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Risk of Inflammatory Bowel Disease following Bacille Calmette-Guérin and Smallpox Vaccination: A Population-based Danish Case-Cohort Study.

Villumsen, Marie; Jess, Tine; Sørup, Signe; Ravn, Henrik; Sturegård, Erik LU ; Benn, Christine Stabell; Aaby, Peter and Roth, Adam LU (2013) In Inflammatory Bowel Diseases 19(8). p.1717-1724
Abstract
BACKGROUND:: Childhood immunology has been suggested to play a role in development of inflammatory bowel disease (IBD) based on the studies of childhood vaccinations, infections, and treatment with antibiotics. Bacille Calmette-Guérin (BCG) and smallpox vaccinations were gradually phased-out in Denmark for children born between 1965 and 1976, hence allowing the study of subsequent risk of Crohn's disease and ulcerative colitis in a unique prospective design. METHODS:: The Copenhagen School Health Records Register contains detailed documentation of vaccination. Among the background cohort of individuals born between 1965 and 1976 (N = 47,622), cases with Crohn's disease (n = 218) and ulcerative colitis (n = 256) were identified through... (More)
BACKGROUND:: Childhood immunology has been suggested to play a role in development of inflammatory bowel disease (IBD) based on the studies of childhood vaccinations, infections, and treatment with antibiotics. Bacille Calmette-Guérin (BCG) and smallpox vaccinations were gradually phased-out in Denmark for children born between 1965 and 1976, hence allowing the study of subsequent risk of Crohn's disease and ulcerative colitis in a unique prospective design. METHODS:: The Copenhagen School Health Records Register contains detailed documentation of vaccination. Among the background cohort of individuals born between 1965 and 1976 (N = 47,622), cases with Crohn's disease (n = 218) and ulcerative colitis (n = 256) were identified through linkage to the Danish National Patient Registry. The vaccination status of the cases was compared with that of a subcohort (n = 5741) of the background cohort and analyzed in a case-cohort design. RESULTS:: No difference in risk of IBD was observed between individuals vaccinated and unvaccinated with BCG (hazard ratio = 0.95; 95% confidence interval, 0.75-1.19) or smallpox vaccine (hazard ratio = 1.01; 95% confidence interval, 0.77-1.32). This was also the case for Crohn's disease and ulcerative colitis separately. However, BCG given before 4 months of age may decrease the risk of IBD (hazard ratio = 0.43; 95% confidence interval, 0.20-0.93). CONCLUSIONS:: This prospective long-term case-cohort study shows that BCG and smallpox vaccination do not cause IBD later in life. These findings are important for the etiological understanding of IBD and of clinical importance because BCG is still one of the most commonly used childhood vaccinations, smallpox vaccine has been reintroduced in the U.S. military, and both vaccines may be used as vectors in new vaccines. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Inflammatory Bowel Diseases
volume
19
issue
8
pages
1717 - 1724
publisher
John Wiley & Sons
external identifiers
  • wos:000329363800018
  • pmid:23624886
  • scopus:84884574921
ISSN
1536-4844
DOI
10.1097/MIB.0b013e318281f34e
language
English
LU publication?
yes
id
d8015ce9-38be-4f84-96d3-c32949674319 (old id 3733270)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23624886?dopt=Abstract
date added to LUP
2013-05-04 21:18:45
date last changed
2019-06-19 01:32:38
@article{d8015ce9-38be-4f84-96d3-c32949674319,
  abstract     = {BACKGROUND:: Childhood immunology has been suggested to play a role in development of inflammatory bowel disease (IBD) based on the studies of childhood vaccinations, infections, and treatment with antibiotics. Bacille Calmette-Guérin (BCG) and smallpox vaccinations were gradually phased-out in Denmark for children born between 1965 and 1976, hence allowing the study of subsequent risk of Crohn's disease and ulcerative colitis in a unique prospective design. METHODS:: The Copenhagen School Health Records Register contains detailed documentation of vaccination. Among the background cohort of individuals born between 1965 and 1976 (N = 47,622), cases with Crohn's disease (n = 218) and ulcerative colitis (n = 256) were identified through linkage to the Danish National Patient Registry. The vaccination status of the cases was compared with that of a subcohort (n = 5741) of the background cohort and analyzed in a case-cohort design. RESULTS:: No difference in risk of IBD was observed between individuals vaccinated and unvaccinated with BCG (hazard ratio = 0.95; 95% confidence interval, 0.75-1.19) or smallpox vaccine (hazard ratio = 1.01; 95% confidence interval, 0.77-1.32). This was also the case for Crohn's disease and ulcerative colitis separately. However, BCG given before 4 months of age may decrease the risk of IBD (hazard ratio = 0.43; 95% confidence interval, 0.20-0.93). CONCLUSIONS:: This prospective long-term case-cohort study shows that BCG and smallpox vaccination do not cause IBD later in life. These findings are important for the etiological understanding of IBD and of clinical importance because BCG is still one of the most commonly used childhood vaccinations, smallpox vaccine has been reintroduced in the U.S. military, and both vaccines may be used as vectors in new vaccines.},
  author       = {Villumsen, Marie and Jess, Tine and Sørup, Signe and Ravn, Henrik and Sturegård, Erik and Benn, Christine Stabell and Aaby, Peter and Roth, Adam},
  issn         = {1536-4844},
  language     = {eng},
  number       = {8},
  pages        = {1717--1724},
  publisher    = {John Wiley & Sons},
  series       = {Inflammatory Bowel Diseases},
  title        = {Risk of Inflammatory Bowel Disease following Bacille Calmette-Guérin and Smallpox Vaccination: A Population-based Danish Case-Cohort Study.},
  url          = {http://dx.doi.org/10.1097/MIB.0b013e318281f34e},
  volume       = {19},
  year         = {2013},
}