{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T19:23:15Z","timestamp":1780341795311,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Foundation","doi-asserted-by":"publisher","award":["NFF180COO34296"],"award-info":[{"award-number":["NFF180COO34296"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: This paper investigates the long-term effects of the measles, mumps, and rubella (MMR) vaccine on healthcare, education, and economic outcomes using a novel dataset from the Copenhagen School Health Records Register. Methods: To address potential endogeneity, we use within-sibling variation in vaccination status induced by different periods of vaccine availability in Denmark. Results: Our findings reveal that, prior to the establishment of herd immunity, vaccinated cohorts experienced substantial protection against hospitalizations related to MMR. During the same period, we also observe modest improvements in educational outcomes and positive\u2014though statistically insignificant\u2014estimates for labor market outcomes among siblings with discordant vaccination status. We find no impact of vaccination on hospitalizations, education, or economic outcomes for cohorts born after herd immunity was established, a period when everyone benefited from herd protection regardless of individual vaccination status. Conclusions: MMR vaccination, before herd immunity, reduced hospitalization due to Measles, Mumps, and Rubella. The impact on later outcomes, such as education, income, and employment lacks statistical precision at conventional levels. Evidence suggest positive self-selection in vaccination among families with high socioeconomic status.<\/jats:p>","DOI":"10.3390\/vaccines13030302","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T06:52:30Z","timestamp":1741675950000},"page":"302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Measles, Mumps, and Rubella Vaccination on Hospitalizations and Human Capital: Evidence from Copenhagen School Health Records"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8870-1992","authenticated-orcid":false,"given":"Onur","family":"Altindag","sequence":"first","affiliation":[{"name":"Department of Economics, Bentley University, Waltham, MA 02452, USA"},{"name":"Institute of Labor Economics (IZA) and National Bureau of Economic Research (NBER), 53113 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-4640","authenticated-orcid":false,"given":"Jane","family":"Greve","sequence":"additional","affiliation":[{"name":"Institute of Labor Economics (IZA) and National Bureau of Economic Research (NBER), 53113 Bonn, Germany"},{"name":"VIVE\u2014The Danish Center for Social Science Research, 1052 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3666-0540","authenticated-orcid":false,"given":"Erdal","family":"Tekin","sequence":"additional","affiliation":[{"name":"Institute of Labor Economics (IZA) and National Bureau of Economic Research (NBER), 53113 Bonn, Germany"},{"name":"School of Public Affairs, American University, Washington, DC 20016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/infdis\/jir111","article-title":"A world without measles","volume":"204","author":"Strebel","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0140-6736(07)60107-X","article-title":"Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study","volume":"369","author":"Wolfson","year":"2007","journal-title":"Lancet"},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention (2024, October 05). History of Measles, Available online: https:\/\/www.cdc.gov\/measles\/about\/history.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.15585\/mmwr.mm7246a3","article-title":"Progress toward measles elimination\u2014Worldwide, 2000\u20132022","volume":"72","author":"Minta","year":"2023","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1257\/jep.25.3.153","article-title":"Killing me softly: The fetal origins hypothesis","volume":"25","author":"Almond","year":"2011","journal-title":"J. Econ. Perspect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1257\/jel.20171164","article-title":"Childhood circumstances and adult outcomes: Act II","volume":"56","author":"Almond","year":"2018","journal-title":"J. Econ. Lit."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/S0169-7218(11)02413-0","article-title":"Human capital development before age five","volume":"Volume 4","author":"Currie","year":"2011","journal-title":"Handbook of Labor Economics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1257\/aer.103.5.1862","article-title":"Early life health interventions and academic achievement","volume":"103","author":"Bharadwaj","year":"2013","journal-title":"Am. Econ. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0163-4453(84)93192-X","article-title":"Measles vaccination and reduction in child mortality: A community study from Guinea-Bissau","volume":"8","author":"Aaby","year":"1984","journal-title":"J. Infect."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1136\/bmj.311.7003.481","article-title":"Non-specific beneficial effect of measles immunisation: Analysis of mortality studies from developing countries","volume":"311","author":"Aaby","year":"1995","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1126\/science.aaa3662","article-title":"Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality","volume":"348","author":"Mina","year":"2015","journal-title":"Science"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e011317","DOI":"10.1136\/bmjopen-2016-011317","article-title":"Introduction of standard measles vaccination in an urban African community in 1979 and overall child survival: A reanalysis of data from a cohort study","volume":"6","author":"Mogensen","year":"2016","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.smim.2018.06.002","article-title":"Non-specific effects of vaccines: Current evidence and potential implications","volume":"Volume 39","author":"Koeken","year":"2018","journal-title":"Seminars in Immunology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/j.cmi.2019.08.011","article-title":"Developing the concept of beneficial non-specific effect of live vaccines with epidemiological studies","volume":"25","author":"Aaby","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e34","DOI":"10.1016\/S1473-3099(22)00498-4","article-title":"Beneficial non-specific effects of live vaccines against COVID-19 