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Letters
November 3, 2004

MMR Vaccination and Febrile Seizures—Reply

JAMA. 2004;292(17):2083-2084. doi:10.1001/jama.292.17.2083-b

In Reply: Drs Hak and Bonten are concerned that we may have underestimated the true association between MMR vaccination and febrile seizures due to confounding by contraindication. We acknowledge that some parents and physicians may refrain from vaccinating children who have an increased risk of developing febrile seizures. Unfortunately, confounding by contraindication may be impossible to eliminate from an observational study on expected adverse effects because the underlying reasons for declining vaccinations are difficult to quantify. However, we have reasons to believe that confounding by contraindication played a limited role in our study.

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