, P. B.
(2005). Risk Factors for Autism: Perinatal Factors, Parental Psychiatric History, and Socioeconomic Status. Am J Epidemiol
161: 916-925
[Abstract][Full Text]
McGreevy, D.
(2005). Risks and benefits of the single versus the triple MMR vaccine: how can health professionals reassure parents?. The Journal of the Royal Society for the Promotion of Health
125: 84-86
[Abstract]
Steuernagel, T.
(2005). Increases in Identified Cases of Autism Spectrum Disorders: Policy Implications. Journal of Disability Policy Studies
16: 138-146
[Abstract]
Goin-Kochel, R. P., Myers, B. J.
(2005). Congenital Versus Regressive Onset of Autism Spectrum Disorders: Parents' Beliefs About Causes. Focus Autism Other Dev Disabl
20: 169-179
[Abstract]
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., Jacobsen, S. J.
(2005). The Incidence of Autism in Olmsted County, Minnesota, 1976-1997: Results From a Population-Based Study. Arch Pediatr Adolesc Med
159: 37-44
[Abstract][Full Text]
Folb, P. I., Bernatowska, E., Chen, R., Clemens, J., Dodoo, A. N. O., Ellenberg, S. S., Farrington, C. P., John, T. J., Lambert, P.-H., MacDonald, N. E., Miller, E., Salisbury, D., Schmitt, H.-J., Siegrist, C.-A., Wimalaratne, O.
(2004). A Global Perspective on Vaccine Safety and Public Health: The Global Advisory Committee on Vaccine Safety. AJPH
94: 1926-1931
[Abstract][Full Text]
Dubik, M., Offit, P. A.
(2004). Measles Virus RNA and Autism Revisited. AAP Grand Rounds
12: 56-57
[Full Text]
Meissner, H. C., Strebel, P. M., Orenstein, W. A.
(2004). Measles Vaccines and the Potential for Worldwide Eradication of Measles. Pediatrics
114: 1065-1069
[Abstract][Full Text]
Parker, S. K., Schwartz, B., Todd, J., Pickering, L. K.
(2004). Thimerosal-Containing Vaccines and Autistic Spectrum Disorder: A Critical Review of Published Original Data. Pediatrics
114: 793-804
[Abstract][Full Text]
VERDOUX, H., BEGAUD, B.
(2004). Pharmaco-epidemiology: what do (and don't) we know about utilisation and impact of psychotropic medications in real-life conditions?. Br. J. Psychiatry
185: 93-94
[Full Text]
Vestergaard, M., Hviid, A., Madsen, K. M., Wohlfahrt, J., Thorsen, P., Schendel, D., Melbye, M., Olsen, J.
(2004). MMR Vaccination and Febrile Seizures: Evaluation of Susceptible Subgroups and Long-term Prognosis. JAMA
292: 351-357
[Abstract][Full Text]
Klein, K. C, Diehl, E. B
(2004). Relationship Between MMR Vaccine and Autism. The Annals of Pharmacotherapy
38: 1297-1300
[Abstract][Full Text]
Jick, H., Kaye, J. A.
(2004). Autism and DPT Vaccination in the United Kingdom. NEJM
350: 2722-2723
[Full Text]
Woo, E. J., Ball, R., Bostrom, A., Shadomy, S. V., Ball, L. K., Evans, G., Braun, M.
(2004). Vaccine Risk Perception Among Reporters of Autism After Vaccination: Vaccine Adverse Event Reporting System 1990-2001. AJPH
94: 990-995
[Abstract][Full Text]
Serajee, F. J., Nabi, R., Hailang Zhong, , Mahbubul Huq, A.H.M.
(2004). Polymorphisms in Xenobiotic Metabolism Genes and Autism. J Child Neurol
19: 413-417
[Abstract]
Fitzpatrick, M.
(2004). MMR: risk, choice, chance. Br Med Bull
69: 143-153
[Abstract][Full Text]
Bardenheier, B., Yusuf, H., Schwartz, B., Gust, D., Barker, L., Rodewald, L.
