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 recommendation.

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]. CNN.com. 2014 Aug 28 [cited 2014 Sep 29]. Available from: http://edition.cnn.com/2014/08/27/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.