Abstract

OBJECTIVES
To investigate if changes in the national Swedish vaccination program coincided with changes in the celiac disease (CD) incidence rate in infants (ie, the Swedish CD Epidemic), and to assess the potential association between these vaccinations and CD risk.
METHODS
All studies were based on the National Swedish Childhood Celiac Disease Register. Using an ecological approach, we plotted changes over time in the national vaccination program in the graph displaying CD incidence rate. A population-based incident case-referent study of invited infants was performed. Exposure information was received through a questionnaire and child health clinic records. Vaccines explored were diphtheria/tetanus, pertussis (acellular), polio (inactivated), Haemophilus influenzae type b (conjugated), measles/mumps/rubella, and live attenuated bacillus Calmette-Guérin (BCG) in children with increased tuberculosis risk. Findings were subjected to a birth cohort analysis.
RESULTS
Introduction of pertussis vaccine coincided in time with decreasing CD incidence rates. In the infant case-referent study, however, neither vaccination against pertussis (odds ratio 0.91; 95% confidence interval 0.60-1.4), nor against Haemophilus influenzae type b or measles/mumps/rubella was associated with CD. Coverage for the diphtheria/tetanus and polio vaccines was 99%. BCG was associated with reduced risk for CD (adjusted odds ratio 0.54; 95% confidence interval 0.31-0.94). Discontinuation of general BCG vaccination did not affect the cumulative incidence of CD at age 15 years.
CONCLUSIONS
Early vaccinations within the national Swedish program were not associated with CD risk, nor could changes in the program explain the Swedish epidemic. A protective effect by BCG was suggested, which could be subject to further studies.

Links

Publisher Full Text

Authors

Myléus A, Stenlund H, Hernell O, Gothefors L, Hammarström ML, Persson LÅ, Ivarsson A

Institution

Department of Public Health and Clinical Medicine, Epidemiology, and Global Health, Umeå University, SE-901 87 Umeå, Sweden. anna.myleus@epiph.umu.se

Source

Pediatrics 130:1 2012 Jul pg e63-70

MeSH

Adolescent
BCG Vaccine
Case-Control Studies
Celiac Disease
Child
Child, Preschool
Cohort Studies
Diphtheria-Tetanus-acellular Pertussis Vaccines
Epidemics
Female
Haemophilus influenzae type b
Humans
Immunization Schedule
Incidence
Infant
Influenza Vaccines
Logistic Models
Male
Mass Vaccination
Measles-Mumps-Rubella Vaccine
Multivariate Analysis
Poliovirus Vaccine, Inactivated
Registries
Risk Factors
Sweden

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22732174