Bardenheier Barbara H, Duffy Jonathan, Duderstadt Susan K, Higgs Jay B, Keith Michael P, Papadopoulos Patricia J, Gilliland William R, McNeil Michael M
Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Rheumatology Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234.
Mil Med. 2016 Oct;181(10):1348-1356. doi: 10.7205/MILMED-D-15-00485.
U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA). Few cases of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been reported in persons who received AVA. Using a matched case-control study design, we assessed the relationship of RA and SLE with AVA vaccination using the Defense Medical Surveillance System. We identified potential cases using International Classification of Diseases, 9th Revision, Clinical Modification codes and confirmed cases with medical record review and rheumatologist adjudication. Using conditional logistic regression, we estimated odds ratios (OR) for AVA exposure during time intervals ranging from 90 to 1,095 days before disease onset. Among 77 RA cases, 13 (17%) had ever received AVA. RA cases were no more likely than controls to have received AVA when looking back 1,095 days (OR: 1.03; 95% confidence interval [CI]: 0.48-2.19) but had greater odds of exposure in the prior 90 days (OR: 3.93; 95% CI: 1.08-14.27). Among the 39 SLE cases, 5 (13%) had ever received AVA; no significant difference in receipt of AVA was found when compared with controls (OR: 0.91; 95% CI: 0.26-3.25). AVA was associated with recent onset RA, but did not increase the risk of developing RA in the long term.
被分配到被认为有炭疽攻击高风险地区的美国军事人员会接种吸附型炭疽疫苗（AVA）。在接种AVA的人群中，报告的类风湿性关节炎（RA）和系统性红斑狼疮（SLE）病例较少。我们采用匹配病例对照研究设计，利用国防医疗监测系统评估RA和SLE与AVA疫苗接种之间的关系。我们使用国际疾病分类第九版临床修订本代码确定潜在病例，并通过病历审查和风湿病专家判定来确诊病例。我们使用条件逻辑回归分析，估计疾病发作前90至1095天期间AVA暴露的比值比（OR）。在77例RA病例中，13例（17%）曾接种过AVA。回顾1095天时，RA病例接种AVA的可能性并不高于对照组（OR：1.03；95%置信区间[CI]：0.48 - 2.19），但在之前90天内暴露的可能性更大（OR：3.93；95% CI：1.08 - 14.27）。在39例SLE病例中，5例（13%）曾接种过AVA；与对照组相比，AVA接种情况无显著差异（OR：0.91；95% CI：0.26 - 3.25）。AVA与近期发病的RA有关，但长期来看不会增加患RA的风险。
