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Autism and chronic disease: Lack of evidence for thimerosal as a contributing factor

Jan E Drutz, MD
Section Editor
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD


Since the 1980s, there has been an increase in the number of cases of autism diagnosed in the United States and other parts of the world [1-9]. Rates of autism spectrum disorders (ASD) in studies from the late 1990s are consistently greater than 10 per 10,000, compared with 4 to 5 per 10,000 in previous decades [7]. Active surveillance in the United States suggests a prevalence of approximately 1 in 68 eight-year-old children in the United States [9]. (See "Autism spectrum disorder: Terminology, epidemiology, and pathogenesis", section on 'Prevalence'.)

This real or perceived increase in autism cases has occurred at a time when there has been a significant increase in the number of recommended childhood vaccines. In the search for a causal relationship, parents of autistic children and some professionals have identified a temporal association between immunizations and the onset of more evident symptoms of autism in the second year of life [10]. It has been suggested that certain vaccines (eg, measles, mumps, and rubella [MMR]) and vaccine constituents (eg, thimerosal) play a role in the development of autism and other chronic diseases [11-16].

Research to prove or disprove a possible relationship between the various components of recommended childhood vaccines and chronic diseases such as autism is ongoing. However, to date, no scientific linkage has been established. The evidence for and against an association between thimerosal and autism and chronic disease will be presented here. The evidence for and against an association between vaccines and autism is discussed separately. (See "Autism and chronic disease: No evidence for vaccines as a contributing factor".)

The clinical features and diagnosis of autism spectrum disorders are discussed separately. (See "Autism spectrum disorder: Clinical features" and "Autism spectrum disorder: Diagnosis".)


Since the 1980s, there has been an increase in the number of cases of autism diagnosed in the United States and other parts of the world [1-9]. Much attention was generated when the California Department of Developmental Services reported a 210 percent increase in the number of persons with autism between 1987 and 1998 [1]. Adequate explanation for the increase was not clear, though there was speculation that changes in diagnostic criteria and an increased awareness of the condition among health-care providers and developmental specialists may have been contributing factors. Subsequent reports analyzing data from cohorts of children with autism from regional developmental centers in California reached opposite conclusions about whether the apparent rise in cases of autism was attributable to changes in diagnostic criteria, misclassification, or in-migration to a generous service system [17,18]. (See "Autism spectrum disorder: Terminology, epidemiology, and pathogenesis", section on 'Epidemiology'.)


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