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February 1, 2001
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"Vaccination does not
appear to increase the
short-term risk of relapse
in multiple sclerosis."
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Vaccinations and the Risk of Relapse in Multiple Sclerosis
This study used patients with relapses of multiple sclerosis as their own controls to examine the risk of relapse associated with vaccination against a number of common diseases. Of 643 patients with relapses, 2.3 percent had been vaccinated during the preceding two months, which was not significantly different from the proportion who had been vaccinated during the control periods. Hence, vaccination does not appear to increase the risk of relapse.
This large study contradicts several previous reports and provides reassurance for physicians and for patients with multiple sclerosis that vaccination against such diseases as tetanus, hepatitis B, and influenza does not increase the short-term risk of relapse.
Related Editorial
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"These results indicate
no association between
hepatitis B vaccination
and the development of
multiple sclerosis."
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Hepatitis B Vaccination and Multiple Sclerosis
There has been concern that hepatitis B vaccination might lead to the development of multiple sclerosis. In this study, data on 192 women with multiple sclerosis and 645 matched controls were analyzed. There was no clear relation between exposure to hepatitis B vaccine and the subsequent development of multiple sclerosis.
This nested case-control study included a large number of women with multiple sclerosis and involved documentation by vaccination certificates. Although the results cannot eliminate the possibility of some weak association, they lend support to the current policies for hepatitis B vaccination.
Related Editorial
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Effect of Risedronate on the Risk of Hip Fracture in Elderly Women
Hip fractures are an important cause of illness and death in older persons, especially women. In this study, two groups of elderly women -- 5445 women 70 to 79 years of age with osteoporosis and 3886 women 80 years of age or older without osteoporosis but with nonskeletal risk factors -- were treated with risedronate or placebo for up to three years. In the group of women 70 to 79 years old, the incidence of hip fracture was 1.9 percent among those given risedronate, as compared with 3.2 percent among those given placebo. In the group of women 80 years old or older, the incidence of hip fracture was 4.2 percent among those given risedronate and 5.1 percent among those given placebo.
Risedronate increases bone mineral density in the spine and hip in women with osteopenia or osteoporosis. The difference in the effect of risedronate on the risk of hip fracture in the two groups of women in this study indicates that increasing bone density is not a panacea for the prevention of hip fracture and reinforces the need to pay attention to nonskeletal risk factors for hip fracture.
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Nutritional and Health Status of Tibetan Children Living at High Altitudes
Children living at high altitudes often grow poorly, but the cause may be poor nutrition and illness rather than altitude per se. In this study of 2078 Tibetan children from birth to 84 months of age who were living in geographically and demographically diverse communities in Tibet, 51 percent had moderately or severely stunted growth. Stunting was more marked among children living in nonurban areas and those with clinical conditions such as rickets, skin lesions, and abdominal distention, but it was not related to altitude.
These results suggest that poor growth in children living at high altitudes cannot be explained merely by place of residence but, rather, is related to nutrition and illness. This means that efforts to improve child health and nutrition should be effective in promoting the growth of children living in these areas.
Related Editorial
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This comprehensive review, part of the Journal's Immunology series, analyzes how allergic inflammation, an imbalance between Th1 and Th2 cells, and airway remodeling contribute to the pathogenesis of asthma.
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This review summarizes the diagnostic evaluation of patients with low back pain. It also offers guidance on the treatment of nonspecific low back pain, herniated disks, spinal stenosis, and chronic low back pain.
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From 1901 to 1903, there were nearly 1600 cases of smallpox in Boston, with 270 deaths. When a program of free, voluntary vaccination proved to be only partially successful, vaccination was required, and those who refused to be vaccinated were fined. A Supreme Court decision upheld a state's right to protect the public from a dangerous communicable disease. The authors discuss the public health, social, and ethical controversies arising from the epidemic.
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