Takahashi Hiroshi, Suzumura Shynsuke, Shirakizawa Fumiko, Wada Noriyuki, Tanaka-Taya Keiko, Arai Satoru, Okabe Nobuhiko, Ichikawa Hironobu, Sato Taizo
Institute for International Cooperation, Japan International Cooperation Agency, Tokyo 162-8433, Japan.
Jpn J Infect Dis. 2003 Jun;56(3):114-7.
To assess the causal association of autism with measles, mumps, and rubella (MMR) vaccine versus that with monovalent measles, mumps, and rubella immunization, a 1:2 sex-adjusted logistic regression analysis was conducted using data on subjects who were growing up in the Tokyo area between 1988 and 1992. When MMR immunization was used as a reference, monovalent measles immunization (odds ratio [OR] = 5.33, 99% confidence interval [CI]: 1.03-27.74), non-mumps immunization (OR = 8, 99%CI: 1.33-48.2), and non-rubella immunization (OR = 8.57, 99%CI: 1.30-56.4) with development of autistic spectrum disorders (ASD) were significantly increased. These results suggest a decreased risk of developing ASD with MMR compared to monovalent antigens. However, our findings may reflect potential selection bias due to requiring written consent, possible delayed vaccination in suspected autism cases, and small sample size (case = 21). For the case group and the control group, immunization completeness rate of each antigen, regardless of the timing of immunization, was 90.5% versus 100% in measles, 42.9% versus 78.6% in mumps (P < 0.01), 52.3% versus 83.3% in rubella (P < 0.01), 14.3% versus 45.2% in varicella (P < 0.01), 100% versus 90.5% in polio>2, 100% versus 97.6% in Diphtheria (D), pertussis, and tetanus (T)>3, 85.7% versus 66.7% in DT, 95.2% versus 92.9% in BCG, and 52.4% versus 81.0% in Japanese encephalitis>3 (P<0.01). Only two case subjects and four control subjects received their measles, mumps, and rubella immunizations separately, suggesting that few Japanese parents might have had concerns about the safety of MMR vaccine. A nation-wide study would be a practical measure to scientifically judge the safety of MMR and other routine childhood immunizations.
为评估自闭症与麻疹、腮腺炎和风疹（MMR）疫苗以及与单价麻疹、腮腺炎和风疹免疫接种之间的因果关联，利用1988年至1992年在东京地区成长的受试者数据进行了1:2性别调整的逻辑回归分析。以MMR免疫接种作为对照时，单价麻疹免疫接种（优势比[OR]=5.33，99%置信区间[CI]：1.03 - 27.74）、非腮腺炎免疫接种（OR = 8，99%CI：1.33 - 48.2）以及非风疹免疫接种（OR = 8.57，99%CI：1.30 - 56.4）与自闭症谱系障碍（ASD）发生风险显著增加相关。这些结果表明，与单价抗原相比，MMR疫苗接种后患ASD的风险降低。然而，我们的研究结果可能反映了因需要书面同意、疑似自闭症病例可能延迟接种疫苗以及样本量小（病例数 = 21）导致的潜在选择偏倚。对于病例组和对照组，无论免疫接种时间如何，每种抗原的免疫接种完成率在麻疹方面分别为90.5%对100%，腮腺炎方面为42.9%对78.6%（P<0.01），风疹方面为52.3%对83.3%（P<0.01），水痘方面为14.3%对45.2%（P<0.01），脊髓灰质炎>2方面为100%对90.5%，白喉（D）、百日咳和破伤风（T）>3方面为100%对97.6%，白喉破伤风（DT）方面为85.7%对66.7%，卡介苗（BCG）方面为95.2%对92.9%，日本脑炎>3方面为52.4%对81.0%（P<0.01）。只有两名病例受试者和四名对照受试者分别接受了麻疹、腮腺炎和风疹免疫接种，这表明很少有日本父母可能担心MMR疫苗的安全性。一项全国性研究将是科学判断MMR疫苗和其他儿童常规免疫接种安全性的切实可行措施。
