Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association
Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association
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DOI：
10.1016/s0140-6736(99)01239-8
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发表时间：
1999-06-12
期刊：
影响因子：
168.9
通讯作者：
Waight, PA
中科院分区：
文献类型：
--
作者：
Taylor, B;Miller, E;Waight, PA
背景。我们进行了一项流行病学研究，以调查麻疹、腮腺炎和风疹（MMR）疫苗是否与自闭症有因果关系。自1979年以来出生的自闭症儿童是在联合王国北泰晤士八个保健区的特殊需要/残疾登记册和特殊学校中确定的。来自临床记录的信息与儿童健康计算系统中保存的免疫数据相关联。我们寻找与1988年英国引入MR - IR疫苗接种相关的发病率或诊断年龄变化趋势的证据。通过病例系列方法调查了在接种疫苗后确定的时期内发病的聚集性。我们确定了498例自闭症（核心自闭症261例，非典型自闭症166例，阿斯伯格综合症71例）。293例符合《国际疾病分类第十版》(ICD10: 214例[82%]核心自闭症，52例[31%]非典型自闭症。[38%]阿斯伯格综合症)。按出生年份划分的病例稳步增加，在引入MMR疫苗接种后，趋势线没有突然“上升”或变化。在18个月之前或之后接种疫苗的病例与从未接种疫苗的病例在诊断时的年龄没有差异。接种MMR疫苗后1年或2年内自闭症发病无时间相关性（相对发病率与对照期比较为0.94 [95% Cl 0.60-1.47]和1.09[0.79-1.52]）。在接种MMR疫苗后的几个月内，发育倒退未聚集（接种MMR疫苗后2个月和4个月内的相对发病率分别为0.92[0.38-2.21]和1.00[0.52-1.95]）。在核心自闭症或非典型自闭症病例中，除了MMR疫苗接种后6个月内的单一间隔外，父母关注的发病年龄没有明显的时间聚类。这似乎是与难以准确定义这种疾病的症状有关的人工制品。解释。我们的分析不支持MMR疫苗和自闭症之间的因果关系。如果这样的关联发生，它是如此罕见，它不能在这个大的区域样本中确定。
Background. We undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism.Methods. Children with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MR IR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method.Findings. We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 [82%] core autism, 52 [31%] atypical autism. 27 [38%] Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0.94 [95% Cl 0.60-1.47] and 1.09 [0.79-1.52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0.92 [0.38-2.21] and 1.00 [0.52-1.95]). No significant temporal clustering for age at onset of parental concern was seen far cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder.Interpretation. Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.