From the Institute of Medical Informatics, Statistics and Epidemiology (A.H.), and Department of Neurology, Klinikum rechts der Isar (C.G., B.H.), Technical University of Munich; National Association of Statutory Health Insurance Physicians of Bavaria (E.D.); and Munich Cluster for Systems Neurology (SyNergy) (B.H.), Munich, Germany.
Neurology. 2019 Aug 27;93(9):e908-e916. doi: 10.1212/WNL.0000000000008012. Epub 2019 Jul 30.
To investigate the hypothesis that vaccination is a risk factor for multiple sclerosis (MS) by use of German ambulatory claims data in a case-control study.
Using the ambulatory claims data of the Bavarian Association of Statutory Health Insurance Physicians covering 2005-2017, logistic regression models were used to assess the relation between MS (n = 12,262) and vaccinations in the 5 years before first diagnosis. Participants newly diagnosed with Crohn disease (n = 19,296) or psoriasis (n = 112,292) and participants with no history of these autoimmune diseases (n = 79,185) served as controls.
The odds of MS were lower in participants with a recorded vaccination (odds ratio [OR] 0.870, < 0.001 vs participants without autoimmune disease; OR 0.919, < 0.001 vs participants with Crohn disease; OR 0.973, = 0.177 vs participants with psoriasis). Lower odds were most pronounced for vaccinations against influenza and tick-borne encephalitis. These effects were consistently observed for different time frames, control cohorts, and definitions of the MS cohort. Effect sizes increased toward the time of first diagnosis.
Results of the present study do not reveal vaccination to be a risk factor for MS. On the contrary, they consistently suggest that vaccination is associated with a lower likelihood of being diagnosed with MS within the next 5 years. Whether this is a protective effect needs to be addressed by future studies.
通过病例对照研究利用德国门诊索赔数据，检验接种疫苗是多发性硬化症（MS）的风险因素这一假说。
使用涵盖 2005 年至 2017 年的巴伐利亚州法定健康保险医生门诊索赔数据，使用逻辑回归模型评估 MS（n=12262）与发病前 5 年内疫苗接种之间的关系。新诊断为克罗恩病（n=19296）或银屑病（n=112292）的参与者和无这些自身免疫性疾病病史的参与者（n=79185）作为对照。
与无自身免疫性疾病的参与者相比，记录接种疫苗的参与者发生 MS 的可能性较低（比值比[OR]0.870，<0.001；OR0.919，<0.001；OR0.973，=0.177）与克罗恩病参与者相比）。接种流感和蜱传脑炎疫苗的效果最为显著。这些效果在不同的时间框架、对照组和 MS 队列的定义中均一致观察到。效应大小随首次诊断时间的推移而增加。
本研究结果并未显示接种疫苗是 MS 的危险因素。相反，它们一致表明接种疫苗与未来 5 年内诊断为 MS 的可能性降低相关。是否存在保护作用需要未来的研究来解决。
