MMR at 9 Months: Rushing in Where Others Fear to Tread?

Indian Pediatrics 2015;51:81-2

Anoop Sharma, Jacob Puliyel

We read with interest the IAP Committee on Immunization
(IAPCOI) recommendation on MMR vaccine at 9 months
of age [1]. In this context, we studied the 2014
immunization practices across 121 countries, including 4
countries in Africa, 34 in the Americas, 13 in the Eastern
Mediterranean region, 51 in Europe, 15 Western Pacific countries and 4 South East Asian countries. In none of
these countries is MMR given at 9 months, except
Mongolia and Thailand. Germany uses it between 11-14
months and others give it after 1 year of age. Japan does
not recommend MMR vaccine at any age.
We now know that the age at which MMR is given
may have a bearing on adverse effects. On 28 September
2014, CNN announced news about a US Center for
Disease Control (CDC) whistle blower - William
Thompson [2] who had formerly co-authored a paper, that
there is no link between the age of MMR vaccination and
subsequent diagnosis of autism [3]. Thompson has now
revealed that there was indeed greater risk of autism in
African-American children vaccinated under 2 years of
age compared to those vaccinated after 3 years. The
statistically significant difference was deliberately omitted
from the paper. Brian Hooker re-analyzed the raw data
from this study and confirmed a 3.4 [fold increase in risk in
children vaccinated prior to the age of 2 years [4]. The
article suggests that there may be genetic and racial
susceptibility to adverse events and administration of the
vaccine at an early age could precipitate it.
The IAPCOI quotes seven studies to support their
claim that vaccination at 9 months is safe. These are small
trials looking mostly at antibody titers following
vaccination. It is difficult to base safety claims or make
general recommendations to a population as a whole, on
these short term studies.
Many pediatricians follow the CoI recommendations
rather than the Government’s National schedule. From the
precautionary practice perspective, given the Thompson
revelations, the CoI may need to reconsider their

1. Vashishtha VM, Yewale VN, Bansal CP, Mehta PJ, for
Indian Academy of Pediatrics, Advisory Committee on
Vaccines and Immunization Practices (ACVIP). IAP
perspectives on measles and rubella elimination strategies.
Indian Pediatr. 2014;51:719-22.
2. Goldschmidt D. Journal questions validity of autism and
vaccine study [Internet].
. 2014 Aug 28 [cited
2014 Sep 29]. Available from:
08/27/health/irpt-cdc-autism-vaccine-study. Accessed
October 28, 2014.
3. DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp
M, Boyle C. Age at first measles-mumps-rubella
vaccination in children with autism and school-matched
control subjects: A population-based study in metropolitan
Atlanta. Pediatrics
. 2004;113:259-66.
4. Hooker BS. Measles-mumps-rubella vaccination timing
and autism among young African American boys: A
reanalysis of CDC data. Transl Neurodegener. 2014;3:16