Letters to the Editor

Measles vaccination as a risk factor for inflammatory bowel disease

The measles-mumps-rubella (MMR) vaccine has been postulated to cause a form of autism characterized by regression and bowel symptoms, and onset occurring shortly after vaccination. It is also claimed that, as a result, there has been a dramatic increase in autism prevalence. These hypotheses have now been tested in a number of epidemiologic studies that are reviewed in this article. None has found any evidence of the existence of a phenotypically distinct form of autism in children who received the MMR vaccine or of a clustering of onset symptoms in children who are autistic after receiving the MMR vaccine. There is no proof that the overall risk of autism is higher in children who were vaccinated with MMR or of an increase in autism prevalence associated with the use of the MMR vaccine. No epidemiologic evidence suggests an association between MMR vaccination and autism. Moreover, epidemiologic evidence against such an association is compelling.

OBJECTIVE:

Measles vaccination has been suggested as a risk for inflammatory bowel disease. Atypical age of measles infection has also been associated with Crohn’s disease. This study was designed to examine the relationship of measles vaccination and age of measles vaccination with later inflammatory bowel disease.

METHODS:

A prospective population-based national birth cohort was used, of those born in 1 wk in April 1970 in Great Britain. The data are from 7616 responding members of the 1970 British Cohort Study with complete vaccination data, who were traced at age 26 yr. A diagnosis of Crohn’s disease, ulcerative colitis, and diabetes mellitus (a control disease) was obtained by survey at age 26 yr, and confirmed by physicians. Vaccination data were from survey at age 5 yr. Measles and mumps infection data were obtained from the survey at age 10 yr. Adjustment was made for sex, household crowding in childhood, and father’s social class at birth.

RESULTS:

No statistically significant association was found between measles vaccination status at 5 yr and Crohn’s disease (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.27–1.63), ulcerative colitis (adjusted OR 0.57, 95% CI 0.20–1.61), or diabetes (adjusted OR 0.75, 95% CI 0.33–1.74). There was a statistically significant trend (p = 0.040) with increasing age of measles vaccination for risk of Crohn’s disease, although this was based on very few cases vaccinated after age 2 yr.

CONCLUSIONS:

In this cohort, monovalent measles vaccination status is not associated with inflammatory bowel disease by age 26 yr. Older age at measles vaccination needs to be examined in other studies to confirm whether it is a genuine risk for Crohn’s disease.

The cause of inflammatory bowel disease (IBD) remains to be established. Evidence has linked measles infection in early childhood with the subsequent risk of developing IBD, particularly Crohn's disease. A cohort study raised the possibility that immunisation with live attenuated measles vaccine, which induces active immunity to measles infection, might also predispose to the later development of IBD, provoking concerns about the safety of the vaccine.

We report a case-control study of 140 patients with IBD (including 83 with Crohn's disease) born in or after 1968, and 280 controls matched for age, sex and general practitioner (GP) area, designed to assess the influence of measles vaccination on later development of IBD. Documentary evidence of childhood vaccination history was sought from GP and community health records.

Crude measles vaccination rates were 56·4% in patients with IBD and 57·1% among controls. Matched odds ratios for measles vaccination were 1·08 (95% CI 0·62–1·88) in patients with Crohn's disease, 0·84 (0·44–1·58) in patients with ulcerative colitis, and 0·97 (0·64–1·47) in all patients with IBD.

These findings provide no support for the hypothesis that measles vaccination in childhood predisposes to the later development of either IBD overall or Crohn's disease in particular.