Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena2Department of Neurology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles.
Department of Research and Evaluation, Kaiser Permanente, Southern California, Pasadena.
JAMA Neurol. 2014 Dec;71(12):1506-13. doi: 10.1001/jamaneurol.2014.2633.
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.
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.
Vaccination of any type (particularly HepB and HPV) identified through the electronic vaccination records system.
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.
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).
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.
由于疫苗接种很常见，即使多发性硬化症（MS）或其他获得性中枢神经系统脱髓鞘综合征（CNS ADS）的风险略有增加，也可能对公共卫生产生重大影响。
确定疫苗，特别是乙型肝炎（HepB）和人乳头瘤病毒（HPV）疫苗，是否会增加 MS 或其他 CNS ADS 的风险。
设计、设置和参与者：这是一项嵌套病例对照研究，使用 Kaiser Permanente Southern California（KPSC）成员完整的电子健康记录中的数据进行。病例通过 2008 年至 2011 年 KPSC 的 CNS ADS 队列确定，其中包括由 MS 专家对病历进行广泛审查。每个病例匹配 5 个对照，匹配年龄、性别和邮政编码。
通过电子疫苗接种记录系统识别的任何类型的疫苗接种（特别是 HepB 和 HPV）。
使用条件逻辑回归分析所有形式的 CNS ADS，该回归调整了种族/民族、医疗保健利用、合并症和症状发作前的传染病。
我们确定了 780 例 CNS ADS 病例和 3885 例对照；92 例病例和 459 例对照为 9 至 26 岁的女性，这是 HPV 疫苗接种的推荐年龄范围。HepB 疫苗接种（比值比[OR]，1.12；95%CI，0.72-1.73）、HPV 疫苗接种（OR，1.05；95%CI，0.62-1.78）或任何疫苗接种（OR，1.03；95%CI，0.86-1.22）与 CNS ADS 风险之间没有关联，直到 3 年后。只有在年龄较小（<50 岁）的个体中，疫苗接种与接种后 30 天内 CNS ADS 发病的风险增加相关（OR，2.32；95%CI，1.18-4.57）。
我们没有发现疫苗与 MS 或任何其他 CNS ADS 的长期关联，这表明两者之间没有因果关系。短期风险增加表明，疫苗可能会加速患有现有疾病的患者从亚临床到显性自身免疫的转变。我们的研究结果支持 CNS ADS 症状在接种疫苗后不久出现的临床传闻，但并不表明需要改变疫苗接种政策。
