Jake Crosby, MPH, Publishes a Letter in Annals of Internal Medicine
The editor of Autism Investigated has published a letter in Annals of Internal Medicine responding to a study disputing the MMR vaccine-autism link that was published in the journal earlier this year. The full exchange between Autism Investigated’s editor and the study authors can be found in the online comments, which can be found by selecting the “Comments” option in the tab to the left of the study.
LETTERS | 3 SEPTEMBER 2019
Measles, Mumps, Rubella Vaccination and Autism
Jake Crosby, MPH
TO THE EDITOR:
Hviid and colleagues’ (1) results contradict their conclusion, a circumstance that also occurred with a study that Hviid coauthored in 2002 (2). The value that stands out in Figure 3 of Hviid and colleagues’ 2019 article is the hazard ratio of autism of 2.69 among children who received the MMR vaccine who have siblings with autism. Although the magnitude of this value is far greater than that of any other reported hazard ratio in this figure, it is not significant because of the small sample size of this group. A preferable alternative would have been to report the risk for autism associated with having a sibling with autism but not receiving the MMR vaccine and then the risk for autism associated with both having an autistic sibling and MMR vaccination. The increased risk in both groups would be both strong and significant, but the magnitude would be substantially higher in those who received the vaccine than in those who did not.
Hviid and colleagues’ results do support a link between the MMR vaccine and autism in the subset of children who have a sibling with autism, with a sibling history of autism serving as an important effect modifier. However, their conclusion states the opposite. The corresponding author of this study did not respond to my e-mail about these concerns.
After the publication of the 2002 study that Hviid coauthored (2), an unpublished comment by an epidemiologist at McGill University (3) suggested that the authors had artificially eliminated the association between the MMR vaccine and autism by adjusting for age. He proposed that age was an effect modifier and that the authors should compare age-stratified rates between participants 24 to 29 months after MMR vaccination and MMR-unvaccinated participants. His letter was never addressed, and his advice was never heeded. We can now count a sibling history of autism as yet another effect modifier that the authors have dismissed to ignore the very real link between the MMR vaccine and autism.
References
1. Hviid A, Hansen JV, Frisch M, et al. Measles, mumps, rubella vaccination and
autism. A nationwide cohort study. Ann Intern Med. 2019. [PMID: 30831578]
doi:10.7326/M18-2101
2. Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of
measles, mumps, and rubella vaccination and autism. N Engl J Med. 2002;347:
1477-82. [PMID: 12421889]
3. Stott C, Blaxill M, Wakefield AJ. MMR and autism in perspective: the Denmark
story. Journal of American Physicians and Surgeons. 2004;9:89-91.
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