A longitudinal cohort study of the relationship between Thimerosal-containing hepatitis B vaccination and specific delays in development in the United States: Assessment of attributable risk and lifetime care costs

J Epidemiol Glob Health. 2016 Jun;6(2):105-18. doi: 10.1016/j.jegh.2015.06.002. Epub 2015 Jul 9.


Epidemiological evidence suggests a link between mercury (Hg) exposure from Thimerosal-containing vaccines and specific delays in development. A hypothesis-testing longitudinal cohort study (n=49,835) using medical records in the Vaccine Safety Datalink (VSD) was undertaken to evaluate the relationship between exposure to Hg from Thimerosal-containing hepatitis B vaccines (T-HBVs) administered at specific intervals in the first 6months of life and specific delays in development [International Classification of Disease, 9th revision (ICD-9): 315.xx] among children born between 1991 and 1994 and continuously enrolled from birth for at least 5.81years. Infants receiving increased Hg doses from T-HBVs administered within the first month, the first 2months, and the first 6months of life were significantly more likely to be diagnosed with specific delays in development than infants receiving no Hg doses from T-HBVs. During the decade in which T-HBVs were routinely recommended and administered to US infants (1991-2001), an estimated 0.5-1million additional US children were diagnosed with specific delays in development as a consequence of 25μg or 37.5μg organic Hg from T-HBVs administered within the first 6months of life. The resulting lifetime costs to the United States may exceed $1 trillion.

Keywords: Ethylmercury; Merthiolate; Thimerosal; Thiomersal; Vaccine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antiviral Agents / adverse effects
  • Antiviral Agents / economics
  • Antiviral Agents / therapeutic use
  • Child
  • Child Development / drug effects
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hepatitis B / drug therapy*
  • Hepatitis B / economics*
  • Hepatitis B Vaccines / adverse effects*
  • Hepatitis B Vaccines / economics*
  • Hepatitis B Vaccines / therapeutic use
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Mercury / adverse effects*
  • Risk Factors
  • Thimerosal / adverse effects*
  • Thimerosal / economics*
  • Thimerosal / therapeutic use
  • United States


  • Antiviral Agents
  • Hepatitis B Vaccines
  • Thimerosal
  • Mercury