Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years

Andreas Rieckmann*, Kathrine Damm Meyle, Naja Hulvej Rod, Jennifer Lyn Baker, Christine Stabell Benn, Peter Aaby, Signe Sørup

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background: Early smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. Methods: We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965–1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. Results: The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91%) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95% confidence interval (CI) 0.72–2.31). For smallpox vaccination only, HR = 1.23 (95% CI 0.53–2.86) for BCG vaccination only, HR = 1.13 (95% CI 0.61–2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95% CI 0.87–3.48) compared with none of these. Vaccination below the age of one year gave similar results. Conclusions: We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.

OriginalsprogEngelsk
TidsskriftVaccine
Vol/bind37
Udgave nummer44
Sider (fra-til)6730-6736
ISSN0264-410X
DOI
StatusUdgivet - 16. okt. 2019

Fingeraftryk

Smallpox
melanoma
childhood
vaccination
confidence interval
Confidence Intervals
Cutaneous Malignant Melanoma
School Health Services
Skin Neoplasms
Denmark
cohort studies
young adults
Population
Young Adult
Cohort Studies

Citer dette

Rieckmann, Andreas ; Meyle, Kathrine Damm ; Rod, Naja Hulvej ; Baker, Jennifer Lyn ; Benn, Christine Stabell ; Aaby, Peter ; Sørup, Signe. / Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years. I: Vaccine. 2019 ; Bind 37, Nr. 44. s. 6730-6736.
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title = "Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years",
abstract = "Background: Early smallpox and Bacillus Calmette-Gu{\'e}rin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. Methods: We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965–1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. Results: The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91{\%}) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95{\%} confidence interval (CI) 0.72–2.31). For smallpox vaccination only, HR = 1.23 (95{\%} CI 0.53–2.86) for BCG vaccination only, HR = 1.13 (95{\%} CI 0.61–2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95{\%} CI 0.87–3.48) compared with none of these. Vaccination below the age of one year gave similar results. Conclusions: We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.",
keywords = "Bacillus Calmette-Gu{\'e}rin vaccine, Cancer, Cutaneous malignant melanoma, Heterologous immunity, Non-specific effects of vaccines, Smallpox vaccine, Vaccinia",
author = "Andreas Rieckmann and Meyle, {Kathrine Damm} and Rod, {Naja Hulvej} and Baker, {Jennifer Lyn} and Benn, {Christine Stabell} and Peter Aaby and Signe S{\o}rup",
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doi = "10.1016/j.vaccine.2019.09.023",
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pages = "6730--6736",
journal = "Vaccine",
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Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years. / Rieckmann, Andreas; Meyle, Kathrine Damm; Rod, Naja Hulvej; Baker, Jennifer Lyn; Benn, Christine Stabell; Aaby, Peter; Sørup, Signe.

I: Vaccine, Bind 37, Nr. 44, 16.10.2019, s. 6730-6736.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Smallpox and BCG vaccination in childhood and cutaneous malignant melanoma in Danish adults followed from 18 to 49 years

AU - Rieckmann, Andreas

AU - Meyle, Kathrine Damm

AU - Rod, Naja Hulvej

AU - Baker, Jennifer Lyn

AU - Benn, Christine Stabell

AU - Aaby, Peter

AU - Sørup, Signe

PY - 2019/10/16

Y1 - 2019/10/16

N2 - Background: Early smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. Methods: We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965–1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. Results: The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91%) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95% confidence interval (CI) 0.72–2.31). For smallpox vaccination only, HR = 1.23 (95% CI 0.53–2.86) for BCG vaccination only, HR = 1.13 (95% CI 0.61–2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95% CI 0.87–3.48) compared with none of these. Vaccination below the age of one year gave similar results. Conclusions: We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.

AB - Background: Early smallpox and Bacillus Calmette-Guérin (BCG) vaccinations have been associated with reduced risk of cutaneous malignant melanoma (CMM). We assessed the association between pre-school smallpox vaccination and early-school BCG vaccination and CMM in a young Danish population. Methods: We conducted a register-based case-cohort study of individuals growing up during the phase-out period of smallpox and BCG vaccination in Denmark (born 1965–1976) utilising the decrease in vaccination during this period. Information on childhood vaccinations and potential confounders from Copenhagen school health records were linked with nationwide registers on cancer (CMM diagnoses), migrations and deaths by personal identification numbers. Results: The individuals were followed from age 18 until 31/12/2014 (maximum age at end of follow-up, 49 years). 188 cases of CMM occurred in the background population of 46,239 individuals; 172 CMM cases (91%) had full information and were analysed. The adjusted hazard ratio (HR) for CMM by BCG and/or smallpox vaccination compared with neither vaccine was 1.29 (95% confidence interval (CI) 0.72–2.31). For smallpox vaccination only, HR = 1.23 (95% CI 0.53–2.86) for BCG vaccination only, HR = 1.13 (95% CI 0.61–2.09) and for both smallpox and BCG vaccination, HR = 1.75 (95% CI 0.87–3.48) compared with none of these. Vaccination below the age of one year gave similar results. Conclusions: We found no strong beneficial effect of smallpox and BCG vaccination against CMM among young adult Danes and with broad confidence intervals our data alone could be compatible with both modest preventive effects, no effects, and modest harmful effects. Our estimates do not contradict a potential modest beneficial effect of neonatal vaccination.

KW - Bacillus Calmette-Guérin vaccine

KW - Cancer

KW - Cutaneous malignant melanoma

KW - Heterologous immunity

KW - Non-specific effects of vaccines

KW - Smallpox vaccine

KW - Vaccinia

U2 - 10.1016/j.vaccine.2019.09.023

DO - 10.1016/j.vaccine.2019.09.023

M3 - Journal article

C2 - 31537447

AN - SCOPUS:85072164125

VL - 37

SP - 6730

EP - 6736

JO - Vaccine

JF - Vaccine

SN - 0264-410X

IS - 44

ER -