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

doi:10.1136/bmj.324.7334.393

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

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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 b.taylor{at}rfc.ucl.ac.uk

Objectives: To investigate whether measles, mumps, andrubella (MMR) vaccination is associated with bowel problems anddevelopmental regression in children with autism, looking forevidence of a "new variant" form ofautism.
Design: Population study with case note review linkedto independently recorded vaccinedata.
Setting: Five health districts in north eastLondon.
Participants: 278 children with core autism and 195 withatypical autism, mainly identified from computerised disabilityregisters and born between 1979 and1998.
Main outcome measures: Recorded bowel problems lasting at least threemonths, age of reported regression of the child's developmentwhere it was a feature, and relation of these to MMRvaccination.
Results: The proportion of children with developmentalregression (25% overall) or bowel symptoms (17%) did not changesignificantly (P value for trend 0.50 and 0.47, respectively)during the 20 years from 1979, a period which included the introductionof MMR vaccination in October 1988. No significant differencewas found in rates of bowel problems or regression in childrenwho received the MMR vaccine before their parents became concernedabout their development (where MMR might have caused or triggeredthe autism with regression or bowel problem), compared with thosewho received it only after such concern and those who had notreceived the MMR vaccine. A possible association between non-specificbowel problems and regression in children with autism was seenbut this was unrelated to MMRvaccination.
Conclusions: These findings provide no support for an MMRassociated "new variant" form of autism with developmental regressionand bowel problems, and further evidence against involvement ofMMR 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

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No link found between MMR vaccine and bowel problems in autistic children
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Rapid Responses:

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A layman's response: Anthony Weston
bmj.com, 10 Feb 2002 [Full text]
No mention of this paper in the print version of BMJ: Jennifer M Fisken, et al.
bmj.com, 11 Feb 2002 [Full text]
No significant difference: Andrew M Williams
bmj.com, 11 Feb 2002 [Full text]
Measles and Autism: Whom do we trust?: James J Bradstreet, MD Fellow AAFP
bmj.com, 12 Feb 2002 [Full text]
Different conclusions from overlapping patient populations?: Dr Martin V Hewitt
bmj.com, 12 Feb 2002 [Full text]
How are health districts selected?: John Daniel Stone
bmj.com, 13 Feb 2002 [Full text]
Illiteracy: Adrian K Midgley
bmj.com, 13 Feb 2002 [Full text]
Interpretation of percentage with bowel problems: Jeremy P Humphries
bmj.com, 14 Feb 2002 [Full text]
There are so Many Parts to the Whole Picture to Consider: Carol A Teasdale
bmj.com, 17 Feb 2002 [Full text]
Then what is the cause?: Alan Challoner
bmj.com, 16 Feb 2002 [Full text]
Re: Then what is the cause?: Lisa C Blakemore-Brown
bmj.com, 17 Feb 2002 [Full text]
Re: Then what is the cause?: David N Andrews
bmj.com, 18 Feb 2002 [Full text]
Numbers with autism: Amelia A Hare
bmj.com, 18 Feb 2002 [Full text]
Re: Then what is the cause?: Malcolm S Law
bmj.com, 19 Feb 2002 [Full text]
Re: There are so Many Parts to the Whole Picture to Consider: Christopher Ish
bmj.com, 21 Feb 2002 [Full text]
weakness in MMR study: anne n. solomon
bmj.com, 21 Feb 2002 [Full text]
Re: Re: There are so Many Parts to the Whole Picture to Consider: Carol A Teasdale
bmj.com, 24 Feb 2002 [Full text]
MMR and autism: the need for robust epidemiology: John B. March
bmj.com, 25 Feb 2002 [Full text]
Repairing the damage whether vaccine-induced or not.: Michael godfrey
bmj.com, 27 Feb 2002 [Full text]
Re: Re: Then what is the cause?: Alan Challoner
bmj.com, 5 Mar 2002 [Full text]
What proportion of parents belive that their childs autism was caused by mmr.: Chris R Lunt
bmj.com, 9 Mar 2002 [Full text]
MMR and Autism - Measuring the Risk: Robert A Greenfield
bmj.com, 14 Mar 2002 [Full text]
MMR vaccination population study: no competing interest?: Eric P Segar
bmj.com, 15 Mar 2002 [Full text]
Authors should provide confidence limits and provide access to raw data: Aubrey Blumsohn
bmj.com, 17 Mar 2002 [Full text]
What is the problem with seperate Vaccines: Scott Cheadle
bmj.com, 29 Mar 2002 [Full text]
Re: No significant difference: Donna M. Cretan
bmj.com, 23 Oct 2002 [Full text]
Joined up thinking: Lisa C Blakemore-Brown
bmj.com, 24 Oct 2002 [Full text]
Immediate Umbilical Cord Clamping as a Cause of Autism: George M. Morley, MB ChB FACOG, et al.
bmj.com, 10 Mar 2003 [Full text]
Re: Re: No significant difference: Ankit Kant
bmj.com, 21 Jun 2003 [Full text]
Another layman's criticism: Michael Yaffey
bmj.com, 4 Aug 2003 [Full text]
Re: other potential causes to consider: Amy V. Haas, BCCE
bmj.com, 7 Nov 2003 [Full text]