Early infectious exposures are not associated with increased risk of pediatric-onset multiple sclerosis

Leena Suleiman; Emmanuelle Waubant; Gregory Aaen; Anita Belman; Leslie Benson; Meghan Candee; Tanuja Chitnis; Mark Gorman; Manu Goyal; Benjamin Greenberg; Yolanda Harris; Janace Hart; Ilana Kahn; Lauren Krupp; Timothy Lotze; Soe Mar; Manikum Moodley; Jayne Ness; Bardia Nourbakhsh; Mary Rensel; Moses Rodriguez; John Rose; Jennifer Rubin; Teri Schreiner; Jan-Mendelt Tillema; Amy Waldman; Bianca Weinstock-Guttman; T Charles Casper; Michael Waltz; Jennifer S Graves; Network of Pediatric Multiple Sclerosis Centers.

doi:10.1016/j.msard.2018.03.015

Early infectious exposures are not associated with increased risk of pediatric-onset multiple sclerosis

Mult Scler Relat Disord. 2018 May:22:103-107. doi: 10.1016/j.msard.2018.03.015. Epub 2018 Mar 26.

Authors

Leena Suleiman¹, Emmanuelle Waubant², Gregory Aaen³, Anita Belman⁴, Leslie Benson⁵, Meghan Candee⁶, Tanuja Chitnis⁷, Mark Gorman⁵, Manu Goyal⁸, Benjamin Greenberg⁹, Yolanda Harris¹⁰, Janace Hart², Ilana Kahn¹¹, Lauren Krupp¹², Timothy Lotze¹³, Soe Mar⁸, Manikum Moodley¹⁴, Jayne Ness¹⁰, Bardia Nourbakhsh¹⁵, Mary Rensel¹⁴, Moses Rodriguez¹⁶, John Rose¹⁷, Jennifer Rubin¹⁸, Teri Schreiner¹⁹, Jan-Mendelt Tillema¹⁶, Amy Waldman²⁰, Bianca Weinstock-Guttman²¹, T Charles Casper²², Michael Waltz²², Jennifer S Graves²; Network of Pediatric Multiple Sclerosis Centers.

Affiliations

¹ Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA. Electronic address: leena.suleiman@ucsf.edu.
² Pediatric Multiple Sclerosis Center, University of California San Francisco, San Francisco, CA, USA.
³ Pediatric Multiple Sclerosis Center, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
⁴ Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University Hospital, Stony Brook, New York, NY, USA.
⁵ Pediatric Multiple Sclerosis and Related Disorders Program, Boston Children's Hospital, Boston, MA, USA.
⁶ Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
⁷ Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, MA, USA.
⁸ University Pediatric Multiple Sclerosis and other Demyelinating Disease Center, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
⁹ University of Texas Southwestern, Dallas, TX, USA.
¹⁰ Center for Pediatric-Onset Demyelinating Disease, Children's Hospital of Alabama, University of Alabama, Birmingham, AL, USA.
¹¹ Children's National Medical Center, Washington, DC, USA.
¹² Pediatric Multiple Sclerosis Center, New York University, New York, NY, USA.
¹³ The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
¹⁵ Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
¹⁶ Mayo Clinic Pediatric Multiple Sclerosis Center, Mayo Clinic, Rochester, MN, USA.
¹⁷ Department of Neurology, University of Utah, Salt Lake City, UT, USA.
¹⁸ Lurie Children's Hospital of Chicago, Chicago, IL, USA.
¹⁹ Rocky Mountain Multiple Sclerosis Center, Children's Hospital Colorado, University of Colorado at Denver, Aurora, CO, USA.
²⁰ Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²¹ Pediatric Multiple Sclerosis Center, Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, USA.
²² Data Coordinating and Analysis Center, University of Utah, Salt Lake City, Utah, USA.

Abstract

Objective: We sought to determine if early infectious exposures such as daycare, early use of antibiotics, vaccinations and other germ exposures including pacifier use and playing on grass are associated with multiple sclerosis (MS) risk in children.

Methods: This was a case-control study of children with MS or clinically isolated syndrome (CIS) and healthy controls enrolled at sixteen clinics participating in the US Network of Pediatric MS Centers. Parents completed a comprehensive environmental questionnaire that captured early infectious exposures, habits, and illnesses in the first five years of life. A panel of at least two pediatric MS specialists confirmed diagnosis of participants. Association of early infectious variables with diagnosis was assessed via multivariable logistic regression analyses, adjusting for age, sex, race, ethnicity, US birth region, and socioeconomic status (SES).

Results: Questionnaire responses for 326 eligible cases (mean age 14.9, 63.5% girls) and 506 healthy pediatric subjects (mean age 14.4, 56.9% girls) were included in analyses. History of flu with high fever before age five (p = 0.01), playing outside in grass and use of special products to treat head lice or scabies (p = 0.04) were associated with increased risk of MS in unadjusted analyses. In the multivariable model adjusted for age, sex, race, ethnicity, and mother's highest educational attainment, these results were not statistically significant. Notably, antibiotic use (p = 0.22) and regular daycare attendance before age 6 (p = 0.09) were not associated with odds of developing MS.

Conclusion: Early infectious factors investigated in this study were not associated with MS risk.

Keywords: Childhood infection; Epidemiology; Multiple sclerosis; Neonatal exposure.

Publication types

Multicenter Study

MeSH terms

Adolescent
Age of Onset
Case-Control Studies
Communicable Diseases / epidemiology*
Environmental Exposure*
Female
Humans
Logistic Models
Male
Multiple Sclerosis / epidemiology*
Multivariate Analysis
Risk Factors
United States

Abstract

Publication types

MeSH terms

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