tetano
Editor, Senior Moderator
Scand J Gastroenterol. 2017 Oct 27:1-9. doi: 10.1080/00365521.2017.1362464. [Epub ahead of print]
[h=1]Influenza and risk of later celiac disease: a cohort study of 2.6 million people.[/h] K?rhus LL[SUP]1,[/SUP][SUP]2[/SUP], Gunnes N[SUP]1[/SUP], St?rdal K[SUP]1,[/SUP][SUP]3[/SUP], Bakken IJ[SUP]1[/SUP], Tapia G[SUP]1[/SUP], Stene LC[SUP]1[/SUP], H?berg SE[SUP]1[/SUP], M?rild K[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] Influenza has been linked to autoimmune conditions, but its relationship to subsequent celiac disease (CD) is unknown. Our primary aim was to determine the risk of CD after influenza. A secondary analysis examined the risk of CD following pandemic influenza vaccination.
[h=4]METHODS:[/h] This nationwide register-based cohort study included 2,637,746 Norwegians (born between 1967-2013) followed during 2006-2014 with information on influenza diagnosed in primary or non-primary care, pandemic vaccination (Pandemrix), and subsequent CD. Cox regression yielded hazard ratios adjusted (HR) for socio-demographic characteristics and earlier healthcare use.
[h=4]RESULTS:[/h] During 13,011,323 person-years of follow-up 7321 individuals were diagnosed with CD (56/100,000 person-years). There were 351,666 individuals diagnosed with influenza, including 82,980 during the 2009-2010 pandemic, and 969,968 individuals were vaccinated. Compared with participants without influenza, who had a CD incidence of 55/100,000 person-years, those diagnosed with seasonal and pandemic influenza had a rate of 68 and 78, per 100,000 person-years, respectively. The HR for CD was 1.29 (95%CI, 1.21-1.38) after seasonal influenza and 1.29 (95%CI, 1.15-1.44) after pandemic influenza; HRs remained significantly increased one year after exposure, when restricted to laboratory-confirmed influenza, and after multivariate adjustments. The reverse association, i.e., risk of influenza after CD, was not significant (HR 1.05; 95%CI, 0.98-1.12). The HR for CD after pandemic vaccination was 1.08 (95%CI, 1.03-1.14).
[h=4]CONCLUSION:[/h] A positive association with influenza diagnosis is consistent with the hypothesis that infections may play a role in CD development. We could neither confirm a causal association with pandemic vaccination, nor refute entirely a small excess risk.
[h=4]KEYWORDS:[/h] Celiac disease; cohort studies; influenza a virus (H1N1 subtype); mass vaccination
PMID: 29076383 DOI: 10.1080/00365521.2017.1362464
[h=1]Influenza and risk of later celiac disease: a cohort study of 2.6 million people.[/h] K?rhus LL[SUP]1,[/SUP][SUP]2[/SUP], Gunnes N[SUP]1[/SUP], St?rdal K[SUP]1,[/SUP][SUP]3[/SUP], Bakken IJ[SUP]1[/SUP], Tapia G[SUP]1[/SUP], Stene LC[SUP]1[/SUP], H?berg SE[SUP]1[/SUP], M?rild K[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] Influenza has been linked to autoimmune conditions, but its relationship to subsequent celiac disease (CD) is unknown. Our primary aim was to determine the risk of CD after influenza. A secondary analysis examined the risk of CD following pandemic influenza vaccination.
[h=4]METHODS:[/h] This nationwide register-based cohort study included 2,637,746 Norwegians (born between 1967-2013) followed during 2006-2014 with information on influenza diagnosed in primary or non-primary care, pandemic vaccination (Pandemrix), and subsequent CD. Cox regression yielded hazard ratios adjusted (HR) for socio-demographic characteristics and earlier healthcare use.
[h=4]RESULTS:[/h] During 13,011,323 person-years of follow-up 7321 individuals were diagnosed with CD (56/100,000 person-years). There were 351,666 individuals diagnosed with influenza, including 82,980 during the 2009-2010 pandemic, and 969,968 individuals were vaccinated. Compared with participants without influenza, who had a CD incidence of 55/100,000 person-years, those diagnosed with seasonal and pandemic influenza had a rate of 68 and 78, per 100,000 person-years, respectively. The HR for CD was 1.29 (95%CI, 1.21-1.38) after seasonal influenza and 1.29 (95%CI, 1.15-1.44) after pandemic influenza; HRs remained significantly increased one year after exposure, when restricted to laboratory-confirmed influenza, and after multivariate adjustments. The reverse association, i.e., risk of influenza after CD, was not significant (HR 1.05; 95%CI, 0.98-1.12). The HR for CD after pandemic vaccination was 1.08 (95%CI, 1.03-1.14).
[h=4]CONCLUSION:[/h] A positive association with influenza diagnosis is consistent with the hypothesis that infections may play a role in CD development. We could neither confirm a causal association with pandemic vaccination, nor refute entirely a small excess risk.
[h=4]KEYWORDS:[/h] Celiac disease; cohort studies; influenza a virus (H1N1 subtype); mass vaccination
PMID: 29076383 DOI: 10.1080/00365521.2017.1362464