BMJ 2002;324:393-396 ( 16 February )

Papers


Measles, mumps, and rubella vaccination and bowel problems or developmental
regression in children with autism: population study

Brent Taylor, professor of community child health, a Elizabeth Miller, head,
b Raghu Lingam, research fellow, a Nick Andrews, statistician, b Andrea
Simmons, research fellow, a Julia Stowe, research associate. a
a Centre for Community Child Health, Royal Free and University College
Medical School, University College London Royal Free Campus, London NW3 2PF,
b Immunisation Division, Public Health Laboratory Service, Communicable
Disease Surveillance Centre, London NW9 5EQ
Correspondence to: B Taylor [log in to unmask]
<mailto:[log in to unmask]>
Objectives: To investigate whether measles, mumps, and rubella (MMR)
vaccination is associated with bowel problems and developmental regression
in children with autism, looking for evidence of a "new variant" form of
autism.
Design: Population study with case note review linked to independently
recorded vaccine data.
Setting: Five health districts in north east London.
Participants: 278 children with core autism and 195 with atypical autism,
mainly identified from computerised disability registers and born between
1979 and 1998.
Main outcome measures: Recorded bowel problems lasting at least three
months, age of reported regression of the child's development where it was a
feature, and relation of these to MMR vaccination.
Results: The proportion of children with developmental regression (25%
overall) or bowel symptoms (17%) did not change significantly (P value for
trend 0.50 and 0.47, respectively) during the 20 years from 1979, a period
which included the introduction of MMR vaccination in October 1988. No
significant difference was found in rates of bowel problems or regression in
children who received the MMR vaccine before their parents became concerned
about their development (where MMR might have caused or triggered the autism
with regression or bowel problem), compared with those who received it only
after such concern and those who had not received the MMR vaccine. A
possible association between non-specific bowel problems and regression in
children with autism was seen but this was unrelated to MMR vaccination.
Conclusions: These findings provide no support for an MMR associated "new
variant" form of autism with developmental regression and bowel problems,
and further evidence against involvement of MMR vaccine in the initiation of
autism.




What is already known on this topic
A "new variant" form of autism has been hypothesised, associated with
developmental regression and bowel problems and caused or triggered by the
MMR vaccination
This postulated association along with media attention has had a major
adverse effect on public confidence in the vaccine
Although population studies have shown no association between autism and MMR
vaccine it has been further postulated that various environmental or genetic
cofactors are required for the effect
What this study adds
The proportion of children with autism who had developmental regression or
bowel problems has not changed over the 20 years from 1979
Neither developmental regression nor bowel problems in children with autism
was associated with MMR vaccination
No evidence was found for a "new variant" form of autism




Edward E. Rylander, M.D.
Diplomat American Board of Family Practice.
Diplomat American Board of Palliative Medicine.