Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study

doi:10.1136/bmj.320.7246.1363

BMJ 2000;320:1363-1367 ( 20 May )

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Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study

Editorial by Shaheen

Matthew Hotopf, senior lecturer, Anthony David, codirector, Lisa Hull, research worker, Khalida Ismail, lecturer, Catherine Unwin, study coordinator, Simon Wessely, codirector.

Gulf War Research Unit, Guy's, King's College, and St Thomas's School of Medicine, King's College London, London SE5 8AZ

Correspondence to: M Hotopf m.hotopf{at}iop.kcl.ac.uk

Objectives: To explore the relation between ill healthafter the Gulf war and vaccines received before or during theconflict. To test the hypothesis that such ill health is limitedto military personnel who received multiple vaccines during deploymentand that pesticide use modifies anyeffect.
Design: Cross sectional study of Gulf war veteransfollowed for six to eight years afterdeployment.
Setting: UK armedforces.
Participants: Military personnel who served in the Gulfand who still had their vaccinerecords.
Main outcome measures: Multisymptom illness as classified by theCenters for Disease Control and Prevention; fatigue; psychologicaldistress; post-traumatic stress reaction; health perception; andphysicalfunctioning.
Results: The response rate for the original surveywas 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receiptof multiple vaccines before deployment was associated with onlyone of the six health outcomes (post-traumatic stress reaction).By contrast five of the six outcomes (all but post-traumatic stressreaction) were associated with multiple vaccines received duringdeployment. The strongest association was for the multisymptomillness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).
Conclusion: Among veterans of the Gulf war there is aspecific relation between multiple vaccinations given during deploymentand later ill health. Multiple vaccinations in themselves do notseem to be harmful but combined with the "stress" of deploymentthey may be associated with adverse health outcomes. These resultsimply that every effort should be made to maintain routine vaccinesduringpeacetime.

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