This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background: The risk of CNS inflammatory demyelination associated with hepatitis B (HB) vaccine is debated, with studies reporting conflicting findings.
Methods: We conducted a population-based case-control study where the cases were children with a first episode of acute CNS inflammatory demyelination in France (1994–2003). Each case was matched on age, sex, and geographic location to up to 12 controls, randomly selected from the general population. Information on vaccinations was confirmed by a copy of the vaccination certificate. The odds ratios (ORs) of CNS inflammatory demyelination associated with HB vaccination were estimated using conditional logistic regression.
Results: The rates of HB vaccination in the 3 years before the index date were 24.4% for the 349 cases and 27.3% for their 2,941 matched controls. HB vaccination within this period was not associated with an increase in the rate of CNS inflammatory demyelination (adjusted OR, 0.74; 0.54–1.02), neither >3 years nor as a function of the number of injections or brand type. When the analysis was restricted to subjects compliant with vaccination, HB vaccine exposure >3 years before index date was associated with an increased trend (1.50; 0.93–2.43), essentially from the Engerix B vaccine (1.74; 1.03–2.95). The OR was particularly elevated for this brand in patients with confirmed multiple sclerosis (2.77; 1.23–6.24).
Conclusions: Hepatitis B vaccination does not generally increase the risk of CNS inflammatory demyelination in childhood. However, the Engerix B vaccine appears to increase this risk, particularly for confirmed multiple sclerosis, in the longer term. Our results require confirmation in future studies.
ADEM = acute disseminated encephalomyelitis; BCG = Bacille Calmette–Guèrin; HB = hepatitis B; MS = multiple sclerosis; OR = odds ratio.
Footnotes
-
Editorial, page 870
e-Pub ahead of print on October 8, 2008, at www.neurology.org.
Funded by grants from the “Agence Française de Sécurité Sanitaire des Produits de Santé” (AFSSAPS), the “Agence Nationale de Recherche sur le SIDA et les hépatites” (ANRS), and the French Ministry of Health by a grant from the “Projet Hospitalier de Recherche Clinique” and by the “Direction Générale de la Santé.” S. Suissa holds a Distinguished Scientist award from the Canadian Institutes of Health Research (CIHR).
Disclosure: The authors report no disclosures.
Received March 21, 2008. Accepted in final form August 6, 2008.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
- Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood
- Editor's Note
- Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
Recombinant hepatitis B vaccine and the risk of multiple sclerosis
Hepatitis vaccines and pediatric multiple sclerosis
Practice guideline update summary: Vaccine-preventable infections and immunization in multiple sclerosis
HEPATITIS B VACCINE AND THE RISK OF CNS INFLAMMATORY DEMYELINATION IN CHILDHOOD