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自闭症与麻疹、腮腺炎和风疹疫苗:无流行病学证据支持因果关联。

Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association.

作者信息

Taylor B, Miller E, Farrington C P, Petropoulos M C, Favot-Mayaud I, Li J, Waight P A

机构信息

Department of Community Child Health, Royal Free and University College Medical School, University College London, UK.

出版信息

Lancet. 1999 Jun 12;353(9169):2026-9. doi: 10.1016/s0140-6736(99)01239-8.

Abstract

BACKGROUND

We undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism.

METHODS

Children with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method.

FINDINGS

We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 [82%] core autism, 52 [31%] atypical autism, 27 [38%] Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0.94 [95% CI 0.60-1.47] and 1.09 [0.79-1.52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0.92 [0.38-2.21] and 1.00 [0.52-1.95]). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder.

INTERPRETATION

Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.

摘要

背景

我们开展了一项流行病学研究,以调查麻疹、腮腺炎和风疹(MMR)疫苗是否可能与自闭症存在因果关系。

方法

从英国北泰晤士河地区8个卫生区的特殊需求/残疾登记册和特殊学校中,识别出1979年以后出生的自闭症儿童。临床记录中的信息与儿童健康计算机系统中保存的免疫接种数据相关联。我们寻找与1988年MMR疫苗引入英国相关的发病率或诊断年龄趋势变化的证据。采用病例系列法研究在规定的疫苗接种后时期内发病的聚集情况。

研究结果

我们识别出498例自闭症病例(261例典型自闭症,166例非典型自闭症,71例阿斯伯格综合征)。293例病例的诊断可依据国际疾病分类第十版(ICD10)标准得到确认(82%为典型自闭症,31%为非典型自闭症,38%为阿斯伯格综合征)。随着出生年份的增加,病例数稳步上升,在引入MMR疫苗后,趋势线没有突然“跃升”或变化。18个月龄之前或之后接种疫苗的病例与从未接种疫苗的病例在诊断年龄上没有差异。在接种MMR疫苗后1年或2年内自闭症发病与接种之间没有时间关联(与对照期相比相对发病率为0.94 [95%可信区间0.60 - 1.47] 和1.09 [0.79 - 1.52])。发育倒退在疫苗接种后的几个月内没有聚集现象(MMR疫苗接种后2个月和4个月内的相对发病率分别为0.92 [0.38 - 2.21] 和1.00 [0.52 - 1.95])。除了MMR疫苗接种后6个月内的一个单一时间段外,典型自闭症或非典型自闭症病例在家长开始关注的发病年龄方面没有明显的时间聚集现象。这似乎是一个与精确界定该疾病症状发作难度相关的假象。

解读

我们的分析不支持MMR疫苗与自闭症之间存在因果关系。如果存在这样的关联,其极为罕见,以至于在这个大型区域样本中无法识别。

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