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Autism spectrum disorder and chronic disease: No evidence for vaccines or thimerosal as a contributing factor

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


The number of cases of autism spectrum disorder (ASD) in the United States and other countries has increased since the 1980s, largely due to changes in diagnostic criteria for ASD and increased awareness of ASD. The increased prevalence of ASD occurred at a time when the number of recommended childhood vaccines also increased, leading to a hypothesis that vaccines (eg, the measles, mumps, and rubella vaccine) or vaccine constituents (eg, thimerosal) contribute to the development of ASD and other chronic diseases. Numerous subsequent studies have demonstrated no scientific linkage between vaccines and ASD.

The proposed association between vaccines or vaccine constituents and ASD and the evidence against the association will be discussed here. The epidemiology, pathogenesis, and clinical features of ASD and communication with vaccine-hesitant caregivers are discussed separately. (See "Autism spectrum disorder: Terminology, epidemiology, and pathogenesis" and "Autism spectrum disorder: Clinical features" and "Standard childhood vaccines: Parental hesitancy or refusal", section on 'Approach to management'.)


The number of cases of ASD in the United States and other countries has increased since the 1980s [1-9]. Rates of 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 [10]. 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'.)

Whether or not the actual incidence of ASD has increased is unclear. Comparing studies with different case definitions, methods of case finding, and sample populations is problematic unless there is rigorous control for these variables. Systematic reviews of the epidemiologic studies suggest that changes in case definitions and increased awareness account for much of the increased prevalence [10-12].


The real or perceived increase in ASD cases occurred at a time when the number of recommended childhood vaccines also increased (to include Haemophilus influenza type b, hepatitis B, varicella, pneumococcal, and influenza vaccines, as well as a second dose of the measles, mumps, and rubella [MMR] vaccine). (See "Standard immunizations for children and adolescents: Overview", section on 'Routine schedule'.)

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Literature review current through: Nov 2017. | This topic last updated: Nov 11, 2017.
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