Intended for healthcare professionals

Rapid response to:


Veterans of the first Gulf war are developing amyotrophic lateral sclerosis

BMJ 2003; 327 doi: (Published 02 October 2003) Cite this as: BMJ 2003;327:766

Rapid Response:

Gulf war and amyotrophic lateral sclerosis

Veterans of the first Gulf war are developing amyotrophic lateral
sclerosis (BMJ 2003; 327: 766) and the US secretary of veterans affairs
has apparently been the first to connect this specific illness with
service during this war (BMJ 2002: 324: 65). To the best of my knowledge,
multiple vaccinations have been the only risk factor clearly related to
ill health in veterans of the Gulf war [1].

In this context, it may be of great significance that, following the mass
campaign of vaccination against hepatitis B, the causal role of this
vaccine has been evoked by the French regulatory authority. The series of
cases of amyotrophic lateral sclerosis collected by the AFSSAPS (and
summarised in its internet site on May 2002) showed a balanced sex ratio
as well as an age range (15-50 years) far youngest than expected: as
frequently seen with drug toxicity, such atypical features as compared to
the natural disease (male predominance, mean age higher than 55 years)
suggest an exogen cause, and this all the more than, for atypical they
are, these demographical characteristics are perfectly consistent with a
shift towards those of the vaccinated population. An additional atypical
feature could be a greater severity of the disease, with a dramatically
shortened survival.

Having regard to the severity of amyotrophic lateral sclerosis and the the
low level of the risk of hepatitis B in our countries, it appears
necessary to undertake a case/control study in order to urgently
investigate on such a suspicion.


[1] Hotopf M, David A, Hull L, Ismail K, Unwin C, Wessely S. Role of
vaccinations as risk factors for ill health in veterans of the Gulf wars:
cross sectional study. BMJ 2000 ; 320 : 1363-7

Competing interests:
None declared

Competing interests: No competing interests

20 October 2003
Girard Marc
78000-Versailles (France)