Association of Autistic Spectrum Disorder and the Measles, Mumps, and Rubella Vaccine A Systematic Review of Current Epidemiological Evidence

Objective:To systematically review the evidence for and against the existence of an association between autistic spectrum disorder (ASD) and the measles, mumps, and rubella (MMR) vaccine. StudyDesign:We conducted a systematic review of the medical literature to identify all controlled epidemio-logical articles examining for an association betweenASD and the MMR vaccine. We extracted data from the ar-ticles on the characteristics and objectives of the study as well as evidence of an association. Results: Twelve articles met the inclusion criteria. One study foundnodifference in the rates of ASDand theMMR vaccine in children who were vaccinated and those who were not. Six studies examined for evidence of an increase inASDassociatedwith an increase in theMMRvaccine cov-erage, none of which showed evidence of an association. Four studies examined if a variant form of ASD was associated with the MMR vaccine, none of which showed evidence of an association. Eight studies attempted to de-termine if there was a temporal association between de-veloping ASD and receiving theMMR vaccine. Of these, 1 study identified an increase in parental concern in the 6-month period following vaccination with MMR in one of its analyses. The results of all other studies showed no association between ASD and the MMR vaccine. Conclusions: The current literature does not suggest an association between ASD and the MMR vaccine; how-ever, limited epidemiological evidence exists to rule out a link between a rare variant form of ASD and the MMR vaccine. Given the real risks of not vaccinating and that the risks and existence of variant ASD remain theoreti-cal, current policies should continue to advocate the use of the MMR vaccine. Arch Pediatr Adolesc Med. 2003;157:628-63