Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
Int J Epidemiol. 2017 Jun 1;46(3):905-913. doi: 10.1093/ije/dyx052.
It has been proposed that childhood vaccinations protect against acute lymphoblastic leukaemia (ALL) in children by modulation of future responses to common infections in childhood. However, the available studies provide inconsistent findings, and population-based cohort studies with longitudinal information on vaccinations are lacking.
In a register-based cohort of all children born in Denmark from 1 January 1990 to 31 December 2008, followed up until age 15 years or 31 December 2009 ( n = 1 225 404), we evaluated exposure to childhood vaccination and risk of childhood ALL, including information on ALL subtypes. Using Cox regression, we estimated hazard ratios (HRs) comparing vaccinated with unvaccinated children.
Childhood ALL was diagnosed in 490 children during 10 829 194 person-years of follow-up. Neither the total number of vaccine doses received nor exposure to each vaccination given in childhood was associated with altered risk of ALL, including the following: (i) Haemophilus influenzae type b [HR, 1.04; 95% confidence interval (CI), 0.68-1.61]; ii) measles, mumps and rubella (HR, 1.01; 95% CI, 0.76-1.34); iii) whole-cell pertussis (HR, 1.10; 95% CI, 0.51-2.39); and iv) diphtheria, tetanus and inactivated polio (HR, 1.14; 95% CI, 0.42-3.13). Analyses conducted according to ALL subtypes defined by immunopheno- and karyotypes showed no association with childhood vaccination.
This nationwide cohort study provides no support of the proposed protective effect of childhood vaccination against childhood ALL.
有人提出，儿童期疫苗接种通过调节儿童期常见感染的未来反应，从而预防儿童急性淋巴细胞白血病（ALL）。然而，现有研究的结果并不一致，并且缺乏具有疫苗接种纵向信息的基于人群的队列研究。
在丹麦，我们对所有于 1990 年 1 月 1 日至 2008 年 12 月 31 日期间出生的儿童（n = 1 225 404）进行了一项基于登记的队列研究，随访至 15 岁或 2009 年 12 月 31 日。我们评估了儿童期疫苗接种与儿童 ALL 风险的关系，包括 ALL 亚型的信息。我们使用 Cox 回归估计了与未接种疫苗的儿童相比，接种疫苗的儿童的危险比（HR）。
在 10 829 194 人年的随访期间，有 490 名儿童被诊断患有 ALL。接受的疫苗总剂量或儿童期每次接种疫苗的暴露均与 ALL 风险的变化无关，包括以下情况：（i）b 型流感嗜血杆菌[HR，1.04；95%置信区间（CI），0.68-1.61]；（ii）麻疹、腮腺炎和风疹（HR，1.01；95% CI，0.76-1.34）；（iii）全细胞百日咳（HR，1.10；95% CI，0.51-2.39）；以及（iv）白喉、破伤风和灭活脊髓灰质炎（HR，1.14；95% CI，0.42-3.13）。根据免疫表型和核型定义的 ALL 亚型进行的分析未显示与儿童疫苗接种有关。
这项全国性队列研究未支持儿童期疫苗接种预防儿童 ALL 的假设保护作用。
