Vaccines and the Risk of Multiple Sclerosis and Other Central Nervous System Demyelinating Diseases

Abstract

IMPORTANCE Because vaccinations are common, even a small increased risk of multiple sclerosis (MS) or other acquired central nervous system demyelinating syndromes (CNS ADS) could have a significant effect on public health. OBJECTIVE To determine whether vaccines, particularly those for hepatitis B (HepB) and human papillomavirus (HPV), increase the risk of MS or other CNS ADS. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted using data obtained from the complete electronic health records of Kaiser Permanente Southern California (KPSC) members. Cases were identified through the KPSC CNS ADS cohort between 2008 and 2011, which included extensive review of medical records by an MS specialist. Five controls per case were matched on age, sex, and zip code. EXPOSURES Vaccination of any type (particularly HepB and HPV) identified through the electronic vaccination records system. MAIN OUTCOMES AND MEASURES All forms of CNS ADS were analyzed using conditional logistic regression adjusted for race/ethnicity, health care utilization, comorbid diseases, and infectious illnesses before symptom onset. RESULTS We identified 780 incident cases of CNS ADS and 3885 controls; 92 cases and 459 controls were females aged 9 to 26 years, which is the indicated age range for HPV vaccination. There were no associations between HepB vaccination (odds ratio [OR], 1.12; 95% CI, 0.72-1.73), HPV vaccination (OR, 1.05; 95% CI, 0.62-1.78), or any vaccination (OR, 1.03; 95% CI, 0.86-1.22) and the risk of CNS ADS up to 3 years later. Vaccination of any type was associated with an increased risk of CNS ADS onset within the first 30 days after vaccination only in younger (<50 years) individuals (OR, 2.32; 95% CI, 1.18-4.57). CONCLUSIONS AND RELEVANCE We found no longer-term association of vaccines with MS or any other CNS ADS, which argues against a causal association. The short-term increase in risk suggests that vaccines may accelerate the transition from subclinical to overt autoimmunity in patients with existing disease. Our findings support clinical anecdotes of CNS ADS symptom onset shortly after vaccination but do not suggest a need for a change in vaccine policy.

Quadrivalent human papillomavirus vaccination in girls and the risk of autoimmune disorders: the Ontario Grade 8 HPV Vaccine Cohort Study

“…The first study followed 997 585 girls aged 10-17 years and did not find a significant risk for the autoimmune disorders assessed, 32 and the second followed 3.9 million girls and women 10-44 years of age and reported no increased risk for multiple sclerosis and other demyelinating diseases of the central nervous system. 33 In addition, 2 small case-control studies involving older age groups, conducted in France 34 and the United States, 35 also reported no increased risk for various autoimmune disorders. However, the studies published to date have been limited by their use of longer-than-recommended risk windows [32][33][34] that could bias toward the null, a lack of validation of vaccination records 32,33 and a direct comparison of vaccinated and unvaccinated girls, [32][33][34] an approach prone to bias.…”

Molecular and clinical relationship between live‐attenuated Japanese encephalitis vaccination and childhood onset myasthenia gravis

“…However, problems generated by immunization, such as vaccination‐related Guillain–Barré syndrome, narcolepsy, acute disseminating encephalomyelitis, and multiple sclerosis, are becoming a public concern 23, 47, 54, 55, 56, 57, 58, 59, 60, 61. Whether the cellular and humoral autoimmunity related to LA‐JEV vaccination is involved in other immune‐mediated neurological diseases also remains unclear.…”

Multiple Sclerosis: Effect of Oral Administration of an Antioxidant Dietary Supplement in C57BL6/N Induced Model of Experimental Autoimmune Encephalomyelitis

“…The external factors, environmental, would be crucial both for the induction of the disease which for its maintenance with the unleashing of relapses. Even vaccinations may precede the onset of the disease is that the unleashing of relapses [15]. Many viruses and some bacteria were repeatedly indicted as responsible for the disease, but none of these has ever been proven.…”