title: Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study.
abstract: U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA). Few cases of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been reported in persons who received AVA. Using a matched case-control study design, we assessed the relationship of RA and SLE with AVA vaccination using the Defense Medical Surveillance System. We identified potential cases using International Classification of Diseases, 9th Revision, Clinical Modification codes and confirmed cases with medical record review and rheumatologist adjudication. Using conditional logistic regression, we estimated odds ratios (OR) for AVA exposure during time intervals ranging from 90 to 1,095 days before disease onset. Among 77 RA cases, 13 (17%) had ever received AVA. RA cases were no more likely than controls to have received AVA when looking back 1,095 days (OR: 1.03; 95% confidence interval [CI]: 0.48-2.19) but had greater odds of exposure in the prior 90 days (OR: 3.93; 95% CI: 1.08-14.27). Among the 39 SLE cases, 5 (13%) had ever received AVA; no significant difference in receipt of AVA was found when compared with controls (OR: 0.91; 95% CI: 0.26-3.25). AVA was associated with recent onset RA, but did not increase the risk of developing RA in the long term.
authors.affiliation: Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Bardenheier
authors.affiliation: Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Duffy
authors.affiliation: Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Duderstadt
authors.affiliation: Rheumatology Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234.
authors.forename: Jay B
authors.initials: JB
authors.lastname: Higgs
authors.affiliation: Rheumatology Service, Walter Reed National Military Medical Center, 4954 N. Palmer Road, Bethesda, MD 20889-5600.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Keith
authors.affiliation: MultiCare Rheumatology Specialists, 1901 S Union Avenue, Suite A221, Tacoma, WA 98405.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Papadopoulos
authors.affiliation: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room A 1005, Bethesda, MD 20814.
authors.forename: William R
authors.initials: WR
authors.lastname: Gilliland
authors.affiliation: Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333.
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNeil
mesh_terms: D000293:Adolescent; D000328:Adult; D000881:Anthrax / Q000517:prevention & control; D022122:Anthrax Vaccines / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*
chemical_list: D022122:Anthrax Vaccines