Highlights
- •Most childhood infections or vaccinations did not increase risk of new CNS demyelination
- •Rubella vaccination in adolescence appeared to be protective for CNS demyelination
- •Infectious mononucleosis (IM) during adolescence increased risk of new CNS demyelination
- •Adolescent tonsillectomy, adjusted for IM, increased risk of CNS demyelination
Abstract
Background
The association between childhood vaccinations and infections and risk of multiple
sclerosis is unclear; few studies have considered age at vaccination/infection.
Objective
To explore age-related associations between childhood vaccinations, infection and
tonsillectomy and risk of a first clinical diagnosis of CNS demyelination.
Methods
Data on case (n = 275, 76.6% female; mean age 38.6 years) and age- and sex-matched control (n = 529) participants in an incident population-based case-control study included self-reported
age at time of childhood vaccinations, infections, and tonsillectomy. Conditional
logistic regression models were used to calculate adjusted odds ratios (AOR) and 95%
confidence intervals (CI).
Results
Poliomyelitis vaccination prior to school-age was associated with increased risk of
a first clinical diagnosis of CNS demyelination (AOR = 2.60, 95%CI 1.02–6.68), based
on a very small unvaccinated reference group. Late (11–15 years) rubella vaccination
(compared to none) was associated with lower odds of being a case (AOR = 0.47, 95%CI
0.27–0.83). Past infectious mononucleosis at 11–15 years (AOR = 2.84, 95%CI 1.0–7.57)
and 16–20 years (AOR = 1.92, 95%CI 1.12–3.27) or tonsillectomy in adolescence (11–15
years: AOR = 2.45, 95%CI 1.12–5.35), including after adjustment for IM, were associated
with increased risk of a first clinical diagnosis of CNS demyelination.
Conclusions
Age at vaccination, infection or tonsillectomy may alter the risk of subsequent CNS
demyelination. Failing to account for age effects may explain inconsistencies in past
findings.
Keywords
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Article info
Publication history
Published online: March 17, 2020
Accepted:
March 16,
2020
Received in revised form:
March 11,
2020
Received:
February 14,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
