Author Topic: (Abst.) Vaccines and risk of MS and other CNS demyelinating diseases  (Read 130 times)

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Offline agate

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From JAMA Neurology, October 20, 2014:

Quote
Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases

Annette Langer-Gould, MD, PhD1,2; Lei Qian, PhD1; Sara Y. Tartof, PhD1; Sonu M. Brara, MD2; Steve J. Jacobsen, MD, PhD1; Brandon E. Beaber, MD2; Lina S. Sy, MPH1; Chun Chao, PhD1; Rulin Hechter, MD, PhD1; Hung Fu Tseng, PhD, MPH1

Author Affiliations:

1Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena
2Department of Neurology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles

Importance 

Because vaccinations are common, even a small increased risk of multiple sclerosis (MS) or other acquired central nervous system demyelinating syndromes (CNS ADS) could have a significant effect on public health.

Objective

To determine whether vaccines, particularly those for hepatitis B (HepB) and human papillomavirus (HPV), increase the risk of MS or other CNS ADS.

Design, Setting, and Participants 

A nested case-control study was conducted using data obtained from the complete electronic health records of Kaiser Permanente Southern California (KPSC) members. Cases were identified through the KPSC CNS ADS cohort between 2008 and 2011, which included extensive review of medical records by an MS specialist. Five controls per case were matched on age, sex, and zip code.

Exposures 

Vaccination of any type (particularly HepB and HPV) identified through the electronic vaccination records system.

Main Outcomes and Measures 

All forms of CNS ADS were analyzed using conditional logistic regression adjusted for race/ethnicity, health care utilization, comorbid diseases, and infectious illnesses before symptom onset.

Results 

We identified 780 incident cases of CNS ADS and 3885 controls; 92 cases and 459 controls were females aged 9 to 26 years, which is the indicated age range for HPV vaccination. There were no associations between HepB vaccination (odds ratio [OR], 1.12; 95% CI, 0.72-1.73), HPV vaccination (OR, 1.05; 95% CI, 0.62-1.78), or any vaccination (OR, 1.03; 95% CI, 0.86-1.22) and the risk of CNS ADS up to 3 years later. Vaccination of any type was associated with an increased risk of CNS ADS onset within the first 30 days after vaccination only in younger (<50 years) individuals (OR, 2.32; 95% CI, 1.18-4.57).

Conclusions and Relevance 

We found no longer-term association of vaccines with MS or any other CNS ADS, which argues against a causal association. The short-term increase in risk suggests that vaccines may accelerate the transition from subclinical to overt autoimmunity in patients with existing disease. Our findings support clinical anecdotes of CNS ADS symptom onset shortly after vaccination but do not suggest a need for a change in vaccine policy.
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.

Offline agate

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MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.

Offline agate

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This abstract of a study reported in JAMA January 6, 2015, discusses human papillomavirus vaccination (HPV) and its possible risk of MS and other CNS demyelinating diseases. It finds no causal connection.

Quote
Quadrivalent HPV Vaccination and Risk of Multiple Sclerosis and Other Demyelinating Diseases of the Central Nervous System

Nikolai Madrid Scheller, MB1; Henrik Svanström, MSc1; Björn Pasternak, MD, PhD1; Lisen Arnheim-Dahlström, PhD2; Karin Sundström, MD, PhD3; Katharina Fink, MD, DrMed4,5; Anders Hviid, DrMedSci1

Author Affiliations

1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
3Department of Laboratory Medicine, Karolinska University Hospital, Stockholm, Sweden
4Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
5Department of Neurology, Karolinska University Hospital, Stockholm, Sweden


Importance

Case reports have suggested a link between human papillomavirus (HPV) vaccination and development of multiple sclerosis and other demyelinating diseases.
Objective  To investigate if quadrivalent HPV (qHPV) vaccination is associated with an increased risk of multiple sclerosis and other demyelinating diseases.

Design, Setting, and Participants

Using nationwide registers we identified a cohort of all females aged 10 years to 44 years in Denmark and Sweden, followed up from 2006 to 2013, information on qHPV vaccination, and data on incident diagnoses of multiple sclerosis and other demyelinating diseases. The primary analysis used a cohort design including vaccinated and unvaccinated study participants. A secondary analysis used a self-controlled case-series design including only cases. Both analyses used a 2-year risk period following vaccination.

Exposures

Information on qHPV vaccination was obtained through the national vaccination and prescription registers.

Main Outcomes and Measures

The primary outcomes were multiple sclerosis and a composite end point of other demyelinating diseases.

Incidence rate ratios were estimated using Poisson regression, comparing rates of events in the 2-year risk periods following vaccination and in unvaccinated time periods.

Results

The study included 3, 983, 824 females, among whom 789, 082 received a total of 1, 927, 581 qHPV vaccine doses. During follow-up, 4322 multiple sclerosis cases and 3300 cases of other demyelinating diseases were identified, of which 73 and 90, respectively, occurred within the risk period. In the cohort analysis, there was no increased risk of multiple sclerosis (crude incidence rates, 6.12 events/100, 000 person-years [95% CI, 4.86-7.69] and 21.54 events/100, 000 person-years [95% CI, 20.90-22.20] for the vaccinated and unvaccinated periods; adjusted rate ratio, 0.90 [95% CI, 0.70-1.15]) or other demyelinating diseases (crude incidence rates, 7.54 events/100, 000 person-years [95% CI, 6.13-9.27] and 16.14 events/100, 000 person-years [95% CI, 15.58-16.71]; adjusted rate ratio, 1.00 [95% CI, 0.80-1.26]) associated with qHPV vaccination. Similarly, no increased risk was found using the self-controlled case-series design (multiple sclerosis: incidence ratio, 1.05 [95% CI, 0.79-1.38]; other demyelinating diseases: incidence ratio, 1.14 [95% CI, 0.88-1.47]).

Conclusions and Relevance 

In this study with nationwide coverage of 2 Scandinavian countries, qHPV vaccination was not associated with the development of multiple sclerosis or other demyelinating diseases. These findings do not support concerns about a causal relationship between qHPV vaccination and demyelinating diseases.
MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.