Institute of Chronic Illnesses, Inc, Silver Spring, MD, USA; CoMeD, Inc., Silver Spring, MD, USA.
Institute of Chronic Illnesses, Inc, Silver Spring, MD, USA; CoMeD, Inc., Silver Spring, MD, USA; CONEM US Autism Research Group, Allen, TX, USA.
J Trace Elem Med Biol. 2018 Mar;46:1-9. doi: 10.1016/j.jtemb.2017.11.001. Epub 2017 Nov 8.
Attention-deficit/hyperactivity disorder (ADHD) is characterized by a marked pattern of inattention and/or hyperactivity-impulsivity that is inconsistent with developmental level and interferes with normal functioning in at least two settings. This study evaluated the hypothesis that infant Thimerosal-containing hepatitis B vaccine (T-HepB) exposure would increase the risk of an ADHD diagnosis. This cross-sectional study examined 4393 persons between 13 and 19 years of age from the combined 1999-2004 National Health and Nutritional Examination Survey (NHANES) by analyzing demographic, immunization, socioeconomic, and health-related variables using the SAS system. Three doses of T-HepB exposure in comparison to no exposure significantly increased the risk of an ADHD diagnosis using logistic regression (adjusted odds ratio=1.980), linear regression (adjusted beta-coefficient=0.04747), Spearman's rank (Rho=0.04807), and 2×2 contingency table (rate ratio=1.8353) statistical modeling even when considering other covariates such as gender, race, and socioeconomic status. Current health status outcomes selected on an a priori basis to not be biologically plausibly linked to T-HepB exposure showed no relationship with T-HepB. The observed study results are biologically plausible and supported by numerous previous epidemiological studies, but because the NHANES data is collected on a cross-sectional basis, it is not possible to ascribe a direct cause-effect relationship between exposure to T-HepB and an ADHD diagnosis. During the decade from 1991 to 2001 that infants were routinely exposed to T-HepB in the United States (US), an estimated 1.3-2.5 million children were diagnosed with ADHD with excess lifetime costs estimated at US $350-$660 billion as a consequence of T-HepB. Although Thimerosal use in the HepB in the US has been discontinued, Thimerosal remains in the HepB in developing countries. Routine vaccination is an important public health tool to prevent infectious diseases, but every effort should be made to eliminate Thimerosal exposure.
注意缺陷多动障碍（ADHD）的特征是明显的注意力不集中和/或多动冲动模式，与发育水平不一致，并干扰至少两个环境中的正常功能。本研究评估了以下假设，即婴儿含硫柳汞乙型肝炎疫苗（T-HepB）暴露会增加 ADHD 诊断的风险。这项横断面研究通过分析人口统计学、免疫接种、社会经济和健康相关变量，使用 SAS 系统对来自 1999-2004 年全国健康和营养调查（NHANES）的 4393 名 13-19 岁的人进行了检查。与无暴露相比，三剂 T-HepB 暴露显著增加了 ADHD 诊断的风险，使用逻辑回归（调整后的优势比=1.980）、线性回归（调整后的β系数=0.04747）、Spearman 等级（Rho=0.04807）和 2×2 列联表（比率比=1.8353）统计模型，即使考虑到性别、种族和社会经济地位等其他协变量。根据先前的流行病学研究，选择了预先确定的当前健康状况结果，这些结果与 T-HepB 暴露没有生物学上的关联，但与 T-HepB 没有关系。观察到的研究结果在生物学上是合理的，并得到了许多先前的流行病学研究的支持，但由于 NHANES 数据是基于横断面收集的，因此不可能确定 T-HepB 暴露与 ADHD 诊断之间存在直接的因果关系。在 1991 年至 2001 年期间，婴儿在美国常规接受 T-HepB 暴露的十年中，估计有 1300 万至 2500 万名儿童被诊断患有 ADHD，由于 T-HepB，终身费用估计为 3500 亿至 6600 亿美元。尽管美国的 HepB 中已不再使用硫柳汞，但在发展中国家的 HepB 中仍含有硫柳汞。常规疫苗接种是预防传染病的重要公共卫生工具，但应尽一切努力消除硫柳汞暴露。
