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In reply
We thank the author for his letter and are in agreement that this investigation represents just a start toward understanding whether or not anthrax vaccination is related to specific health end points. We are currently conducting other studies on this topic, which may add to this body of knowledge.1
Our decision to analyze an 18-week period following vaccination followed the guidance of epidemiologists, clinicians, and a neuro-ophthalmologist who participated in this optic neuritis study. We describe this decision as a major strength of the study2 as it decreases the likelihood that an alternate causation was introduced during the study period. Many neurological disorders do have substantial latency periods; however, a long latency period does not appear to be characteristic of potentially vaccine-mediated optic neuritis.3
We are also in agreement that there likely are genetic risk factors for vaccine adverse events; unfortunately, it was beyond the scope of this study to obtain specimens and conduct clinical tests to evaluate those risk factors. Although we accounted for adverse reactions coded from the International Classification of Diseases, Ninth Revision, Clinical Modification, and other toxic effects during the neuro-ophthalmic diagnostic review, we realize that it is possible that minor or otherwise unreported adverse events may not have been included in this review. Additionally, US military policy is to review previous adverse events as part of screening for contraindications to immunization.4 Attempts to retrospectively collect information (subsequent to the optic neuritis diagnosis) on previously unreported and/or minor adverse events may have introduced bias to the study.
Our research agenda, which was approved by a workgroup of the National Vaccine Advisory Committee, specified a focused study of whether anthrax vaccine was related to optic neuritis and did not extend to other neurological conditions. Since optic neuritis is sometimes the sentinel event in a multiple sclerosis diagnosis, we stratified our multivariate regression analyses based on previous multiple sclerosis diagnosis; no statistically significant difference was found. The vaccine safety study of demyelinating diseases by DeStefano et al5 researched these 2 conditions together as does an upcoming systematic review of vaccines and demyelinating conditions, which includes our study in the meta-analysis (Cochrane Vaccines Field, unpublished data, 2006).
As previously addressed, the distribution of our sample by sex on Table 1 reflects a typographical error, not the actual sample we analyzed. Sex was one of our matching criteria, and the proportion of men should be 69.3% for both controls (n = 2351) and cases (n = 784).
Correspondence: Dr Payne, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop A-47, Atlanta, GA 30333 (dvp6@cdc.gov).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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