Вакцинация и риск развития лейкоза у детей

[AlexGold]

Vaccination history and risk of childhood leukaemia

Int J Epidemiol 2005; 34(5):1100-1109

Xiaomei Ma [1]*, Monique B. Does [2], Catherine Metayer [2], Carolyn Russo [3], Alan Wong [3], and Patricia A. Buffler [2]

1 Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT 06520-8034, USA

2 School of Public Health, University of California, Berkeley, CA 94720-7360, USA

3 Kaiser Permanente Northern California Region, Pediatric Oncology, 900 Kiely Blvd, Santa Clara, CA 95051, USA

* To whom correspondence should be addressed.
Xiaomei Ma, E-mail: [Ссылки доступны только зарегистрированным пользователям ]

Background. Previous studies on vaccination and childhood leukaemia generated inconsistent results.

Methods. In the Northern California Childhood Leukaemia Study, a case-control study with incident cases and matched birth certificate controls, detailed written vaccination records were collected. A total of 323 cases aged 0-14 years at diagnosis and 409 controls were included in this analysis. All vaccinations were censored on the reference date (date of diagnosis for cases and the corresponding date for matched controls). Conditional logistic regression analysis was conducted, adjusting for potential confounding factors. A primary variable of interest is the number of administrations (doses) of various types of vaccines.

Results Vaccinations against diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, and rubella were not associated with the risk of leukaemia. The odds ratio for each dose of Haemophilus influenzae type b (Hib) vaccine was 0,81 (95% CI 0,68-0,96). Compared with children who received two or fewer doses of Hib vaccine, those who received three or more doses had a significantly reduced risk of childhood leukaemia (odds ratio = 0,55, 95% confidence interval 0,32-0,94). The number of doses of hepatitis B vaccine received was not associated with leukaemia risk.

Conclusions. Hib vaccination is associated with a reduced risk of childhood leukaemia. Future studies with detailed exposure assessment and large sample sizes are needed to further address the role of vaccinations in the etiology of childhood leukaemia.

Доброго времени суток!
Так как прививка от Haemophilus influenzae type b (Hib) в Латвии обязательна, хотелось бы узнать, есть ли еще какие-либо исследования на данную тему. СтОит ли делать детям данную прививку, или стОит отказаться? Все- таки лейкоз- не насморк и не поствакцинальное покраснение (((
Заранее спасибо за ответ!

[Dr.Vad]

Ann Epidemiol. 2000 Oct 1;10(7):474.
Haemophilus influenzae type b vaccination and risk of childhood leukemia in a vaccine trial in finland.
Groves F, Auvinen A, Hakulinen T.
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

PURPOSE: To compare the incidence of childhood leukemia among children who received multiple early vaccine doses versus a single late dose in the context of a clinical trial in Finland during 1986 and 1987.METHODS: The trial was offered to the parents of all 114,000 children born in Finland between October 1, 1985 and August 31, 1987; 98% of the eligible children were enrolled. The vaccine consisted of heat-sized capsular polysaccharide of Haemophilus influenzae type b (Hib) coupled to diptheria toxoid (PRP-D). Children with odd birth dates received four doses of the vaccine at the ages of 3, 4, 6, and 14 months; children with even birth dates received only one dose, at the age of 24 months. The numbers of boys and girls with even and odd birth dates during the window of eligibility who remained alive during the follow-up period were obtained from the Finnish Population Registry. Numbers of leukemia cases diagnosed through 1996 among children with even and odd birth dates during the window of eligibility were obtained from the Finnish Cancer Registry. Poisson regression analysis of leukaemia incidence rates was conducted using the number of cases as the outcome variable and the natural logarithm of number of children at risk as an offset term. For comparison of the early and late vaccination groups, a binary variable based on odd or even date of birth was used.RESULTS: Among the 114,000 subjects, a total of 77 cases of childhood leukaemia were diagnosed: 33 in the early-vaccination group and 44 in the late-vaccination group. The incidence of childhood leukaemia was lower in the early-vaccination group (relative risk 0.72, 95% confidence interval 0.46-1.13) than in the late-vaccination group, but the difference did not reach statistical significance.CONCLUSIONS: Our results suggest that early vaccination against Hib may reduce the incidence of childhood leukaemia, but confirmatory studies are needed.

[Dr.Vad]

...there is a suggestion that maternal infection during pregnancy may be linked with an increased risk of childhood leukaemia development. However, the results of all the studies on childhood exposure to infections (six increased, 12 decreased risks, seven no significant effect) and childhood immunizations (four protective, two increased risk, four non-significant effect) are inconclusive.

Из McNally RJ, Eden TO.
An infectious aetiology for childhood acute leukaemia: a review of the evidence.
Br J Haematol. 2004 Nov;127(3):243-63. Review.

[die_arztin]

Уважаемая barta! В приведенных ссылках написано, что вакцина против Haemophilus influenzae Типа B СНИЖАЕТ риск лейкоза

[Leylochka]

Вообще-то, прочитав данные этих исследований, нельзя сказать, что эта вакцина снижает риск развития лейкемии. Вывод только один: из всех привитых этой вакциной больше заболело тех, кого прививали один раз, а не несколько.

Вполне может быть, что эти люди вообще бы не заболели, если бы их не прививали.

Вот если бы исследовали коли-во заболевших из привитой группы и непривитой, это было бы показательнее.

Ну это, конечно, мое, чисто дилетантское мнение. А что врачи скажут?

[AlexGold]

Сообщение от Leylochka

Вот если бы исследовали коли-во заболевших из привитой группы и непривитой, это было бы показательнее.

Естественно, в исследовании присутствовали контрольные группы, которые получили 0 доз соответствующей вакцины. Другое дело, что стпень снижения риска зависела и от числа доз, поскольку получившие 3 или более доз ХИБ-вакцины имели меньший риск, по сравнению с получившими 2 или менее доз. Самое главное, что риск не увеличивается. Насколько он уменьшается, если уменьшается, - не столь важно.

[Leylochka]

А-аа, я думала, что 2 и менее не означает в том числе и 0.

[Ptaha]

извините, а я не совсем поняла. Получение доз менее 3-ех - это значит не довели вакцинацию или как? А то детям, старше 2-ух делают всего 1 прививку. Они тоже попадают в коридор повышенного риска?

[AlexGold]

Сообщение от Ptaha

извините, а я не совсем поняла. Получение доз менее 3-ех - это значит не довели вакцинацию или как?

В зависимости от возраста начала вакцинации, число рекомендованных доз вакцины против ХИБ-инфекции варьирует от 1 до 4.

Сообщение от Ptaha

Они тоже попадают в коридор повышенного риска?

Никакого повышения риска данные исследования не показали.