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. 2016 Oct;181(10):1348-1356.
doi: 10.7205/MILMED-D-15-00485.

Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study

Barbara H Bardenheier  1 , Jonathan Duffy  1 , Susan K Duderstadt  1 , Jay B Higgs  2 , Michael P Keith  3 , Patricia J Papadopoulos  4 , William R Gilliland  5 , Michael M McNeil  1
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Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study

Barbara H Bardenheier et al. Mil Med. 2016 Oct.

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.

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Figures

FIGURE 1.
FIGURE 1.
RA analysis: box plot of the number of AVA doses received during each exposure interval (median, interquartile range, and range) for cases and controls. The horizontal line in the middle of the box plot is the median. The circle is the mean. The length of the box represents the interquartile range (distance between the 25th and 75th percentiles). The vertical lines (called whiskers) issuing from the box extend to the group minimum and maximum values.
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