title: Disability among US Army Veterans vaccinated against anthrax.
abstract: BACKGROUND
  To protect troops against the use of anthrax as a biological weapon, the US Department of Defense began an anthrax vaccination program in 1998. 14 years after the inception of the vaccination program, there is no evidence suggesting vaccination against anthrax carries long-term health risks for Active Duty Soldiers.
  
  
  OBJECTIVE
  To investigate the association between Anthrax Vaccine Adsorbed (AVA) received while on Active Duty and subsequent disability determined by the Veterans Benefits Administration.
  
  
  METHODS
  Case-control study nested in the cohort of all Active Duty personnel known to have separated from the US Army between December 1, 1997 and December 31, 2005. Cases were ≥10% disabled, determined either by the Army prior to separation (N=5846) or by the Veterans Benefits Administration (VBA) after separation (N=148,934). Controls (N=937,705) separated from the Army without disability, and were not receiving pensions from the VBA as of April 2007. Data were from the Total Army Injury and Health Outcomes Database and the VBA Compensation and Pension and Benefits database.
  
  
  RESULTS
  Disability status (yes/no); for primary disability, percent disabled (≥10%, 20%, >20%) and type of disability.
  
  
  RESULTS
  Vaccination against anthrax was four times more likely among disabled Veterans with hostile fire pay records (HFP, a surrogate for deployment). Vaccinated Soldiers with HFP had lower odds of disability separation from the Army 0.89 (0.80, 0.98); there was no association between vaccine and receiving Army disability benefits among those without HFP (OR=1.05, CI: 0.96, 1.14). Vaccination was negatively associated with receiving VA disability benefits for those with HFP (OR=0.66, CI: 0.65, 0.67), but there was little or no association between vaccine and receipt of VA disability benefits for those without HFP (OR=0.95, CI: 0.93, 0.97).
  
  
  CONCLUSIONS
  Risk of disability separation from the Army and receipt of disability compensation from the VA were not increased in association with prior exposure to AVA. This study provides evidence that vaccination against anthrax is not associated with long term disability.
authors.affiliation: ENVIRON International Corporation, Amherst, MA 01002, United States. ssulsky@environcorp.com
authors.forename: Sandra I
authors.initials: SI
authors.lastname: Sulsky
authors.forename: Rose
authors.initials: R
authors.lastname: Luippold
authors.forename: Patrick
authors.initials: P
authors.lastname: Garman
authors.forename: Hayley
authors.initials: H
authors.lastname: Hughes
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Amoroso
mesh_terms: D000293:Adolescent; D000328:Adult; D022122:Anthrax Vaccines / Q000008:administration & dosage*; D016022:Case-Control Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D014481:United States; D014493:United States Department of Veterans Affairs; D014611:Vaccination / Q000009:adverse effects*; D014728:Veterans / Q000706:statistics & numerical data*; D014729:Veterans Disability Claims / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022122:Anthrax Vaccines