title: Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study.
abstract: OBJECTIVE
  To explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect.
  
  
  METHODS
  Cross sectional study of Gulf war veterans followed for six to eight years after deployment.
  
  
  METHODS
  UK armed forces.
  
  
  METHODS
  Military personnel who served in the Gulf and who still had their vaccine records.
  
  
  METHODS
  Multisymptom illness as classified by the Centers for Disease Control and Prevention; fatigue; psychological distress; post-traumatic stress reaction; health perception; and physical functioning.
  
  
  RESULTS
  The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).
  
  
  CONCLUSIONS
  Among veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the "stress" of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.
authors.affiliation: Gulf War Research Unit, Guy's, King's College, and St Thomas's School of Medicine, King's College London, London SE5 8AZ. m.hotopf@iop.kcl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Hotopf
authors.forename: A
authors.initials: A
authors.lastname: David
authors.forename: L
authors.initials: L
authors.lastname: Hull
authors.forename: K
authors.initials: K
authors.lastname: Ismail
authors.forename: C
authors.initials: C
authors.lastname: Unwin
authors.forename: S
authors.initials: S
authors.lastname: Wessely
mesh_terms: D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration; D016017:Odds Ratio; D018923:Persian Gulf Syndrome / Q000209:etiology*; D010575:Pesticides / Q000009:adverse effects; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D013997:Time Factors; D006113:United Kingdom; D014611:Vaccination / Q000009:adverse effects*; D014612:Vaccines / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D010575:Pesticides; D014612:Vaccines