{"id":698,"date":"2015-05-02T11:00:57","date_gmt":"2015-05-02T11:00:57","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=698"},"modified":"2017-08-21T11:47:44","modified_gmt":"2017-08-21T11:47:44","slug":"primary-care-corner-with-geoffrey-modest-md-mmr-vaccination-and-autism-again","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/05\/02\/primary-care-corner-with-geoffrey-modest-md-mmr-vaccination-and-autism-again\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: MMR vaccination and autism, again"},"content":{"rendered":"

By: Dr. Geoffrey Modest\u00a0<\/strong><\/span><\/p>\n

Yet another study on the relationship (or lack \u200bthereof) between MMR vaccination and autism. I bring this up since this is a large study but includes kids at higher risk of autism\u00a0(see\u00a0JAMA. 2015;313(15):1534-1540<\/strong>). This is a retrospective cohort study from a large health insurer (Optum)\u00a0database, using claims data (the insurer is mostly in the south and Midwest of the US, though does\u00a0have people in all regions. 75% white, 9% Hispanic, 3.5% black and 3.5%\u00a0Asian). <\/span><\/p>\n

\"Untitled\"<\/a><\/p>\n

Details:<\/span><\/p>\n

–95,727 kids who had\u00a0older siblings. Autism spectrum disorder (ASD) was\u00a0defined\u00a0as 2 claims with a\u00a0diagnosis of autistic disorder or pervasive developmental disorder, including Asperger. All kids were continuously enrolled in the health plan from birth to age 5 during 2001-2012.<\/span>
\n –944 (1.04%) were diagnosed with ASD.\u00a01929 had an older sibling with ASD, of which 134 (6.9%) were diagnosed with ASD, vs 860 (0.9%) of those without an older sib having\u00a0ASD<\/span>
\n –MMR vaccination rates were 84% (n= 78,564) at 2 years of age and 92% (86,063) at 5 years\u00a0in those without an affected older sib, and 73% (n=1409) at 2 years and 86% (n=1660) at 5 years\u00a0in those with an older sib with ASD<\/span>
\n –for children with an older sib with ASD: at age 2, the adjusted relative risk of ASD for 1 dose of MMR vs no vaccine was 0.76 (0.49-1.18); at age 5 the RR for 2 doses of MMR vs no vaccine was 0.56 (0.31-1.01) \u00a0— ie, a trend to lower likelihood!!<\/span>
\n –for\u00a0children with no older sib with ASD: at age 2, the adjusted relative risk\u00a0of ASD for 1 dose of MMR vs no vaccine was 0.91 (0.67-1.20); at age 5 the RR for 2 doses of MMR vs no vaccine was 1.12\u00a0(0.78-1.59)<\/span>
\n –risk was adjusted for birth year, sex, region, race\/ethnicity, maternal\/paternal highest education level, mother’s and father’s\u00a0age at birth of index infant, Childhood Chronic Condition score, seizure, allergies, preterm birth<\/span><\/p>\n

So, bottom line: another study not finding a link between MMR and ASD, even in kids at higher risk of ASD because of family history (older sib with diagnosis of ASD). Not a great study, since based on insurance claims, but seems to me quite likely that ASD would have been coded as a diagnosis, especially with the concern about the linkage with\u00a0MMR. Although the insured are a select population (eg\u00a0working),\u00a0the prevalence of ASD reported as\u00a01.04% is in line with the\u00a0nationally-reported 1.5%, and the % of younger\u00a0sibs developing ASD who have an affected older sib\u00a0(6.9%) is also within the range of\u00a0published estimates of 6.4-24.7%.\u00a0I am actually impressed in this study that 86% of 5 year olds with an affected sib actually got 2 MMR vaccines, given the hype in the popular press!! and, maybe MMR vaccination is even protective, given the trend noted a<\/span>bove.<\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest\u00a0 Yet another study on the relationship (or lack \u200bthereof) between MMR vaccination and autism. I bring this up since this is a large study but includes kids at higher risk of autism\u00a0(see\u00a0JAMA. 2015;313(15):1534-1540). This is a retrospective cohort study from a large health insurer (Optum)\u00a0database, using claims data (the insurer is […]<\/p>\n

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