Brain Advance Access originally published online on February 1, 2007
Brain 2007 130(4):1105-1110; doi:10.1093/brain/awl368
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Hepatitis B vaccine and risk of relapse after a first childhood episode of CNS inflammatory demyelination
1Assistance publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Bicêtre, INSERM U802, Université Paris Sud 11, Le Kremlin Bicêtre, France and 2Division of Clinical Epidemiology, McGill University and Royal Victoria Hospital, Montreal, Canada
Correspondence to: Yann Mikaeloff, MD, PhD, Service de Neurologie Pédiatrique, CHU Bicêtre, Assistance publique-Hôpitaux de Paris, 78 avenue du Général Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France E-mail: yann.mikaeloff{at}bct.aphp.fr
Public concern about possible increases in the risk of multiple sclerosis associated with hepatitis B vaccination has led to low vaccination coverage. We investigated whether this vaccination after a first episode of acute CNS inflammatory demyelination in childhood increased the risk of conversion to multiple sclerosis. We studied the French Kid Sclérose en Plaques (KIDSEP) neuropaediatric cohort of patients enrolled between 1994 and 2003 from their first episode of acute CNS inflammatory demyelination (inclusion in the cohort) until the occurrence of a second episode, up to 2005. A Cox proportional hazards model of time-dependent vaccine exposure was used to evaluate the effect of vaccination (hepatitis B, tetanus) during follow-up on the risk of second episode occurrence (conversion to multiple sclerosis). The cohort included 356 subjects with a mean follow-up of 5.8 years (SD 2.7). Relapse occurred in 146 (41%) subjects during follow-up; 33 subjects were exposed to hepatitis B vaccine and 28 to tetanus vaccine at some time during follow-up. The adjusted hazard ratio (HR) for relapse occurring within 3 years of hepatitis B vaccination was 0.78 (0.32–1.89) and during any time period was 1.09 (0.53–2.24). The adjusted HR for relapse occurring within 3 years of tetanus vaccination was 0.99 (0.58–1.67) and during any time period was 1.08 (0.63–1.83). We conclude that vaccination against hepatitis B or tetanus after a first episode of CNS inflammatory demyelination in childhood does not appear to increase the risk of conversion to multiple sclerosis, although the possibility of a small increase in risk cannot be excluded.
Key Words: child; epidemiology; hepatitis B vaccine; immune-mediated demyelination; multiple sclerosis
Abbreviations: HB, hepatitis B; MS, multiple sclerosis
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Received September 26, 2006. Revised November 6, 2006. Accepted December 5, 2006.
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