States Controversy and Its Relationship to MMR Immunization Rates in the United Media Coverage of the Measles-Mumps-Rubella Vaccine and Autism

OBJECTIVE. The purpose of this work was to assess the association between media coverage of the MMR-autism controversy and MMR immunization in the United States. METHODS. The public-use files of the National Immunization Survey were used to estimate annual MMR coverage from 1995 to 2004. The primary outcome was selective measles-mumps-rubella nonreceipt, that is, those children who received all childhood immunizations except MMR. Media coverage was measured by using LexisNexis, a comprehensive database of national and local news media. Factors associated with MMR nonreceipt were identified by using a logistic regression model. RESULTS. Selective MMR nonreceipt, occurring in as few as 0.77% of children in the 1995 cohort, rose to 2.1% in the 2000 National Immunization Survey. Children included in the 2000 National Immunization Survey were born when the putative link between MMR and autism surfaced in the medical literature but before any significant media attention occurred. Selective nonreceipt was more prevalent in private practices and unrelated to family characteristics. MMR nonreceipt returned to baseline before sustained media coverage of the MMR-autism story began. CONCLUSIONS. There was a significant increase in selective MMR nonreceipt that was temporally associated with the publication of the original scientific literature, suggesting a link between MMR and autism, which preceded media coverage of the MMR-autism controversy. This finding suggests a limited influence of mainstream media on MMR immunization in the United States. T LAST DECADE has seen a steady growth in the production and availability of new vaccines to the pediatric market. During the past 2 years alone, 4 new vaccines were introduced into the routine pediatric immunization schedule in the United States, and 3 existing vaccines were given new indications.1 This expansion in vaccine recommendations has been met by increasing concern for vaccine safety raised by individuals who question the potential for vaccine adverse effects despite a lack of reliable data to support these claims.2 In the face of this growing skepticism, the challenge for our public health community is to better understand how physician and public perception of vaccines and vaccine-preventable diseases affects vaccine uptake. Perhaps one of the best opportunities to examine the influence of public perception on vaccine uptake is to focus on the putative link between the measles-mumps-rubella (MMR) vaccine and autism first put forth by Wakefield et al in February 1998.3 Although this study was significantly flawed and later discredited,4 it was widely publicized in the British press. Consequently, national rates of MMR coverage in Britain fell from 92% to 73%, with rates in parts of London as low as 50%.5 This decrease in coverage resulted in measles outbreaks6 and the first measles death in the United Kingdom in more than a decade.5 Although there was a dramatic impact on MMR receipt in Britain, the impact of the Wakefield et al3 study and its subsequent media coverage have never been studied nationally in the United States, despite concern within the public health community.7 The potential impact is not a trivial question. What’s Known on This Subject In 1998, researchers suggested a link between MMR and autism. Although significantly flawed, this article waswidely reported in the Britishmedia, with a subsequent decrease in MMR immunization. What This Study Adds This study is the first tomeasure the population-level impact of theMMR controversy in the United States and the first to quantify coverage of the MMR autism debate in the American media. www.pediatrics.org/cgi/doi/10.1542/ peds.2007-1760 doi:10.1542/peds.2007-1760