title: Recombinant hepatitis B vaccine and the risk of multiple sclerosis: a prospective study.
abstract: BACKGROUND
  A potential link between the recombinant hepatitis B vaccine and an increased risk of multiple sclerosis (MS) has been evaluated in several studies, but some of them have substantial methodologic limitations.
  
  
  METHODS
  The authors conducted a nested case-control study within the General Practice Research Database (GPRD) in the United Kingdom. The authors identified patients who had a first MS diagnosis recorded in the GPRD between January 1993 and December 2000. Cases were patients with a diagnosis of MS confirmed through examination of medical records, and with at least 3 years of continuous recording in the GPRD before their date of first symptoms (index date). Up to 10 controls per case were randomly selected, matched on age, sex, practice, and date of joining the practice. Information on receipt of immunizations was obtained from the computer records.
  
  
  RESULTS
  The analyses include 163 cases of MS and 1,604 controls. The OR of MS for vaccination within 3 years before the index date compared to no vaccination was 3.1 (95% CI 1.5, 6.3). No increased risk of MS was associated with tetanus and influenza vaccinations.
  
  
  CONCLUSIONS
  These findings are consistent with the hypothesis that immunization with the recombinant hepatitis B vaccine is associated with an increased risk of MS, and challenge the idea that the relation between hepatitis B vaccination and risk of MS is well understood.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. miguel_hernan@post.harvard.edu
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Hernán
authors.forename: Susan S
authors.initials: SS
authors.lastname: Jick
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Olek
authors.forename: Hershel
authors.initials: H
authors.lastname: Jick
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D017325:Hepatitis B Vaccines / Q000009:adverse effects*; D006801:Humans; D007252:Influenza Vaccines; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D013745:Tetanus Toxoid; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014611:Vaccination; D014614:Vaccines, Synthetic / Q000009:adverse effects
chemical_list: D017325:Hepatitis B Vaccines; D007252:Influenza Vaccines; D013745:Tetanus Toxoid; D014614:Vaccines, Synthetic