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.
Vestergaard M, Madsen KM, Olsen J, et al. MMR Vaccination and Febrile Seizures—Reply. JAMA. 2004;292(17):2083–2084. doi:https://doi.org/10.1001/jama.292.17.2083-b
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