Research Paper On Vaccines

Research Paper On Vaccines-36
We included many autism risk factors for stratification and confounder adjustment, on the basis of a literature review on environmental autism risk factors and availability of data in our registers (12); these were maternal age, paternal age, smoking during pregnancy, method of delivery, preterm birth, 5-minute Apgar score, low birthweight, and head circumference.For variables with missing values, we included a missing value category in the analyses.From the Danish National Patient Register comprising diagnoses from all somatic departments, we obtained information on several syndromes and conditions with an inherent increased risk for autism (fragile X syndrome, tuberous sclerosis, Angelman syndrome, Down syndrome, Di George syndrome, neurofibromatosis, Prader–Willi syndrome, and congenital rubella syndrome) (11).

We included many autism risk factors for stratification and confounder adjustment, on the basis of a literature review on environmental autism risk factors and availability of data in our registers (12); these were maternal age, paternal age, smoking during pregnancy, method of delivery, preterm birth, 5-minute Apgar score, low birthweight, and head circumference.For variables with missing values, we included a missing value category in the analyses.From the Danish National Patient Register comprising diagnoses from all somatic departments, we obtained information on several syndromes and conditions with an inherent increased risk for autism (fragile X syndrome, tuberous sclerosis, Angelman syndrome, Down syndrome, Di George syndrome, neurofibromatosis, Prader–Willi syndrome, and congenital rubella syndrome) (11).

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Information on autism spectrum disorder diagnoses in the study period was obtained from the Danish Psychiatric Central Register (10).

Child psychiatrists diagnose and assign diagnostic codes for this register, which contains information from psychiatric hospitals and psychiatric wards (inpatients and outpatients in the study period).

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.

The DTa P-IPV/Hib vaccine is offered in 3 doses at 3, 5, and 12 months. General practitioners administer all childhood vaccinations and are reimbursed when reporting these to the National Board of Health; these reports are included in the Danish National Health Service Register (9).

We obtained individual-level information on MMR1 and MMR2 vaccinations and other childhood vaccinations administered in the first year of life.In a 2014 meta-analysis, 10 observational studies on childhood vaccines were identified: 5 cohort studies and 5 case–control studies (2).Of these, 2 cohort studies and 4 case–control studies specifically addressed MMR and autism, all reporting no association.A criticism of our and other previous observational studies has been that these did not address the concern that MMR vaccination could trigger autism in specific groups of presumably susceptible children, in contrast to all children (6); the current study addresses this concern in detail.We evaluate the risk for autism after MMR vaccination in subgroups of children defined according to environmental and familial autism risk factors.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).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).This is consistent with more recent studies of note (3, 4).We previously addressed this issue in a nationwide cohort study of 537 303 Danish children with 738 cases of autism spectrum disorders (5).

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