No link found between MMR vaccine and autism

1. No link found between MMR vaccine and autism, even among children with other risk factors for autism

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2101

Editorial: http://annals.org/aim/article/doi/10.7326/M19-0596

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A nationwide cohort study of all children born in Denmark to Danish-born mothers between 1999 through 2010 concluded that the mumps, measles, and rubella (MMR) vaccine does not increase the risk of autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases following vaccination. The findings are published in Annals of Internal Medicine.

The hypothesized link between measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake. Currently, there is a concerning increase in measles cases in Europe and the U.S., and the World Health Organization (WHO) has declared vaccine hesitancy as one of the top 10 threats to global health.

Researchers from Statens Serum Institut, Copenhagen, Denmark used a Danish population registry to evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination. Of the 657,461 children included in the analysis over a decade of follow-up, 6,517 were diagnosed with autism. Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93. Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination. According to the researchers, this study adds to previous studies through significant additional statistical power and addresses questions about susceptible subgroups and autism clustering.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Anders Peter Hviid, DrMedSci, please contact Michael Gjølbye Madsen at migm@ssi.dk or +45 3268 8173.

2. Low-dose aspirin does not seem to improve survival after prostate cancer diagnosis

Abstract: http://annals.org/aim/article/doi/10.7326/M17-3085

Editorial: http://annals.org/aim/article/doi/10.7326/M19-0525

URLs go live when the embargo lifts

Low-dose aspirin use does not seem to reduce the overall risk for prostate cancer death at the population level. However, results for extended exposure periods suggest that low-dose aspirin might be inversely associated with prostate cancer mortality after 5 years from cancer diagnosis. Findings from a nationwide cohort study are published in Annals of Internal Medicine.

Recent studies suggest that aspirin use may improve survival in patients with prostate cancer, but study results are inconclusive.

Researchers from the Danish Cancer Society Research Center, Aarhus University Hospital, Copenhagen University Hospital, and University of Southern Denmark used nationwide registries in Denmark to assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality. Their analysis did not find convincing evidence of an overall protective effect of low-dose aspirin for men with prostate cancer. However, they did find a reduced risk for prostate cancer mortality with low-dose aspirin use among patients with low Gleason scores, meaning that their prostate cancer was unlikely to progress, and among those who took low-dose aspirin for an extended period of time.

The authors of an accompanying editorial from Tampere University and Tampere University Hospital in Finland speculate that improved prostate cancer-specific survival among aspirin users with low Gleason scores might be explained by inaccurate tumor grading occurring less frequently in aspirin users than nonusers. Aspirin is an anti-inflammatory drug that lowers serum prostate-specific antigen levels; however, whether this leads to accurate determination of tumor aggressiveness in aspirin users remains to be determined in further studies, according to the authors. They suggest that future research evaluate aspirin exposures longer than those studied to date and investigate the effects of aspirin exposure on disease classification.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Charlotte Skriver, MSc at skriver@cancer.dk. The lead author of the editorial, Teemu J. Murtola, MD, PhD, can be reached directly at teemu.murtola@tuni.fi.

3. Methanol toxicity can be a rare consequence of occupational exposure

Abstract: http://annals.org/aim/article/doi/10.7326/L18-0584

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Clinicians should be aware that methanol toxicity can be a rare consequence of occupational exposure. A case report is published in Annals of Internal Medicine.

Methanol toxicity is a potentially life-threatening condition that usually occurs by ingestion of household products, such as solvents, antifreeze, or fuel. It may cause mild symptoms, such as drowsiness and headaches, but could develop into a significant illness that includes vision changes, blindness, coma, convulsions, and respiratory arrest.

Researchers from Genesys Regional Medical Center; Grand Blanc, Michigan reported the case of a 42-year-old man who came to the emergency department complaining of flank pain and headache. He described 1 day of nausea, multiple episodes of emesis, and blurred vision leading to bilateral vision loss. While taking a detailed history, the clinicians learned that the patient had taken a new job as a materials handler at a propane company 6 weeks earlier where his job was to inspect, fill, and load propane cylinders. Two weeks after starting the new job, he had begun having lapses in memory and atypical behaviors, such as leaving his car running or the lawn sprinklers on overnight. Since methanol is routinely added to propane to prevent valve freezing, the clinicians deduced that the patient had occupational exposure to a mixture of propane and methanol and developed methanol toxicity secondary to inhalation and dermal absorption. Based on their diagnosis, the clinicians were able to successfully treat and release the patient.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org.To interview the lead author, Michael Beattie, DO, please contact him directly at michael.beattie@ascension.org.

Also New in this issue:

Should a Prison Salt Trial Be Federally Funded?

Paul P. Christopher, MD, and Michael D. Stein, MD

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3382

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