Characterised as "perhaps the most damaging medical hoax of the 20th Century",[15] it led to a sharp drop in vaccination rates in the UK and Ireland. Promotion of the claimed link, which continues in anti-vaccination propaganda despite being refuted,[16][17] led to an increase in the incidence of measles and mumps, resulting in deaths and serious permanent injuries.[18][19] Following the initial claims in 1998, multiple large epidemiological studies were undertaken. Reviews of the evidence by the Centers for Disease Control and Prevention,[6] the American Academy of Pediatrics, the Institute of Medicine of the US National Academy of Sciences,[7] the UK National Health Service,[8] and the Cochrane Library[23] all found no link between the MMR vaccine and autism.[24] Physicians, medical journals, and editors[30] have described Wakefield's actions as fraudulent and tied them to epidemics and deaths.[31][32]