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Vaccinations and Risk of Central Nervous System Demyelinating Diseases in Adults
Frank DeStefano, MD, MPH;
Thomas Verstraeten, MD;
Lisa A. Jackson, MD, MPH;
Catherine A. Okoro, MS;
Patti Benson, MPH;
Steven B. Black, MD;
Henry R. Shinefield, MD;
John P. Mullooly, PhD;
William Likosky, MD, MA;
Robert T. Chen, MD; for the Vaccine Safety Datalink Research Group
Arch Neurol. 2003;60:504-509.
Background Several case reports of the onset or exacerbation of multiple sclerosis or other demyelinating conditions shortly after vaccination have suggested that vaccines may increase the risk of demyelinating diseases.
Objective To evaluate the association between vaccination and onset of multiple sclerosis or optic neuritis.
Design Case-control study involving cases of multiple sclerosis or optic neuritis among adults 18 to 49 years of age. Data on vaccinations and other risk factors were obtained from computerized and paper medical records and from telephone interviews.
Setting Three health maintenance organizations.
Participants Four hundred forty case subjects and 950 control subjects matched on health maintenance organization, sex, and date of birth.
Interventions None.
Main Outcome Measures Onset of first symptoms of demyelinating disease at any time after vaccination and during specified intervals after vaccination (<1 year, 1-5 years, and >5 years).
Results Cases and controls had similar vaccination histories. The odds ratios (95% confidence intervals), adjusted for potential confounding variables, of the associations between ever having been vaccinated and risk of demyelinating disease (multiple sclerosis and optic neuritis combined) were 0.9 (0.6-1.5) for hepatitis B vaccine; 0.6 (0.4-0.8) for tetanus vaccination; 0.8 (0.6-1.2) for influenza vaccine; 0.8 (0.5-1.5) for measles, mumps, rubella vaccine; 0.9 (0.5-1.4) for measles vaccine; and 0.7 (0.4-1.0) for rubella vaccine. The results were similar when multiple sclerosis and optic neuritis were analyzed separately. There was no increased risk according to timing of vaccination.
Conclusion Vaccination against hepatitis B, influenza, tetanus, measles, or rubella is not associated with an increased risk of multiple sclerosis or optic neuritis.
From the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga (Drs DeStefano, Verstraeten, and Chen and Ms Okoro); Center for Health Studies, Group Health Cooperative, Seattle, Wash (Dr Jackson and Ms Benson); Department of Epidemiology, University of Washington, Seattle (Dr Jackson); Pediatric Vaccine Study Center, Northern California Kaiser Permanente, Oakland (Drs Black and Shinefield); Center for Health Research, Northwest Kaiser Permanente, Portland, Ore (Dr Mullooly); and Departments of Neurology, University of Washington and Minor and James Medical, Seattle (Dr Likosky).
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