Early vaccinations are not risk factors for celiac disease.
OBJECTIVE
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.
Department of Public Health and Clinical Medicine, Epidemiology, and Global Health, Umeå University, SE-901 87 Umeå, Sweden. anna.myleus@epiph.umu.se
Anna
A
Myléus
Hans
H
Stenlund
Olle
O
Hernell
Leif
L
Gothefors
Marie-Louise
ML
Hammarström
Lars-Åke
LÅ
Persson
Anneli
A
Ivarsson
D000293:Adolescent; D001500:BCG Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D002446:Celiac Disease / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000008:administration & dosage / Q000009:adverse effects; D058872:Epidemics; D005260:Female; D019741:Haemophilus influenzae type b / Q000276:immunology; D006801:Humans; D007115:Immunization Schedule; D015994:Incidence; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D032541:Mass Vaccination / Q000009:adverse effects*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D015999:Multivariate Analysis; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
D001500:BCG Vaccine; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D007252:Influenza Vaccines; D022542:Measles-Mumps-Rubella Vaccine; D011054:Poliovirus Vaccine, Inactivated