Ahlgren Cecilia, Torén Kjell, Odén Anders, Andersen Oluf
Institute of Clinical Neuroscience, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
Eur J Epidemiol. 2009;24(9):541-52. doi: 10.1007/s10654-009-9367-2. Epub 2009 Jul 26.
Viral infections are probably involved in the pathogenesis of multiple sclerosis (MS). A recent cohort study in the Gothenburg population revealed no change in MS incidence associated with the introduction of the Swedish measles, mumps and rubella vaccination programmes. The aim of the present study was to clarify whether these infections or vaccinations, and two other infections, varicella and infectious mononucleosis, influence MS risk. We performed a population-based case-control study in Gothenburg that included 509 MS cases and 2,067 controls, born 1959-1986. Data on infections and vaccinations were obtained from questionnaires and from child health and school health records. We found no significant associations between measles, mumps, rubella or varicella and MS risk. These results were consistent between the two source materials. Infectious mononucleosis was associated with significantly higher MS risk (odds ratio 2.03, 95% CI 1.52-2.73). Overall, there was no significant association between measles-mumps-rubella (MMR) vaccination and MS risk, while those MMR vaccinated before age ten only were at significantly higher MS risk (odds ratio 4.92, 95% CI 1.97-12.20). Those MMR vaccinated both before and after age ten had intermediate MS risk. Infection with measles, mumps, rubella and varicella did not influence MS risk in contrast to infectious mononucleosis which conferred doubled MS risk. The association with 'early' MMR vaccination only was an isolated finding, limited by a small number of subjects and multiple testing. Most likely this was a chance finding. Future studies could investigate it on an a priori basis.
病毒感染可能与多发性硬化症（MS）的发病机制有关。最近在哥德堡人群中进行的一项队列研究显示，随着瑞典麻疹、腮腺炎和风疹疫苗接种计划的推行，MS发病率没有变化。本研究的目的是阐明这些感染或疫苗接种，以及另外两种感染，水痘和传染性单核细胞增多症，是否会影响MS风险。我们在哥德堡进行了一项基于人群的病例对照研究，纳入了509例MS病例和2067名对照，他们出生于1959年至1986年。关于感染和疫苗接种的数据来自问卷调查以及儿童健康和学校健康记录。我们发现麻疹、腮腺炎、风疹或水痘与MS风险之间没有显著关联。这两种来源材料的结果是一致的。传染性单核细胞增多症与显著更高的MS风险相关（比值比2.03，95%置信区间1.52 - 2.73）。总体而言，麻疹-腮腺炎-风疹（MMR）疫苗接种与MS风险之间没有显著关联，而仅在10岁之前接种MMR的人群MS风险显著更高（比值比4.92，95%置信区间1.97 - 12.20）。在10岁之前和之后都接种MMR的人群MS风险处于中间水平。与麻疹、腮腺炎、风疹和水痘感染不同，传染性单核细胞增多症使MS风险加倍，前者并未影响MS风险。仅与“早期”MMR疫苗接种的关联是一个孤立的发现，受限于受试者数量少和多次检验。很可能这是一个偶然发现。未来的研究可以在预先设定的基础上对此进行调查。
