National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia; The Canberra Hospital, Canberra, Australia.
The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia; Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia.
Mult Scler Relat Disord. 2020 Jul;42:102062. doi: 10.1016/j.msard.2020.102062. Epub 2020 Mar 18.
The association between childhood vaccinations and infections and risk of multiple sclerosis is unclear; few studies have considered age at vaccination/infection.
To explore age-related associations between childhood vaccinations, infection and tonsillectomy and risk of a first clinical diagnosis of CNS demyelination.
Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported age at time of childhood vaccinations, infections, and tonsillectomy. Conditional logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI).
Poliomyelitis vaccination prior to school-age was associated with increased risk of a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02-6.68), based on a very small unvaccinated reference group. Late (11-15 years) rubella vaccination (compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI 0.27-0.83). Past infectious mononucleosis at 11-15 years (AOR = 2.84, 95%CI 1.0-7.57) and 16-20 years (AOR = 1.92, 95%CI 1.12-3.27) or tonsillectomy in adolescence (11-15 years: AOR = 2.45, 95%CI 1.12-5.35), including after adjustment for IM, were associated with increased risk of a first clinical diagnosis of CNS demyelination.
Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS demyelination. Failing to account for age effects may explain inconsistencies in past findings.
儿童期疫苗接种与感染和多发性硬化症之间的关联尚不清楚；很少有研究考虑疫苗接种/感染的年龄。
探讨儿童期疫苗接种、感染和扁桃体切除术与首次中枢神经系统脱髓鞘临床诊断之间的年龄相关性。
本研究数据来自一项以人群为基础的病例对照研究，病例组（n=275，76.6%为女性；平均年龄 38.6 岁）和年龄及性别匹配的对照组（n=529）参与者报告了儿童时期疫苗接种、感染和扁桃体切除术的年龄。采用条件逻辑回归模型计算调整后的比值比（AOR）和 95%置信区间（CI）。
基于未接种疫苗的参考组人数非常少，上学前接种脊髓灰质炎疫苗与首次中枢神经系统脱髓鞘临床诊断风险增加相关（AOR=2.60，95%CI 1.02-6.68）。与未接种相比，11-15 岁时接种风疹疫苗（AOR=0.47，95%CI 0.27-0.83）的可能性较低。11-15 岁（AOR=2.84，95%CI 1.0-7.57）和 16-20 岁（AOR=1.92，95%CI 1.12-3.27）时既往传染性单核细胞增多症，或青少年时期（11-15 岁：AOR=2.45，95%CI 1.12-5.35）进行扁桃体切除术，包括在调整传染性单核细胞增多症后，与首次中枢神经系统脱髓鞘临床诊断风险增加相关。
疫苗接种、感染或扁桃体切除术的年龄可能会改变随后发生中枢神经系统脱髓鞘的风险。不考虑年龄效应可能解释了过去研究结果的不一致性。
