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In a 2014 meta-analysis, 10 observational studies on childhood vaccines were identified: 5 cohort studies and 5 case–control studies (2).
Of these, 2 cohort studies and 4 case–control studies specifically addressed MMR and autism, all reporting no association.
The DTa P-IPV/Hib vaccine is offered in 3 doses at 3, 5, and 12 months. General practitioners administer all childhood vaccinations and are reimbursed when reporting these to the National Board of Health; these reports are included in the Danish National Health Service Register (9).
We obtained individual-level information on MMR1 and MMR2 vaccinations and other childhood vaccinations administered in the first year of life.
Information on autism spectrum disorder diagnoses in the study period was obtained from the Danish Psychiatric Central Register (10).
Child psychiatrists diagnose and assign diagnostic codes for this register, which contains information from psychiatric hospitals and psychiatric wards (inpatients and outpatients in the study period).
In our cohort, MMR vaccination was not associated with autistic disorder (rate ratio, 0.92 [95% CI, 0.68 to 1.24]) or other autism spectrum disorders (rate ratio, 0.83 [CI, 0.65 to 1.07]).
In this study, we aimed to evaluate the association again in a more recent and nonoverlapping cohort of Danish children that has greater statistical power owing to more children, more cases, and longer follow-up.
The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine acceptance almost 2 decades after the controversial and later retracted paper from 1998 (1), even though observational studies have not been able to identify an increased risk for autism after MMR vaccination.Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort.Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).There were no thimerosal-containing vaccines in the Danish program during the study period.The specific MMR vaccine used in the study period contained the following vaccine strains: Schwarz (measles, 2000 to 2007) or Ender's Edmonton (measles, 2008–2013), Jeryl Lynn (mumps), and Wistar RA 27/3 (rubella).