A U.S. electronic health record analysis of 2,560,035 children examined whether receiving the first measles-mumps-rubella (MMR) vaccine before age two was linked to childhood autism. Using an age-anchored landmark design that compared vaccinated and unvaccinated children within narrow age windows (11.5-24 months and subwindows such as 14.5-17.5 and 17.5-24 months), investigators used Cosmos EHR data, excluded children diagnosed with autism by 11 months, and followed children up to age eight or December 2024. The sample prevalence of a narrow childhood-autism diagnostic code was 2.55% and 91.4% had received MMR by 24 months. In the primary adjusted analysis the hazard ratio for autism after first MMR between 11.5 and 24 months was 0.97 (99% CI 0.91-1.03), consistent with no increased risk; two later windows showed modestly lower HRs (0.90 and 0.92) that authors attribute to residual bias rather than protection.
The analysis adjusted for maternal age, race/ethnicity, gestational age, small-for-gestational-age status, multiple birth, pregnancy diabetes or genitourinary infections, neighborhood disadvantage, and region, and avoided post-vaccination covariates. A negative-control test using the pneumococcal booster produced similar null findings, supporting the method. Limitations include reliance on observational EHRs, lack of family-history data (which could confound vaccination decisions), shorter follow-up among unvaccinated children, and exclusion of children without linked birth-parent records. Authors Todd L. Burstain, Dale Jacques, and Jennifer M. Burstain published the paper in The Pediatric Infectious Disease Journal.
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