Measles-Mumps-Rubella Vaccination and Asthma-like Disease in Early Childhood

Anders Hviid; Mads Melbye

Disclosures

Am J Epidemiol. 2008;168(11):1277-1283. 

In This Article

Abstract and Introduction

Abstract

The authors evaluated the association between receipt of measles-mumps-rubella (MMR) vaccine and asthma-like disease in early childhood in a Danish nationwide cohort study (N = 871,234). Two outcomes were included: hospitalizations with asthma diagnoses and use of anti-asthma medications (for a subset of the cohort only). Poisson regression was used to estimate rate ratios according to vaccination status. MMR-vaccinated children were less often hospitalized with an asthma diagnosis (rate ratio (RR) = 0.75, 95% confidence interval (CI): 0.73, 0.78) and used fewer courses of anti-asthma medication (RR = 0.92, 95% CI: 0.91, 0.92) than unvaccinated children. This "protective" effect of MMR vaccine was more pronounced for hospitalizations with severe asthma diagnoses (status asthmaticus: RR = 0.63, 95% CI: 0.49, 0.82) and use of medication that was highly specific for asthma (long-acting β2-agonist inhalant: RR = 0.68, 95% CI: 0.63, 0.73). MMR vaccine was not negatively associated with anti-asthma medications often used for wheezing illnesses in early childhood (systemic β2-agonist: RR = 1.02, 95% CI: 1.01, 1.02). These results are compatible not with an increased risk of asthma following MMR vaccination but rather with the hypothesis that MMR vaccination is associated with a reduced risk of asthma-like disease in young children.

Introduction

The "hygiene hypothesis" suggests that early childhood exposure to microbial agents protects against atopic disease through an immunomaturing effect.[1,2] In this context, common childhood vaccines are of obvious interest, and a number of hypotheses linking childhood vaccines and atopy have been proposed.[3] One suggestion is that vaccines indirectly increase the risk of atopy by preventing "beneficial" infections in early childhood.[4] Another suggestion is that vaccines themselves have direct atopy-promoting effects—for example, by increasing immunoglobulin E levels[5] or by unbalancing the immune system.[6] The majority of analytical studies have not been able to confirm an adverse effect of childhood vaccination on atopic disease, and some have even indicated a protective effect of vaccines.[7,8] However, large, well-controlled prospective studies are few, and given the importance of national vaccination programs and the possibility of vaccine safety scares,[9] further research into the association between vaccines and atopic diseases is needed.

We evaluated the hypothesis of an increased risk of asthma-like disease after measles-mumps-rubella (MMR) vaccination in Denmark in a nationwide historically prospective cohort study. We evaluated both the association between MMR vaccination and hospitalizations with asthma diagnoses in early childhood and the association between MMR vaccination and use of anti-asthma medication in early childhood.

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