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Cited by 710Vaccine Coverage and HesitancyAutism Spectrum Disorder ResearchVirology and Viral Diseases

A population-based study of measles, mumps, and rubella vaccination and autism.

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Madsen, Kreesten Meldgaard, Hviid, Anders, Vestergaard, Mogens, Schendel, Diana, Wohlfahrt, Jan, Thorsen, Poul, Olsen, Jørn, Melbye, Mads·2002·New England Journal of Medicine
DOI 10.1056/nejmoa021134
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Abstract

BACKGROUND: It has been suggested that vaccination against measles, mumps, and rubella (MMR) is a cause of autism. METHODS: We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was selected on the basis of data from the Danish Civil Registration System, which assigns a unique identification number to every live-born infant and new resident in Denmark. MMR-vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register, which contains information on all diagnoses received by patients in psychiatric hospitals and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. RESULTS: Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. CONCLUSIONS: This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

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Crossref · 10.1056/nejmoa021134

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  • A Danish retrospective cohort study of more than half a million children born 1991-1998 found no association between age at MMR vaccination, receipt of vaccination, or time since vaccination, and development of autism spectrum disorders.

    “A larger retrospective cohort study, and to date one of the most definitive findings of no causal link between MMR vaccine and autism, was performed by a Danish group and published in the New England Journal of Medicine in 2002 (Madsen et al., 2002). The authors reviewed the records of more than half a million children born in Denmark during the study period (1991–1998) and found no association”

    From Vaccine Safety: Myths and Misinformation (2020) · cites this paper as Madsen et al., 2002

    The Abstract and Results report a retrospective cohort of 537,303 children born in Denmark from 1991 through 1998 and no increased risk of autistic disorder or other autistic-spectrum disorders among vaccinated children. The Results report no association with age at vaccination or time since vaccination for autistic disorder specifically; they do not state that finding for other autistic-spectrum disorders. Page numbers were not supplied in our copy. (LLM, conf=0.86)

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  • Large epidemiological studies have refuted the postulated link and affirmed that MMR vaccine has neither a correlative nor causative link to autism spectrum disorders.

    “Large epidemiological studies, in particular the two referenced herein, have since clearly refuted the postulated link, and have substantively affirmed that vaccination, and the MMR vaccine in particular, have neither a correlative nor causative link to autism spectrum disorders.”

    From Vaccine Safety: Myths and Misinformation (2020) · cites this paper as Madsen et al., 2002

    The Discussion reports similar autism risk in MMR-vaccinated and unvaccinated children, no temporal clustering, and no association with autistic-spectrum disorders. The Abstract calls this strong evidence against MMR causing autism. The study does not assess vaccination generally or establish the categorical absence of any causal link, so the citing sentence goes beyond its findings. (LLM, conf=0.86)

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  • After adjustment for confounders, the relative risk for autism is 0.92 (95% CI 0.68 to 1.24) and 0.83 (95% CI 0.65 to 1.07) for other autistic spectrum disorders in the Danish cohort of children born between January 1991 and December 1998.

    “After adjustment for confounders, the RR for autism is 0.92 (95% CI 0.68 to 1.24) and 0.83 (95% CI 0.65 to 1.07) for other autistic spectrum disorders.”

    From Vaccines for measles, mumps and rubella in children (2012) · cites this paper as Madsen 2002

  • For more than a decade, a multitude of large-scale epidemiological studies have provided evidence refuting the notion that MMR vaccination causes ASD, including the role of vaccinations containing thiomersal in ASD etiology.

    “For more than a decade, a multitude of large-scale epidemiological studies have provided evidence refuting this notion [179, 180] including the role of vaccinations containing thiomersal in the ASD etiology [181].”

    From The contribution of environmental exposure to the etiology of autism spectrum disorder (2019) · cites this paper as [179]

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Cites

1 retracted

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Research works printed but not linked: 4

  1. [1]1. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hy- perplasia, non-specific colitis, and pervasive developmental disorder in chil- dren. Lancet 1998;351:637-41.
  2. [8]8. Griffin DE, Ward BJ, Jauregui E, Johnson RT, Vaisberg A. Immune ac- tivation in measles. N Engl J Med 1989;320:1667-72.
  3. [18]18. Causality assessment of adverse events following immunization. Wkly Epidemiol Rec 2001;76:85-9.
  4. [31]31. Clayton D, Hills M. Statistical models in epidemiology. Oxford, Eng- land: Oxford University Press, 1993.

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Authors
Madsen, K. M., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., Olsen, J., & Melbye, M.
Affiliations
  • Statens Serum Institut (DK)
  • Centers for Disease Control and Prevention (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2002-11-07
Volume
347
Issue
19
Pages
1477-1482
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa021134
OpenAlex
W2073545687
Cited by
710
References
31
Citations by year
2026: 13 · 2025: 13 · 2024: 11 · 2023: 16 · 2022: 13 · 2021: 23 · 2020: 24 · 2019: 30 · 2018: 27 · 2017: 21 · 2016: 21 · 2015: 28 · 2014: 30 · 2013: 27 · 2012: 28
FWCI
64.42
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
Keywords
MMR vaccine, MMR vaccination, autism spectrum disorder, autistic disorder, vaccine safety, childhood immunization
MeSH terms
Autistic Disorder, Birth Weight, Child Development Disorders, Pervasive, Denmark, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Male, Registries, Retrospective Studies, Risk, Risk Factors, Measles-Mumps-Rubella Vaccine

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