PEDIATRICS Vol. 108 No. 4 October 2001, p. e58
ELECTRONIC ARTICLE:
No Evidence for A New Variant of
Measles-Mumps-Rubella-Induced Autism
Received Mar 26, 2001; accepted May 25, 2001.
From the * Institute of Psychiatry, Department of Child and
Adolescent Psychiatry, King's College London, London, United Kingdom;
Objective. A link has been postulated
between measles-mumps-rubella (MMR) vaccine and a form of autism that
is a combination of developmental regression and gastrointestinal
symptoms that occur shortly after immunization. This hypothesis has
involved 3 separate claims: 1) that there is new phenotype of autism
involving regression and gastrointestinal symptoms, 2) that this new
variant is responsible for the alleged rise of autism rates, and 3)
that this phenotype is associated with biological findings suggestive
of the persistence of measles infection. We tested the first of these
claims. If this new "autistic enterocolitis" syndrome had some
validity, then 1 or several of the following 6 predictions should be
supported by empirical data: 1) childhood disintegrative disorder has
become more frequent, 2) the mean age of first parental concern for
autistic children who are exposed to MMR is closer to the mean
immunization age than in children who are not exposed to MMR, 3)
regression in the development of children with autism has become more
common in MMR-vaccinated children, 4) the age of onset for autistic
children with regression clusters around the MMR immunization date and is different from that of autistic children without regression, 5)
children with regressive autism have distinct symptom and severity profiles, and 6) regressive autism is associated with gastrointestinal symptoms and/or inflammatory bowel disorder.
Methods. Three samples were used. Epidemiologic data on 96 children (95 immunized with MMR at a median age of 13.5 months) who
were born between 1992 and 1995 and had a pervasive developmental
disorder diagnosis as reported in a recent UK survey (post-MMR sample) were compared with data from 2 previous clinical samples (1 pre-MMR [n = 98] and 1 post-MMR [n = 68]) of autistic patients. All patients were assessed with the
standardized Autism Diagnostic Interview (ADI), allowing rigorous
comparison of age at first parental concerns and rates of regression
across samples. Reliability was excellent on ADI scores, age of
parental concern, and developmental regression. Furthermore, data on
bowel symptoms and disorders were available in the epidemiologic survey
from both pediatric and parental sources, and immunization dates were
obtained from computerized records.
Results. The prevalence of childhood disintegrative
disorder was 0.6/10 000 (95% confidence interval: 0.02-3.6/10 000);
this very low rate is consistent with previous estimates and is not
suggestive of an increased frequency of this form of pervasive
developmental disorder in samples of children who are immunized with
MMR. There was no difference in the mean age at first parental concern
between the 2 samples exposed to MMR (19.3 and 19.2 months) and the
pre-MMR sample (19.5 months). Thus, MMR immunization was not associated with a shift toward an earlier age for first parental concerns. Similarly, the rate of developmental regression reported in the post-MMR sample (15.6%) was not different from that in the pre-MMR sample (18.4%); therefore, there was no suggestion that regression in
the developmental course of autism had increased in frequency since MMR
was introduced. In the epidemiologic sample, the subset of autistic
children with regression had no other developmental or clinical
characteristics, which would have argued for a specific, etiologically
distinct phenotype. Parents of autistic children with developmental
regression detected the first symptoms at a very similar age (19.8 months) to those of autistic children without regression (19.3 months).
Moreover, the mean intervals from MMR immunization to parental
recognition of autistic symptoms were comparable in autistic children
with or without regression (248 vs 272 days; not significant). In the
epidemiologic sample, gastrointestinal symptoms were reported in 18.8%
of children. Constipation was the most common symptom (9.4%), and no
inflammatory bowel disorder was reported. Furthermore, there was no
association between developmental regression and gastrointestinal
symptoms (odds ratio: 0.63; 95% confidence interval: 0.06-3.2; not
significant), and only 2.1% of the sample experienced both problems, a
rate that did not exceed chance expectations.
Conclusions. No evidence was found to support a distinct
syndrome of MMR-induced autism or of "autistic enterocolitis."
These results add to the recent accumulation of large-scale
epidemiologic studies that all failed to support an association between
MMR and autism at population level. When combined, the current findings
do not argue for changes in current immunization programs and
recommendations.
Child Development Center, Central Clinic, Stafford, United Kingdom.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  R.A. Smith, H. Farnworth, B. Wright, and V. Allgar Are there more bowel symptoms in children with autism compared to normal children and children with other developmental and neurological disorders?: A case control study Autism, July 1, 2009; 13(4): 343 - 355. [Abstract] [PDF]
|
|
|
|
|
|
L. D. Wiggins, C. E. Rice, and J. Baio Developmental regression in children with an autism spectrum disorder identified by a population-based surveillance system Autism, July 1, 2009; 13(4): 357 - 374. [Abstract] [PDF]
|
|
|
|
|
|
S. T. Schultz, H. S. Klonoff-Cohen, D. L. Wingard, N. A. Akshoomoff, C. A. Macera, and Ming Ji Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: The results of a parent survey Autism, May 1, 2008; 12(3): 293 - 307. [Abstract] [PDF]
|
|
|
|
 |
|
 R. J. Landa, K. C. Holman, and E. Garrett-Mayer Social and Communication Development in Toddlers With Early and Later Diagnosis of Autism Spectrum Disorders Arch Gen Psychiatry, July 1, 2007; 64(7): 853 - 864. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ozonoff, B. J. Williams, and R. Landa Parental report of the early development of children with regressive autism: The delays-plus-regression phenotype Autism, December 1, 2005; 9(5): 461 - 486. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Fitzpatrick MMR: risk, choice, chance Br. Med. Bull., June 1, 2004; 69(1): 143 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 MMR vaccine - how effective and how safe? DTB, April 1, 2003; 41(4): 25 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Taylor, E. Miller, R. Lingam, N. Andrews, A. Simmons, and J. Stowe Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study BMJ, February 16, 2002; 324(7334): 393 - 396. [Abstract] [Full Text] [PDF]
|
|
