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A Case-Control Study From the Vaccine Safety Datalink Project

Robert L. Davis, MD, MPH; Piotr Kramarz, MD; Kari Bohlke, ScD; Patti Benson, MPH; Robert S. Thompson, MD; John Mullooly, PhD; Steve Black, MD; Henry Shinefield, MD; Edwin Lewis, MPH; Joel Ward, MD; S. Michael Marcy, MD; Eileen Eriksen, MPH; Frank Destefano, MD, MPH; Robert Chen, MD; for the Vaccine Safety Datalink Team

Arch Pediatr Adolesc Med. 2001;155:354-359.

Context  A link between measles virus–containing vaccines and inflammatory bowel disease (IBD) has been suggested by recent studies.

Objective  To address whether receipt or timing of measles-containing vaccine (MCV) increases risk for IBD.

Design  A case-control study.

Setting  Four large health maintenance organizations (HMOs) that are part of the Centers for Disease Control and Prevention's Vaccine Safety Datalink project.

Patients or Other Participants  A total of 155 persons with codes from International Classification of Diseases, Ninth Revision specific for IBD, born between 1958 and 1989 and enrolled from birth to the onset of disease, were identified. Up to 5 controls were matched by sex, HMO, and birth year.

Intervention  None.

Main Outcome Measures  Risk for IBD, Crohn's disease, and ulcerative colitis.

Results  Past vaccination was not associated with an increased risk for Crohn's disease (odds ratio [OR] for measles-mumps-rubella vaccine [MMR], 0.4; 95% confidence interval [CI], 0.08-2.0), ulcerative colitis (OR, 0.8; 95% CI, 0.18-3.56), or IBD (OR, 0.59; 95% CI, 0.21-1.68). Risk for IBD was not increased among children vaccinated who were younger than 12 months (OR for MMR, 0.61; 95% CI, 0.15-2.45) or aged 12 to 18 months (OR, 0.86; 95% CI, 0.28-2.59) relative to unvaccinated children. Children vaccinated with MMR who were older than 18 months were at significantly decreased risk for IBD (OR, 0.16; 95% CI, 0.04-0.68). Neither past vaccination nor age at vaccination with other MCV was associated with increased risk for Crohn's disease, ulcerative colitis, or IBD. Risk for Crohn's disease, ulcerative colitis, or IBD was not elevated in the time immediately following vaccination with either vaccine.

Conclusions  Vaccination with MMR or other MCV, or the timing of vaccination early in life, did not increase the risk for IBD.

From the Departments of Pediatrics (Dr Davis), University of Washington School of Medicine, and Epidemiology (Dr Davis), University of Washington School of Public Health, Seattle, and the Center for Health Studies (Drs Davis, Bohlke, and Thompson and Ms Benson), Group Health Cooperative, Seattle; the Vaccine Safety and Development Branch (Drs Kramarz, Destefano, and Chen), National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Ga; the Center for Health Research (Dr Mullooly), Northwest Kaiser Permanente, Portland, Ore; the Division of Research (Drs Black and Shinefield and Mr Lewis), Kaiser Permanente of Northern California, Oakland; the UCLA Center for Vaccine Research (Dr Ward and Ms Eriksen), Harbor-UCLA Medical Center, Torrance; and the Kaiser-UCLA Vaccine Research Group (Dr Marcy), Southern California Kaiser Permanente, Panorama City.

Corresponding author and reprints: Robert L. Davis, MD, MPH, Immunization Studies Program, Center for Health Studies Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448.

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