A study of approximately 95,000 children with older siblings found that the measles-mumps-rubella (MMR) vaccine is not associated with an increased risk of autism spectrum disorders regardless of whether older siblings had been diagnosed on the autism spectrum - and epidemiological papers say those children should be at higher risk for an autism diagnosis.

During the last 15 years, no valid study has found a link between the MMR vaccine and ASD but some parents and people selling alternative medicines continue to associate the vaccine with ASD. Surveys of parents who have children with ASD suggest that many believe the MMR vaccine was a contributing cause.

What is known is that younger siblings of children with an autism spectrum diagnosis are already at higher risk for an autism diagnosis compared with the general population - and that might prompt anti-vaccine parents to avoid vaccinating their younger children, according to background information in the article. 

Anjali Jain, M.D., of the Lewin Group, Falls Church, Va., and colleagues examined ASD occurrence by MMR vaccine status in a large sample of U.S. children who have older siblings with and without ASD. The researchers used an administrative claims database associated with a large commercial health plan. Participants included children continuously enrolled in the health plan from birth to at least 5 years of age during 2001-2012 who also had an older sibling continuously enrolled for at least 6 months between 1997 and 2012.

Of the 95,727 children included in the study, 1,929 (2.01 percent) had an older sibling with ASD. Overall, 994 (1.04 percent) children in the cohort had ASD diagnosed during follow-up. Among those who had an older sibling with ASD, 134 (6.9 percent) were diagnosed with ASD, compared with 860 (0.9 percent) diagnosed with ASD among those with siblings without ASD. The MMR vaccination rate (l dose or more) for the children with unaffected siblings (siblings without ASD) was 84 percent (n = 78,564) at 2 years and 92 percent (n = 86,063) at age 5 years. In contrast, the MMR vaccination rates for children with older siblings with ASD were lower (73 percent at age 2 years and 86 percent at age 5 years). Analysis of the data indicated that MMR vaccine receipt was not associated with an increased risk of ASD at any age.

"Consistent with studies in other populations, we observed no association between MMR vaccination and increased ASD risk among privately insured children. We also found no evidence that receipt of either 1 or 2 doses of MMR vaccination was associated with an increased risk of ASD among children who had older siblings with ASD. As the prevalence of diagnosed ASD increases, so does the number of children who have siblings diagnosed with ASD, a group of children who are particularly important as they were undervaccinated in our observations as well as in previous reports," the authors write.

Citation: JAMA doi:10.1001/jama.2015.3077