Trends in Selective Childhood Measles-Mumps-Rubella (MMR) Vaccine Nonreceipt Surrounding the MMR-Autism Controversy: National Immunization Survey Analyses, 1996-2019.

While vaccination has been hailed as one of the most significant, life-saving public health achievements, vaccine hesitancy and resistance has consistently come from those concerned about risks associated with vaccinating children. The Wakefield et al. paper published in The Lancet in 1998 claiming that the measles, mumps, and rubella (MMR) vaccine caused autism was a pivotal moment in the modern anti-vaccine movement despite its retraction from the journal in 2010. The public-use files of the National Immunization Survey (NIS-Child) were used to evaluate temporal trends surrounding the publication and subsequent retraction of the Wakefield et al. paper at key points between the period 1996 to 2019. The primary outcome was MMR nonreceipt. Demographic factors associated with vaccination status were assessed using a logistic regression model. The odds of selective MMR nonreceipt increased from 1.3 in 2000 (CI: 1.296-1.303) to 2.1 (CI: 2.050-2.066) in 2019. Across all four NIS survey years analyzed, higher maternal education level correlated with higher odds of selective MMR nonreceipt. Other key demographic factors that demonstrated significantly higher odds of selective MMR nonreceipt included income bracket greater than $50,000 and attending a private medical practice. The odds of both overall and selective MMR nonreceipt increased over time with no reduction observed after the retraction of the Wakefield et al. paper. Key demographic factors outlined herein provide an opportunity for targeted outreach to encourage increased MMR vaccination uptake.