MMR & Autism - Madgen et al, NEJM 2002

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Evidence based medicine for why parents should vaccinate their kids
Niru Arunthavasothy
Mind Map by Niru Arunthavasothy, updated more than 1 year ago
Niru Arunthavasothy
Created by Niru Arunthavasothy over 7 years ago
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Resource summary

MMR & Autism - Madgen et al, NEJM 2002
  1. Research Question: MMR cause autism?
    1. Funded: Danish Research Foundation, CDC, National Alliance for Autism Research
      1. Year Study Began: Retrospective, 1991-1999
        1. Published: 2002 NEJM
          1. Study Location: Denmark
            1. Who was studied? All children born in Denmark Jan 1991-Dec 1998
              1. Who was excluded? Conditions associated with Autism: Tuberous sclerosis, Angelman syndrome, Fragile X, Congenital Rubella +emigration+death
                1. How many patients? 537,303 (82% received MMR, and 18% didn't)
                  1. Outcome measured: which children received MMR, at what age vaccine administered
                    1. Denmark Vaccination Schedule MMR: 15 months, 12 years (booster)
                      1. Australia: 12 months MMR, 18 months MMRV (varicella)
                        1. Identification of Autism: Suspected --> child psychiatrist --> registry, Method: check registry, date when diagnosis made
                          1. Follow-up: monitored for autism to age 1 until end of study period (Dec 31, 1999, mean age at end of study 5 years)
                            1. End point: rates of autism and rates of autism-spectrum disorders
                              1. Results
                                1. 82% of chidlren in study received MMR vaccine
                                  1. mean age of vaccination 17 months
                                    1. mean age of diagnosis was 4 years and 3 months
                                      1. prevalence of Autism among 8 year old's in study was 7.7/10,000 (0.08%)
                                        1. no clustering of autism diagnosis at any time interval after vaccination
                                          1. No association between age at which vaccine given and the subsequent development of autism
                                          2. Limitations
                                            1. Families with hx of Autism would not have vaccinated their kids due to published link between MMR and Autism
                                              1. Dataset did not contain the date when the 1st symptoms were noted, it is possible clustering of first symptoms post vaccination but NOT diagnoses (due to delay)
                                              2. Controversy
                                                1. Autism signs and symptoms: 2nd and 3rd year of life, shortly after giving MMR vaccine
                                                  1. Wakefield et al, Lancet 1998, retracted 2010, stated series of children developed GI symptoms, and signs of Autism after MMR, FALSIFIED DATA
                                                    1. AAP undertook a systematic review of all research vaccine safety and review failed to link MMR to Autism (MAGLIONE et al, Paediatrics, 2014)
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