(2004). Are Parental Vaccine Safety Concerns Associated With Receipt of Measles-Mumps-Rubella, Diphtheria and Tetanus Toxoids With Acellular Pertussis, or Hepatitis B Vaccines by Children?. Arch Pediatr Adolesc Med
158: 569-575
[Abstract][Full Text]
Muhle, R., Trentacoste, S. V., Rapin, I.
(2004). The Genetics of Autism. Pediatrics
113: e472-e486
[Abstract][Full Text]
DeStefano, F., Bhasin, T. K., Thompson, W. W., Yeargin-Allsopp, M., Boyle, C.
(2004). Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta. Pediatrics
113: 259-266
[Abstract][Full Text]
Hviid, A., Stellfeld, M., Wohlfahrt, J., Melbye, M.
(2003). Association Between Thimerosal-Containing Vaccine and Autism. JAMA
290: 1763-1766
[Abstract][Full Text]
Wright, S.
(2003). Measles, mumps, and rubella vaccine was not associated with autism in children. Evid. Based Nurs.
6: 89-89
[Full Text]
Gurney, J. G., Fritz, M. S., Ness, K. K., Sievers, P., Newschaffer, C. J., Shapiro, E. G.
(2003). Analysis of Prevalence Trends of Autism Spectrum Disorder in Minnesota. Arch Pediatr Adolesc Med
157: 622-627
[Abstract][Full Text]
Wilson, K., Mills, E., Ross, C., McGowan, J., Jadad, A.
(2003). Association of Autistic Spectrum Disorder and the Measles, Mumps, and Rubella Vaccine: A Systematic Review of Current Epidemiological Evidence. Arch Pediatr Adolesc Med
157: 628-634
[Abstract][Full Text]
Mullins, M. E.
(2003). Measles-Mumps-Rubella Vaccine and Autism. Pediatrics
112: 206-206
[Full Text]
Frid, P. J
(2003). The measles, mumps, and rubella vaccine was not associated with autism in children. Evid. Based Med.
8: 93-93
[Full Text]
Tidmarsh, L.
(2003). There is little evidence that combined vaccination against measles, mumps, and rubella is associated with autism. Evid. Based Ment. Health
6: 62-62
[Full Text]
(2003). MMR vaccine - how effective and how safe?. DTB
41: 25-29
[Abstract][Full Text]
(2003). Measles-Mumps-Rubella Vaccine and Autism: No Link Found. JWatch Neurology
2003: 9-9
[Full Text]
Spitzer, W. O., Mullins, M. E., Wakefield, A. J., Noble, K. K., Miyasaka, K., Madsen, K. M., Campion, E. W.
(2003). Measles, Mumps, and Rubella Vaccination and Autism. NEJM
348: 951-954
[Full Text]
Rathore, M. H., Barton, L. L.
(2003). MMR Vaccine and Autism: A Population-based Study. AAP Grand Rounds
9: 16-17
[Full Text]
Fombonne, E.
(2003). The Prevalence of Autism. JAMA
289: 87-89
[Full Text]
(2002). No Link Between MMR Vaccine and Autism. Journal Watch Dermatology
2002: 8-8
[Full Text]
(2002). Autism and the MMR Vaccine: No Connection Found. JWatch Psychiatry
2002: 5-5
[Full Text]
Newschaffer, C. J., Fallin, D., Lee, N. L.
(2002). Heritable and Nonheritable Risk Factors for Autism Spectrum Disorders. Epidemiol Rev
24: 137-153
[Full Text]
(2002). No Link Between MMR Vaccine and Autism. JWatch Pediatrics
2002: 1-1
[Full Text]
(2002). No Link Between MMR Vaccine and Autism. JWatch General
2002: 6-6
[Full Text]
Tanne, J. H.
(2002). MMR vaccine is not linked with autism, says Danish study. BMJ
325: 1134-1134
[Full Text]
Risher, J. F, Murray, H E., Prince, G. R
(2002). Organic mercury compounds: human exposure and its relevance to public health. Toxicol Ind Health
18: 109-160
[Abstract]