Hepatitis B Vaccination and the Risk of Multiple Sclerosis
Alberto Ascherio, M.D., Dr.P.H., Shumin M. Zhang, M.D., Sc.D., Miguel A. Hernan, M.D., Dr.P.H., Michael J. Olek, M.D., Paul M. Coplan, Sc.D., Kimberly Brodovicz, M.P.H., and Alexander M. Walker, M.D., Dr.P.H.
Background Reports of multiple sclerosis developing after hepatitisB vaccination have led to the concern that this vaccine mightbe a cause of multiple sclerosis in previously healthy subjects.
Methods We conducted a nested case–control study in twolarge cohorts of nurses in the United States, those in the Nurses'Health Study (which has followed 121,700 women since 1976) andthose in the Nurses' Health Study II (which has followed 116,671women since 1989). For each woman with multiple sclerosis, weselected as controls five healthy women and one woman with breastcancer. Information about hepatitis B vaccination was obtainedby means of a mailed questionnaire and was confirmed by meansof vaccination certificates. The analyses included 192 womenwith multiple sclerosis and 645 matched controls (534 healthycontrols and 111 with breast cancer) and were conducted withthe use of conditional logistic regression.
Results The multivariate relative risk of multiple sclerosisassociated with exposure to the hepatitis B vaccine at any timebefore the onset of the disease was 0.9 (95 percent confidenceinterval, 0.5 to 1.6). The relative risk associated with hepatitisB vaccination within two years before the onset of the diseasewas 0.7 (95 percent confidence interval, 0.3 to 1.8). The resultswere similar in analyses restricted to women with multiple sclerosisthat began after the introduction of the recombinant hepatitisB vaccine. There was also no association between the numberof doses of vaccine received and the risk of multiple sclerosis.
Conclusions These results indicate no association between hepatitisB vaccination and the development of multiple sclerosis.
Source Information
From the Departments of Epidemiology (A.A., M.A.H., A.M.W.) and Nutrition (A.A., S.M.Z.), Harvard School of Public Health, Boston; the Multiple Sclerosis Unit, Center for Neurological Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston (M.J.O.); and Merck Research Laboratories, West Point, Pa. (P.M.C., K.B.).
Address reprint requests to Dr. Ascherio at the Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave., Boston, MA 02115, or at alberto.ascherio{at}channing.harvard.edu.
Mikaeloff, Y., Caridade, G., Suissa, S., Tardieu, M.
(2009). Hepatitis B vaccine and the risk of CNS inflammatory demyelination in childhood. Neurology
72: 873-880
[Abstract][Full Text]
Ness, J. M., Bale, J. F. Jr
(2009). Hepatitis vaccines and pediatric multiple sclerosis: Does timing or type matter?. Neurology
72: 870-871
[Full Text]
Forrester, M. B., Coleman, L., Kornberg, A. J.
(2009). Multiple Sclerosis in Childhood: Clinical and Radiological Features. J Child Neurol
24: 56-62
[Abstract]
Tai, A., O'Reilly, E., Alroy, K., Simon, K., Munger, K., Huber, B., Ascherio, A
(2008). Human endogenous retrovirus-K18 Env as a risk factor in multiple sclerosis. Mult Scler
14: 1175-1180
[Abstract]
Djeriri, K., Laurichesse, H., Merle, J. L., Charof, R., Abouyoub, A., Fontana, L., Benchemsi, N., Elharti, E., El Aouad, R., Chamoux, A., Beytout, J.
(2008). Hepatitis B in Moroccan health care workers. Occup Med (Lond)
58: 419-424
[Abstract][Full Text]
Mikaeloff, Y., Caridade, G., Rossier, M., Suissa, S., Tardieu, M.
(2007). Hepatitis B Vaccination and the Risk of Childhood-Onset Multiple Sclerosis. Arch Pediatr Adolesc Med
161: 1176-1182
[Abstract][Full Text]
Mikaeloff, Y., Caridade, G., Assi, S., Tardieu, M., Suissa, S., on behalf of the KIDSEP study group of the French,
(2007). Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination. Brain
130: 1105-1110
[Abstract][Full Text]
Poland, G. A., Jacobson, R. M.
(2004). Prevention of Hepatitis B with the Hepatitis B Vaccine. NEJM
351: 2832-2838
[Full Text]
Naismith, R. T., Cross, A. H.
(2004). Does the hepatitis B vaccine cause multiple sclerosis?. Neurology
63: 772-773
[Full Text]
Hernan, M. A., Jick, S. S., Olek, M. J., Jick, H.
