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P584. Vaccination and risk for inflammatory bowel disease: results of a meta-analysis

Background

Environmental factors play an important role in the pathogenesis of inflammatory bowel disease (IBD). Immunization of children has been considered as one hypothesis as to why IBD emerged initially in developed countries. The aim of this study was to perform a systematic review and meta-analysis of previously published studies on association between immunization and the development of IBD.

Methods

Studies and abstracts investigating the relationship between vaccination and subsequent risk for development of IBD were reviewed. Only randomized controlled trials, cohort and case–control studies were included in the analysis. Childhood or adult immunizations with any vaccine type, at any dose, conditioning or vaccine scheduled were used as inclusion criteria. Electronic search from Pubmed and Embase databases was performed between 1979 and 2013 to identified studies fulfilling inclusion criteria.

Results

Nine studies including 1865 IBD patients were included in the meta-analysis, seven case–control studies (five population-based) and two population-based cohort studies. Studied vaccination were vaccine with Bacille Calmette-Guérin (BCG), vaccines against diphtheria, tetanus, poliomyelitis, pertussis, measles, rubella, mumps and the combined MMR vaccine. Overall, there was no significant association between childhood immunization and risk for developing IBD: BCG, RR = 1.54 (IC 95%: 0.54–4.42), diphteria, RR = 1.24 (0.80–1.94), tetanus, RR = 1.27 (0.77–2.08), pertussis, RR = 1.39 (0.68–2.84), poliomyelitis, RR = 1.79 (0.88–3.66), MMR vaccine, RR = 0.67 (0.36–1.24), measles, RR = 1.10 (0.69–1.75). There was a significant heterogeneity between studies analyzing measles [I(2) = 69%, p = 0.006] and poliomyelitis vaccines [I(2) = 67%, p = 0.049]. Specific analysis of risk for Crohn's disease (CD) or ulcerative colitis (UC) that excluded one study without distinction demonstrated a significant association between poliomyelitis vaccine and risk for developing CD (RR = 2.28; 1.12–4.63) or UC (RR = 3.48; 1.2–9.71).

Conclusion

Results of this meta-analysis show no evident association between childhood immunization and risk for developing IBD. Association between poliomyelitis vaccine and risk for CD or UC should be analyzed with caution because of studies heterogeneity.

  • Written by:

    G. Pineton de Chambrun1, L. Dauchet2, C. Gower-Rousseau2, A. Cortot1, J.-F. Colombel3, L. Peyrin-Biroulet4, 1Lille University Hospital, North of France University, Gastroenterology, Lille, France, 2Lille University Hospital, North of France University, Epidemiology, Lille, France, 3Mount Sinai Hospital, Gastroenterology, New-York, United States, 4Nancy University Hospital, Université de Lorraine, Gastroenterology and Hepatology, Vandoeuvre-les-Nancy, France