疫苗与多发性硬化症发作住院风险。

Vaccines and the Risk of Hospitalization for Multiple Sclerosis Flare-Ups.

机构信息

Department of Pharmacology, Hospital Group Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France.

Anti-Infective Evasion and Pharmacoepidemiology, Centre for Epidemiology and Population Health, INSERM U1018, Villejuif, France.

出版信息

JAMA Neurol. 2023 Oct 1;80(10):1098-1104. doi: 10.1001/jamaneurol.2023.2968.

DOI:10.1001/jamaneurol.2023.2968

PMID:37669073

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10481324/

Abstract

IMPORTANCE

Scientific literature is sparse about the association of vaccination with the onset of multiple sclerosis (MS) flare-ups. Immunization by vaccines of the entire population is crucially important for public health.

OBJECTIVE

To evaluate the risk of hospitalization for severe MS flare-ups after vaccination in patients with MS.

DESIGN, SETTING, PARTICIPANTS: This cohort study included patients diagnosed with MS between January 1, 2007, and December 31, 2017, who were included in the System of National Health Databases, a national health claims database in France. In a nested case-crossover analysis, cases were defined by vaccine exposure prior to the onset of hospitalization due to an MS flare-up, and flare-up rates were compared with those that occurred prior to vaccine exposure in up to 4 control time windows immediately preceding the at-risk time window (ie, the MS flare-up) for each patient. Data were analyzed from January 2022 to December 2022.

EXPOSURE

Receipt of at least 1 vaccination, including the diphtheria, tetanus, poliomyelitis, pertussis, or Haemophilus influenzae (DTPPHi) vaccine, influenza vaccine, and pneumococcal vaccine, during follow-up.

MAIN OUTCOMES AND MEASURES

The primary outcome was the risk of hospitalization for an MS flare-up after receipt of a vaccine. Adjusted odds ratios (AORs) and 95% CIs were derived using conditional logistic regression to measure the risk of hospitalization for an MS flare-up associated with vaccination.

RESULTS

A total of 106 523 patients constituted the MS cohort (mean [SD] age, 43.9 [13.8] years; 76 471 females [71.8%]; 33 864 patients [31.8%] had incident MS and 72 659 patients [68.2%] had prevalent MS) and were followed up for a mean (SD) of 8.8 (3.1) years. Of these patients, 35 265 (33.1%) were hospitalized for MS flare-ups during the follow-up period for a total of 54 036 MS-related hospitalizations. The AORs of hospitalization for an MS flare-up and vaccine exposure in the 60 days prior to the flare-up were 1.00 (95% CI, 0.92-1.09) for all vaccines, 0.95 (95% CI, 0.82-1.11) for the DTPPHi, 0.98 (95% CI, 0.88-1.09) for the influenza vaccine, and 1.20 (95% CI, 0.94-1.55) for the pneumococcal vaccine.

CONCLUSIONS AND RELEVANCE

A nationwide study of the French population found no association between vaccination and the risk of hospitalization due to MS flare-ups. However, considering the number of vaccine subtypes available, further studies are needed to confirm these results.

摘要

重要性

关于疫苗接种与多发性硬化症（MS）发作之间关联的科学文献很少。为了公众健康，对整个人群进行疫苗免疫至关重要。

目的

评估 MS 患者接种疫苗后因严重 MS 发作而住院的风险。

设计、设置、参与者：本队列研究纳入了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间在法国国家健康数据系统（一个全国性的健康索赔数据库）中确诊为 MS 的患者。在嵌套病例对照分析中，病例定义为在因 MS 发作而住院之前疫苗暴露，在每个患者的风险时间窗（即 MS 发作）之前的最多 4 个对照时间窗内，将疫苗暴露前的发作率与疫苗暴露前的发作率进行比较。数据于 2022 年 1 月至 2022 年 12 月进行分析。

暴露

在随访期间至少接种了 1 种疫苗，包括白喉、破伤风、脊髓灰质炎、百日咳或流感嗜血杆菌（DTPPHi）疫苗、流感疫苗和肺炎球菌疫苗。

主要结果和措施

主要结局是接种疫苗后因 MS 发作而住院的风险。使用条件逻辑回归得出调整后的优势比（AOR）和 95%置信区间，以衡量与疫苗接种相关的 MS 发作住院风险。

结果

共有 106523 例患者构成 MS 队列（平均[标准差]年龄为 43.9[13.8]岁；76471 名女性[71.8%]；33864 例患者[31.8%]为新发 MS，72659 例患者[68.2%]为现患 MS），随访平均（标准差）为 8.8（3.1）年。在此期间，这些患者中有 35265 人（33.1%）因 MS 发作住院，共发生 54036 例 MS 相关住院治疗。在发作前 60 天内疫苗暴露与 MS 发作住院的 AOR 为 1.00（95%CI，0.92-1.09），所有疫苗为 0.95（95%CI，0.82-1.11），DTPPHi 为 0.98（95%CI，0.88-1.09），流感疫苗为 0.98（95%CI，0.88-1.09），肺炎球菌疫苗为 1.20（95%CI，0.94-1.55）。