and other unrelated infections","volume":"23","author":"Aaby","year":"2023","journal-title":"Lancet Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1126\/science.366.6465.560","article-title":"How measles causes the body to \u2018forget\u2019past infections","volume":"366","author":"Frederick","year":"2019","journal-title":"Science"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41467-018-07515-0","article-title":"Studies into the mechanism of measles-associated immune suppression during a measles outbreak in the Netherlands","volume":"9","author":"Laksono","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1257\/pol.20190509","article-title":"The long-term effects of measles vaccination on earnings and employment","volume":"14","author":"Atwood","year":"2022","journal-title":"Am. Econ. J. Econ. Policy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"102828","DOI":"10.1016\/j.jhealeco.2023.102828","article-title":"Mass vaccination and educational attainment: Evidence from the 1967\u201368 Measles Eradication Campaign","volume":"92","author":"Barteska","year":"2023","journal-title":"J. Health Econ."},{"key":"ref_20","unstructured":"van den Berg, G.J., Scholder, S.v.H.K., and Vitt, N. (2023). Early Life Exposure to Measles and Later-Life Outcomes: Evidence from the Introduction of a Vaccine, School of Economics, University of Bristol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"102974","DOI":"10.1016\/j.jhealeco.2025.102974","article-title":"The Long Term Benefits of Vaccination Campaigns: Evidence from Measles","volume":"101","author":"Atwood","year":"2025","journal-title":"J. Health Econ."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5020","DOI":"10.1016\/j.vaccine.2015.04.072","article-title":"The causal effect of childhood measles vaccination on educational attainment: A mother fixed-effects study in rural South Africa","volume":"33","author":"Anekwe","year":"2015","journal-title":"Vaccine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4336","DOI":"10.1016\/j.vaccine.2019.06.025","article-title":"Anthropometric, cognitive, and schooling benefits of measles vaccination: Longitudinal cohort analysis in Ethiopia, India, and Vietnam","volume":"37","author":"Nandi","year":"2019","journal-title":"Vaccine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2777","DOI":"10.1080\/00036846.2011.566203","article-title":"The effect of vaccination on children\u2019s physical and cognitive development in the Philippines","volume":"44","author":"Bloom","year":"2012","journal-title":"Appl. Econ."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6019","DOI":"10.1080\/00036846.2015.1061647","article-title":"The effect of childhood measles vaccination on school enrolment in Matlab, Bangladesh","volume":"47","author":"Driessen","year":"2015","journal-title":"Appl. Econ."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Card, D. (1999). The Causal Effect of Education on Earnings. Handbook of Labor Economics, Elsevier.","DOI":"10.1016\/S1573-4463(99)03011-4"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1006\/jvbe.2001.1868","article-title":"Social exclusion and the transition from school to work: The case of young people not in education, employment, or training (NEET)","volume":"60","author":"Bynner","year":"2002","journal-title":"J. Vocat. Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S1574-0692(06)01007-5","article-title":"Earnings functions, rates of return and treatment effects: The Mincer equation and beyond","volume":"1","author":"Heckman","year":"2006","journal-title":"Handb. Econ. Educ."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2213","DOI":"10.1016\/j.jpubeco.2007.02.002","article-title":"Do dropouts drop out too soon? Wealth, health and happiness from compulsory schooling","volume":"91","author":"Oreopoulos","year":"2007","journal-title":"J. Public Econ."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kirkedal, A.B.K., M\u00f8ller, J.E., Stensballe, L.G., and Zoffmann, V. (2022). Parents\u2019 and Health Professionals\u2019 Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age\u2014A Qualitative Thematic Analysis Embedded in a Randomized Trial. Vaccines, 11.","DOI":"10.3390\/vaccines11010067"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1017\/mdh.2020.19","article-title":"Reasonable Grounds? The Delayed Introduction of MMR Vaccine in Denmark and the Netherlands, 1977\u201387","volume":"64","author":"Berg","year":"2020","journal-title":"Med. Hist."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Altindag, O., Andersen, M., Baker, J.L., Greve, J., and Tekin, E. (2024). Information on Measles, Mumps and Rubella Vaccine in the Copenhagen School Health Records Register. Scand. J. Public Health, 14034948241247882.","DOI":"10.1177\/14034948241247882"},{"key":"ref_33","first-page":"2418","article-title":"Kendskab og holdninger samt tilslutning de f\u00f8rste 2 \u00e5r til de nye vaccinationer mod m\u00e6slinger, f\u00e5resyge og r\u00f8de hunde","volume":"151","author":"Kaaber","year":"1989","journal-title":"Ugeskr L\u00e6ger"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"30027","DOI":"10.2807\/1560-7917.ES.2015.20.39.30027","article-title":"Phylogenetic and epidemiological analysis of measles outbreaks in Denmark, 2013 to 2014","volume":"20","author":"Rasmussen","year":"2015","journal-title":"Eurosurveillance"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1093\/ije\/dyn164","article-title":"Cohort profile: The Copenhagen school health records register","volume":"38","author":"Baker","year":"2009","journal-title":"Int. J. Epidemiol."},{"key":"ref_36","unstructured":"Danish Ministry of Children and Education (2025, March 01). Elever der Ikke Afl\u00e6gger alle Obligatoriske 9.-Klassespr\u00f8ver, Available online: https:\/\/www.uvm.dk\/-\/media\/filer\/uvm\/publikationer\/2021\/210112-elever-der-ikke-aflaegger-alle-obligatoriske-9-klasseproever-ua.pdf."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/3\/302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:39Z","timestamp":1760028639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/3\/302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,11]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["vaccines13030302"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13030302","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,11]]}}}