Season of infectious mononucleosis as a risk factor for multiple sclerosis: a UK primary care case-control study

Christina Downham; Elizabeth Visser; Mark Vickers; Carl Counsell

doi:10.1016/j.msard.2017.07.009

Season of infectious mononucleosis as a risk factor for multiple sclerosis: a UK primary care case-control study

Christina Downham, Elizabeth Visser, Mark Vickers, Carl Counsell

Aberdeen Royal Infirmary

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS).

Objective: We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months.

Methods: We identified all patients with MS diagnosed aged 16 to 60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure.

Results: Based on 9,247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66).

Conclusion: We found no evidence that the season of IM influences the risk of subsequent MS.

Original language	English
Pages (from-to)	103-106
Number of pages	4
Journal	Multiple Sclerosis and Related Disorders
Volume	17
Early online date	8 Jul 2017
DOIs	https://doi.org/10.1016/j.msard.2017.07.009
Publication status	Published - Oct 2017

Bibliographical note

This study is based in part on data from the Full Feature General Practice Research Database obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone.

Access to the GPRD database was funded through the Medical Research Council’s licence agreement with MHRA.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

We acknowledge the data management support of the Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland through NHS Grampian investment in the Grampian DaSH.

Keywords

multiple sclerosis
infectious mononucleosis
seasons
risk factors

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Accepted Manuscript
© 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Accepted author manuscript, 61.4 KBLicence: CC BY-NC-ND
im_in_ms_flow_chartAccepted author manuscript, 77.5 KBLicence: CC BY-NC-ND
Supplemental TablesAccepted author manuscript, 15 KBLicence: CC BY-NC-ND

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Cite this

@article{52729dea70b145f5b9049a02f657f069,

title = "Season of infectious mononucleosis as a risk factor for multiple sclerosis: a UK primary care case-control study",

abstract = "Background: Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). Objective: We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. Methods: We identified all patients with MS diagnosed aged 16 to 60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Results: Based on 9,247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). Conclusion: We found no evidence that the season of IM influences the risk of subsequent MS. ",

keywords = "multiple sclerosis, infectious mononucleosis, seasons, risk factors",

author = "Christina Downham and Elizabeth Visser and Mark Vickers and Carl Counsell",

note = "This study is based in part on data from the Full Feature General Practice Research Database obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone. Access to the GPRD database was funded through the Medical Research Council{\textquoteright}s licence agreement with MHRA. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We acknowledge the data management support of the Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland through NHS Grampian investment in the Grampian DaSH. ",

year = "2017",

month = oct,

doi = "10.1016/j.msard.2017.07.009",

language = "English",

volume = "17",

pages = "103--106",

journal = "Multiple Sclerosis and Related Disorders",

issn = "2211-0348",

publisher = "Elsevier",

}

TY - JOUR

T1 - Season of infectious mononucleosis as a risk factor for multiple sclerosis

T2 - a UK primary care case-control study

AU - Downham, Christina

AU - Visser, Elizabeth

AU - Vickers, Mark

AU - Counsell, Carl

N1 - This study is based in part on data from the Full Feature General Practice Research Database obtained under licence from the UK Medicines and Healthcare Products Regulatory Agency. However, the interpretation and conclusions contained in this study are those of the authors alone. Access to the GPRD database was funded through the Medical Research Council’s licence agreement with MHRA. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. We acknowledge the data management support of the Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland through NHS Grampian investment in the Grampian DaSH.

PY - 2017/10

Y1 - 2017/10

N2 - Background: Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). Objective: We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. Methods: We identified all patients with MS diagnosed aged 16 to 60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Results: Based on 9,247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). Conclusion: We found no evidence that the season of IM influences the risk of subsequent MS.

AB - Background: Infectious mononucleosis (IM) and vitamin D deficiency are both risk factors for multiple sclerosis (MS). Objective: We wished to establish if IM in the winter months when vitamin D levels are low may be a greater risk factor for MS than IM in the summer months. Methods: We identified all patients with MS diagnosed aged 16 to 60 in a large primary care database in the United Kingdom and matched each by age, sex, general practice and observation period with up to six controls. We identified a coded diagnosis of IM prior to the index date (date of diagnosis). Logistic regression was used to calculate the odds ratio for prior IM exposure in cases versus controls and for winter versus summer exposure in cases and controls with prior IM exposure. Results: Based on 9,247 cases and 55,033 matched controls (246 and 846 with prior IM respectively), IM was associated with the development of MS (OR 1.77, 95%CI 1.53-2.05) but there was no evidence that IM in the winter as opposed to summer was associated with developing MS (OR 1.09, 95%CI 0.72-1.66). Conclusion: We found no evidence that the season of IM influences the risk of subsequent MS.

KW - multiple sclerosis

KW - infectious mononucleosis

KW - seasons

KW - risk factors

U2 - 10.1016/j.msard.2017.07.009

DO - 10.1016/j.msard.2017.07.009

M3 - Article

SN - 2211-0348

VL - 17

SP - 103

EP - 106

JO - Multiple Sclerosis and Related Disorders

JF - Multiple Sclerosis and Related Disorders

ER -

Season of infectious mononucleosis as a risk factor for multiple sclerosis: a UK primary care case-control study

Abstract

Bibliographical note

Keywords

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