Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta
* National Immunization Program, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Battelle Memorial Institute, Centers for Public Health Research and Evaluation, Atlanta, Georgia
National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
Objective. To compare ages at first measles-mumps-rubella (MMR) vaccination between children with autism and children who did not have autism in the total population and in selected subgroups, including children with regression in development.
Methods. A case-control study was conducted in metropolitan Atlanta. Case children (N = 624) were identified from multiple sources and matched to control children (N = 1824) on age, gender, and school. Vaccination data were abstracted from immunization forms required for school entry. Records of children who were born in Georgia were linked to Georgia birth certificates for information on maternal and birth factors. Conditional logistic regression was used to estimate odds ratios (ORs).
Results. The overall distribution of ages at MMR vaccination among children with autism was similar to that of matched control children; most case (70.5%) and control children (67.5%) were vaccinated between 12 and 17 months of age. Similar proportions of case and control children had been vaccinated before 18 or before 24 months. No significant associations for either of these age cutoffs were found for specific case subgroups, including those with evidence of developmental regression. More case (93.4%) than control children (90.6%) were vaccinated before 36 months (OR: 1.49; 95% confidence interval: 1.04–2.14 in the total sample; OR: 1.23; 95% confidence interval: 0.64–2.36 in the birth certificate sample). This association was strongest in the 3- to 5-year age group.
Conclusions. Similar proportions of case and control children were vaccinated by the recommended age or shortly after (ie, before 18 months) and before the age by which atypical development is usually recognized in children with autism (ie, 24 months). Vaccination before 36 months was more common among case children than control children, especially among children 3 to 5 years of age, likely reflecting immunization requirements for enrollment in early intervention programs.
Key Words: autism • autism spectrum disorders • MMR vaccine • immunizations • epidemiology
Abbreviations: MMR, measles-mumps-rubella • IOM, Institute of Medicine • MADDSP, Metropolitan Atlanta Developmental Disabilities Program • DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition • ASD, autism spectrum disorder • MR, mental retardation • OR, odds ratio • CI, confidence interval
Received for publication Apr 24, 2003; Accepted Jul 15, 2003.
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