(2004). Recombinant hepatitis B vaccine and the risk of multiple sclerosis: A prospective study. Neurology
63: 838-842
[Abstract][Full Text]
Karayiannis, P., Main, J., Thomas, H. C.
(2004). Hepatitis vaccines. Br Med Bull
70: 29-49
[Full Text]
Bale, J. F. JR
(2004). Topical Review: Neurologic Complications of Immunization. J Child Neurol
19: 405-412
[Abstract]
Riise, T.
(2003). Can we contract multiple sclerosis from our working environment?. Mult Scler
9: 217-218
Stenager, E., Bronnum-Hansen, H., Koch-Henriksen, N.
(2003). The risk of multiple sclerosis in nurses: a population-based epidemiological study. Mult Scler
9: 299-301
[Abstract]
DeStefano, F., Verstraeten, T., Jackson, L. A., Okoro, C. A., Benson, P., Black, S. B., Shinefield, H. R., Mullooly, J. P., Likosky, W., Chen, R. T.
(2003). Vaccinations and Risk of Central Nervous System Demyelinating Diseases in Adults. Arch Neurol
60: 504-509
[Abstract][Full Text]
Offit, P. A., Hackett, C. J.
(2003). Addressing Parents' Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases?. Pediatrics
111: 653-659
[Abstract][Full Text]
Lorber, B.
(2002). Update in Infectious Diseases. ANN INTERN MED
137: 974-980
[Full Text]
Havinga, W., Offit, P. A., Gerber, M. A., Hackett, C., Marcuse, E., Gellin, B.
(2002). Too Many Vaccinations?. Pediatrics
110: 648-649
[Full Text]
Belloni, C., Avanzini, M. A., De Silvestri, A., Martinetti, M., Pasi, A., Coslovich, E., Autelli, M., Masanti, M. L., Cuccia, M., Tinelli, C., Rondini, G., Lorini, R.
(2002). No Evidence of Autoimmunity in 6-Year-Old Children Immunized at Birth With Recombinant Hepatitis B Vaccine. Pediatrics
110: e4-4
[Abstract][Full Text]
Sibilia, J, Maillefert, J F
(2002). Vaccination and rheumatoid arthritis. Ann Rheum Dis
61: 575-576
[Full Text]
Abramson, J. S., Pickering, L. K.
(2002). US Immunization Policy. JAMA
287: 505-509
[Full Text]
Ascherio, A., Munger, K. L., Lennette, E. T., Spiegelman, D., Hernan, M. A., Olek, M. J., Hankinson, S. E., Hunter, D. J.
(2001). Epstein-Barr Virus Antibodies and Risk of Multiple Sclerosis: A Prospective Study. JAMA
286: 3083-3088
[Abstract][Full Text]
Millichap, J. G., Rathore, M. H.
(2001). Increased Risk of Seizures Following DTP and MMR Vaccine Is Not Associated with Any Long-Term Adverse Consequences. AAP Grand Rounds
6: 54-55
[Full Text]
Dennehy, P. H.
(2001). Active Immunization in the United States: Developments over the Past Decade. Clin. Microbiol. Rev.
14: 872-908
[Abstract][Full Text]
Begaud, B., Alperovitch, A., Hanslik, T., Viboud, C., Flahault, A., Gout, O., Sturkenboom, M. C.J.M., Fourrier, A., Buttinelli, C., Salvetti, M., Ristori, G., Hostetler, L., Ascherio, A., Zhang, S. M., Walker, A. M., Confavreux, C., Suissa, S., Saddier, P.
(2001). Vaccinations and Multiple Sclerosis. NEJM
344: 1793-1796
[Full Text]
Hartung, H.-P.
(2001). ADEM: Distinct disease or part of the MS spectrum?. Neurology
56: 1257-1260
[Full Text]
Rathore, M. H.
(2001). Guillain-Barre Syndrome Not Related to MMR. AAP Grand Rounds
5: 46-47
[Full Text]
(2001). No Significant Risk to Vaccination in MS. JWatch Neurology
2001: 1-1
[Full Text]
(2001). From Rumor to Reality: Vaccinations Not Associated with MS Onset or Relapse. JWatch Infect. Diseases
2001: 1-1
[Full Text]
(2001). No Link Between Vaccination and Multiple Sclerosis. JWatch General
2001: 1-1
[Full Text]
Gellin, B. G., Schaffner, W.
(2001). The Risk of Vaccination -- The Importance of "Negative" Studies. NEJM
344: 372-373
[Full Text]
DeStefano, F., Verstraeten, T., Newman, J.P., Noseworthy, J. H., Poland, G. A.
(2001). Multiple Sclerosis. NEJM
344: 381-382
[Full Text]
Previous
