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Tetanus vaccination and risk of multiple sclerosis

A systematic review

From the Department of Epidemiology, Harvard School of Public Health, Boston, MA.

Address correspondence and reprint requests to Dr. Miguel A. Hernán, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115; e-mail: miguel_hernan{at}post.harvard.edu

Objective: To conduct a systematic review on the association between tetanus vaccination and the risk of multiple sclerosis (MS).

Methods: The authors searched the databases Medline, LILACS, EMBASE, and Science Citation Index including the period 1966 to September 1, 2005. Eligible studies had to meet the following inclusion criteria: presentation of original data, case-control or cohort design, physician-confirmed diagnosis of MS as the outcome of interest, attempt to ascertain vaccinations in a period before the diagnosis, and report of an association measure between tetanus vaccination and incidence of MS, and its 95% CI or enough information to compute it. Study specific log ORs were weighted by the inverse of their variances to obtain a pooled estimate and its 95% CI.

Results: The OR of MS associated with history of tetanus vaccination was 0.67 (95% CI: 0.55 to 0.81). There was little indication of heterogeneity of results across studies.

Conclusion: Tetanus vaccination is associated with a lower risk of multiple sclerosis.

Supported in part by a Fulbright fellowship and a grant from the MMA Foundation for Medical Research (Madrid, Spain) (A.A.).

Disclosure: The authors report no conflicts of interest.

Received December 13, 2005. Accepted in final form March 29, 2006.