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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.

Little is known about risk factors for febrile seizures, making it difficult for parents and physicians to identify children as high risk. We stratified the study population according to some of the most important risk factors (sibling history of febrile seizures, sex, birth weight, and gestational age), but the rate ratios did not vary significantly. Furthermore, the . . . [Full Text of this Article]

Mogens Vestergaard, MD, PhD
mv@soci.au.dk

Kreesten Meldgaard Madsen, MD; Jørn Olsen, MD, PhD
Danish Epidemiology Science Centre
Department of Epidemiology and Social Medicine
Aarhus University
Aarhus, Denmark

Anders Hviid, MSci; Jan Wohlfahrt, MSci; Mads Melbye, MD, DMedSci
Danish Epidemiology Science Centre
Department of Epidemiology Research
Statens Serum Institut
Copenhagen, Denmark

Poul Thorsen, MD, PhD; Diana Schendel, PhD
North Atlantic Neuro-Epidemiology Alliances
Department of Epidemiology and Social Medicine
Aarhus University

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