Vaccinations and the risk of relapse in multiple sclerosis
Vaccinations and the risk of relapse in multiple sclerosis
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DOI：
10.1056/nejm200102013440501
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发表时间：
2001-02-01
影响因子：
158.5
通讯作者：
Vukusic, S
中科院分区：
文献类型：
--
作者：
Confavreux, C;Suissa, S;Vukusic, S
背景：有人担心接种疫苗可能会加速多发性硬化症的发作或导致复发。由于最近在法国的B型肝炎疫苗接种计划，有新的报告，活动性多发性硬化症的风险增加后vaccination.Methods：我们进行了一项病例交叉研究，以评估是否接种疫苗增加多发性硬化症复发的风险。受试者是1993年至1997年期间复发的欧洲多发性硬化症数据库中的患者。指数复发是通过神经科医生就诊确认的首次复发，之前至少有12个月的无复发期。通过标准化的电话访谈获得关于疫苗接种的信息，并通过医疗记录加以确认。暴露于疫苗接种在两个月的风险期前复发进行了比较，在前四个两个月的控制期间的相对风险的计算，这是估计与使用条件logistic regression.Results：643例多发性硬化症复发，15%的报告已接种疫苗在过去的12个月。94%的疫苗接种报告得到了证实。在所有患者中，2.3%的人在前两个月的风险期内接种了疫苗，而在四个控制期中的一个或多个期间接种了疫苗的人为2.8%至4.0%。与前两个月内接种任何疫苗相关的复发相对风险为0.71（95%置信区间为0.40至1.26）。与破伤风、B型肝炎或流感疫苗接种相关的复发特异性风险没有增加（相对风险范围为0.22 - 1.08）。基于一个和三个月的风险期分析得出了类似的结果。结论：疫苗接种似乎不会增加多发性硬化症复发的短期风险。（新英格兰医学杂志2001;344：319-26。）版权所有（C）2001马萨诸塞州医学会。
Background: There has been some concern that vaccination may precipitate the onset of multiple sclerosis or lead to relapses. Since the recent hepatitis B vaccination program in France, there have been new reports of an increased risk of active multiple sclerosis after vaccination.Methods: We conducted a case-crossover study to assess whether vaccinations increase the risk of relapse in multiple sclerosis. The subjects were patients included in the European Database for Multiple Sclerosis who had a relapse between 1993 and 1997. The index relapse was the first relapse confirmed by a visit to a neurologist and preceded by a relapse-free period of at least 12 months. Information on vaccinations was obtained in a standardized telephone interview and confirmed by means of medical records. Exposure to vaccination in the two-month risk period immediately preceding the relapse was compared with that in the four previous two-month control periods for the calculation of relative risks, which were estimated with the use of conditional logistic regression.Results: Of 643 patients with relapses of multiple sclerosis, 15 percent reported having been vaccinated during the preceding 12 months. The reports of 94 percent of these vaccinations were confirmed. Of all the patients, 2.3 percent had been vaccinated during the preceding two-month risk period as compared with 2.8 to 4.0 percent who were vaccinated during one or more of the four control periods. The relative risk of relapse associated with exposure to any vaccination during the previous two months was 0.71 (95 percent confidence interval, 0.40 to 1.26). There was no increase in the specific risk of relapse associated with tetanus, hepatitis B, or influenza vaccination (range of relative risks, 0.22 to 1.08). Analyses based on risk periods of one and three months yielded similar results.Conclusions: Vaccination does not appear to increase the short-term risk of relapse in multiple sclerosis. (N Engl J Med 2001;344:319-26.) Copyright (C) 2001 Massachusetts Medical Society.