Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis
TL;DR: Evidence is provided that no correlation exists between the prevalence of MMR vaccination and the rapid increase in the risk of autism over time, and the explanation for the marked increase in risk of the diagnosis of autism in the past decade remains uncertain.
Abstract: 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.
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01 Jan 2008
TL;DR: This article is reproduced from the previous edition, volume 3, pp. 59–71, of Elsevier Inc.
Abstract: Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) Study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY). This article describes key features of the Global Burden of Disease analytic approach, the evolution of the GBD starting from the first study for the year 1990, and summarizes the methodological improvements incorporated into GBD revisions carried out by the World Health Organization. It also reviews controversies and criticisms, and examines priorities and issues for future GBD updates.
1,011 citations
TL;DR: This overview examines the types of rhetoric individuals may encounter online in order to better understand why the anti-vaccination movement can be convincing, despite lacking scientific support for their claims.
806 citations
Cites background from "Mumps, measles, and rubella vaccine..."
...[113] Kaye JA, del Mar Melero-Montes M, Jick H....
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TL;DR: The identification of chromosomal abnormalities and Mendelian syndromes among individuals with autism, in conjunction with data from genome screens and candidate-gene studies, has helped to refine the view of the complex genetics that underlies autism spectrum conditions.
Abstract: Since autism was first recognized as a disorder in 1943, speculation about its aetiology has ranged from biological to psychological and back again. After twin studies during the 1970s and 1980s yielded unequivocal evidence for a genetic component, aetiological research in autism began to focus primarily on uncovering the genetic mechanisms involved. The identification of chromosomal abnormalities and Mendelian syndromes among individuals with autism, in conjunction with data from genome screens and candidate-gene studies, has helped to refine the view of the complex genetics that underlies autism spectrum conditions.
798 citations
Cites methods from "Mumps, measles, and rubella vaccine..."
...Kaye et al. (2001) Time trend analysis of data from UK database 141 GI, gastrointestinal; MMR, measles–mumps–rubella; PDD, pervasive developmental disorder....
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TL;DR: Results suggest that prenatal environmental factors and parental psychopathology are associated with the risk of autism, and these factors seem to act independently.
Abstract: Research suggests that heredity and early fetal development play a causal role in autism. This case-control study explored the association between perinatal factors, parental psychiatric history, socioeconomic status, and risk of autism. The study was nested within a cohort of all children born in Denmark after 1972 and at risk of being diagnosed with autism until December 1999. Prospectively recorded data were obtained from nationwide registries in Denmark. Cases totaled 698 children with a diagnosis of autism; each case was individually matched by gender, birth year, and age to 25 controls. Analyses by conditional logistic regression produced risk ratios and 95% confidence intervals. Adjusted analyses showed that the risk of autism was associated with breech presentation (risk ratio (RR) = 1.63, 95% confidence interval (CI): 1.18, 2.26), low Apgar score at 5 minutes (RR = 1.89, 95% CI: 1.10, 3.27), gestational age at birth <35 weeks (RR = 2.45, 95% CI: 1.55, 3.86), and parental psychiatric history (schizophrenia-like psychosis: RR = 3.44, 95% CI: 1.48, 7.95; affective disorder: RR = 2.91, 95% CI: 1.65, 5.14). Analyses showed no statistically significant association between risk of autism and weight for gestational age, parity, number of antenatal visits, parental age, or socioeconomic status. Results suggest that prenatal environmental factors and parental psychopathology are associated with the risk of autism. These factors seem to act independently.
688 citations
Cites result from "Mumps, measles, and rubella vaccine..."
...5 per 10,000 until 1990, increasing to about 9 per 10,000 until 1999, for children aged 2–9 years) similar to those in studies conducted in other countries (31, 32)....
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TL;DR: The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence of autism in pre-school children is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders.
Abstract: For decades after Kanner's original paper on the subject was published in 1943, autism was generally considered to be a rare condition with a prevalence of around 2-4 per 10,000 children. Then, studies carried out in the late 1990s and the present century reported annual rises in incidence of autism in pre-school children, based on age of diagnosis, and increases in the age-specific prevalence rates in children. Prevalence rates of up to 60 per 10,000 for autism and even more for the whole autistic spectrum were reported. Reasons for these increases are discussed. They include changes in diagnostic criteria, development of the concept of the wide autistic spectrum, different methods used in studies, growing awareness and knowledge among parents and professional workers and the development of specialist services, as well as the possibility of a true increase in numbers. Various environmental causes for a genuine rise in incidence have been suggested, including the triple vaccine for measles, mumps and rubella (MMR]. Not one of the possible environmental causes, including MMR, has been confirmed by independent scientific investigation, whereas there is strong evidence that complex genetic factors play a major role in etiology. The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders. Whether there is also a genuine rise in incidence remains an open question.
645 citations
References
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TL;DR: In this paper, the authors investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder, and identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
2,505 citations
1,125 citations
TL;DR: The authors' analyses do not support a causal association between MMR vaccine and autism, and it is suggested that if such an association occurs, it is so rare that it could not be identified in this large regional sample.
722 citations
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10 May 2001
TL;DR: A simple system of subgrouping based solely on a description of the type of social impairment will be used, which avoids the confusion inherent in trying to identify the named syndromes.
Abstract: simple practical skills and social adaptation from early childhood and that abnormalities were recognisable from the second year of life. Many clinicians diagnose on their interpretation of Asperger’s clinical descriptions, rather than insisting on normal development before 3 years in the areas mentioned. In this article, a simple system of subgrouping based solely on a description of the type of social impairment will be used, which avoids the confusion inherent in trying to identify the named syndromes. This simple subgrouping has proved helpful in clinical practice even though the groups are no more sharply differentiated and permanent than in any other existing method of classification in the specialty.
524 citations