TABLE 4-6Studies Included in the Weight of Epidemiologic Evidence for MMR Vaccine and MS Onset in Adults

CitationOperationally Defined OutcomeStudy SettingDefined Study PopulationStudy DesignSample SizePrimary Effect Size Estimatea (95% CI or p value)Heterogeneous Subgroups at Higher RiskbLimitations (Negligible or Serious)c
DeStefano et al. (2003)Date of MS onset from medical records or telephone interviewsThree HMOs participating in the VSDAges 18-49 years at MS diagnosis dateCase-control Controls matched by date of birth (within 1 year)332 patients with MSAdjusted OR of MS onset onset anytime after MMR vaccination: 0.9 (95% CI, 0.4-1.8)None describedSerious
Cases had MS diagnosed by a physician from 1/1/1995 through 12/31/1999722 matched controls
Ahlgren et al. (2009b)Date of MS onset from medical records and confirmed by authorsAdministrative registries from Sahlgrenska University Hospital and the National Patient Register of SwedenBorn in Gothenburg, Sweden, from 1959–1986Case-control208 patients with MSOR of MS onset with MMR vaccination compared to no MMR vaccination: 1.13 (95% CI, 0.62–2.05; p = .6849)None describedSerious
Cases had MS onset at 10 years of age or older888 controlsOR of MS onset with monovalent or combined measles, mumps, and rubella vaccination compared to no vaccination: 1.22 (95% CI, 0.77-1.92; p = .4101)
OR of MS onset with “early” MMR vaccination compared to MMR vaccinations given at other ages: 4.92 (95% CI, 1.97-12.20; p = .0006)
a

The committee assumed statistical significance below the conventional 0.05 level unless otherwise stated by the authors.

b

The risk/effect estimate for the subgroup/alternate definition of exposure or outcome differs significantly (e.g., is heterogeneous with nonoverlapping 95% confidence intervals) compared with the risk/effect estimate reported for the primary group/definition.

c

Studies designated as serious had more methodological limitations than those designated as negligible. Studies assessed as having very serious limitations were not considered in the weight of epidemiologic evidence.

From: 4, Measles, Mumps, and Rubella Vaccine

Cover of Adverse Effects of Vaccines
Adverse Effects of Vaccines: Evidence and Causality.
Committee to Review Adverse Effects of Vaccines; Institute of Medicine; Stratton K, Ford A, Rusch E, et al., editors.
Washington (DC): National Academies Press (US); 2011 Aug 25.
Copyright 2012 by the National Academy of Sciences. All rights reserved.

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