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The coding classification used in the study period was the International Classification of Diseases, 10th Revision; we used the codes F84.0 (autistic disorder), F84.1 (atypical autism), F84.5 (Asperger syndrome), F84.8 (other pervasive developmental disorder), and F84.9 (unspecified pervasive developmental disorder).We defined our main study outcome of autism as a diagnosis of any of these autism spectrum disorders.This is consistent with more recent studies of note (3, 4).
Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.
The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination.
Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort.
Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).
In our cohort, MMR vaccination was not associated with autistic disorder (rate ratio, 0.92 [95% CI, 0.68 to 1.24]) or other autism spectrum disorders (rate ratio, 0.83 [CI, 0.65 to 1.07]).
In this study, we aimed to evaluate the association again in a more recent and nonoverlapping cohort of Danish children that has greater statistical power owing to more children, more cases, and longer follow-up.There were no thimerosal-containing vaccines in the Danish program during the study period.The specific MMR vaccine used in the study period contained the following vaccine strains: Schwarz (measles, 2000 to 2007) or Ender's Edmonton (measles, 2008–2013), Jeryl Lynn (mumps), and Wistar RA 27/3 (rubella).It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine acceptance almost 2 decades after the controversial and later retracted paper from 1998 (1), even though observational studies have not been able to identify an increased risk for autism after MMR vaccination.Table 1 of the Supplement provides a complete list of variables with categorizations).These variables were obtained from the Danish Medical Birth Registry, which includes information on the parents and the newborn, pregnancy, date of birth, multiple births, gestational age, and vital status and other physical characteristics of the newborn (13).This unique identifier is used in all other national registries and allows for individual-level linkage of health-related information, including vaccinations and autism diagnoses.The Danish childhood vaccination program is voluntary and free of charge.The mainstays of the early part of the Danish program are MMR and a diphtheria, tetanus, acellular pertussis, inactivated polio, and type b (DTa P-IPV/Hib) combination.A first dose of MMR vaccine is offered at 15 months (MMR1), with a second dose (MMR2) at 12 years of age or, since 2008, at 4 years of age.