{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:38:31Z","timestamp":1788219511153,"version":"build-2803163510"},"reference-count":46,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000261","name":"Multiple Sclerosis Society of Canada","doi-asserted-by":"publisher","award":["#2435"],"award-info":[{"award-number":["#2435"]}],"id":[{"id":"10.13039\/501100000261","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["#MOP\u201097777"],"award-info":[{"award-number":["#MOP\u201097777"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["#MOP\u2010142705"],"award-info":[{"award-number":["#MOP\u2010142705"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["#PJT\u2010159647"],"award-info":[{"award-number":["#PJT\u2010159647"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["#MCH\u201097593"],"award-info":[{"award-number":["#MCH\u201097593"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>The bacillus Calmette\u2013Guerin (BCG) vaccine could reduce the incidence of multiple sclerosis (MS) through immunomodulation. Previous studies, presenting some limitations, reported no association. We re\u2010examined this association in a large cohort focusing on relapsing\u2013remitting MS (RRMS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The cohort included 400,563 individuals, and was linked with the Quebec provincial BCG vaccination registry and administrative health data. Individuals were followed up from 1983 to 2014 and then within Period 1 (1983\u20131996) and Period 2 (1997\u20132014), for the occurrence of MS. Incident MS cases were defined as those with \u22653\u00a0hospital or physician claims for MS. Subjects with \u22651 drug reimbursement for MS disease\u2010modifying therapies were classified as RRMS. Cox proportional hazards regression was used to estimate hazard ratios (HRs) over the follow\u2010ups, adjusting for potential confounders. Possible effect modification due to sex was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 178,335 (46%) individuals were BCG vaccinated. There were 274 (0.06%) incident MS cases identified in 1983\u20131996, and 1433 (0.4%) in 1997\u20132014. No association was found with RRMS, either in Period 1 (adjusted HR [HR<jats:sub>adj<\/jats:sub>]\u00a0=\u00a00.96, 95% confidence interval [CI] = 0.63\u20131.45; 96 cases) or in Period 2 (HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a01.02, 95% CI = 0.85\u20131.23; 480 cases). The remaining MS cases, for whom the phenotype was unknown, were positively associated with BCG over the entire follow\u2010up (HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a01.25, 95% CI = 1.10\u20131.41; 1131 cases) and in Period 2 (HR<jats:sub>adj<\/jats:sub>\u00a0=\u00a01.33, 95% CI = 1.17\u20131.52; 953 cases). No interaction with sex was found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Findings suggest that BCG vaccination does not decrease the risk of RRMS, and that future studies should consider phenotypes of MS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15290","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T08:48:00Z","timestamp":1644914880000},"page":"1791-1804","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bacillus Calmette\u2013Guerin vaccination and multiple sclerosis: A population\u2010based birth cohort study in Quebec, Canada"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8530-2811","authenticated-orcid":false,"given":"Philippe","family":"Corsenac","sequence":"first","affiliation":[{"name":"Epidemiology and Biostatistics Unit Centre Armand\u2010Frappier Sant\u00e9 Biotechnologie Institut national de la recherche scientifique  Laval Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4196-3773","authenticated-orcid":false,"given":"Marie\u2010\u00c9lise","family":"Parent","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Unit Centre Armand\u2010Frappier Sant\u00e9 Biotechnologie Institut national de la recherche scientifique  Laval Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0213-8711","authenticated-orcid":false,"given":"Christina","family":"Wolfson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health School of Population and Global Health McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3718-1584","authenticated-orcid":false,"given":"Nathalie","family":"Arbour","sequence":"additional","affiliation":[{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al Department of Neurosciences Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-1754","authenticated-orcid":false,"given":"Pierre","family":"Duquette","sequence":"additional","affiliation":[{"name":"Centre de recherche du centre hospitalier de l'Universit\u00e9 de Montr\u00e9al Department of Neurosciences Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8314-9497","authenticated-orcid":false,"given":"Andrea","family":"Benedetti","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health School of Population and Global Health McGill University  Montreal Quebec Canada"},{"name":"Respiratory Epidemiology and Clinical Research Unit Research Institute of McGill University Health Center  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8784-1336","authenticated-orcid":false,"given":"Hugues","family":"Richard","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Unit Centre Armand\u2010Frappier Sant\u00e9 Biotechnologie Institut national de la recherche scientifique  Laval Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5508-9565","authenticated-orcid":false,"given":"Simona","family":"St\u00e4ger","sequence":"additional","affiliation":[{"name":"Centre Armand\u2010Frappier Sant\u00e9 Biotechnologie Institut national de la recherche scientifique  Laval Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5215-8086","authenticated-orcid":false,"given":"Marie\u2010Claude","family":"Rousseau","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Unit Centre Armand\u2010Frappier Sant\u00e9 Biotechnologie Institut national de la recherche scientifique  Laval Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000360528"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-012-0953-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/817238"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-020-04709-7"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2017.08.002"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13925"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0169460"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.05.009"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.01.033"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.03116"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/imr.12968"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.06.045"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.02777"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.130540"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-011-5984-2"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1981.tb00756.x"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1989.tb03841.x"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000110369"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1997.tb00075.x"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-003-0147-6"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1159\/000080094"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12759"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiu508"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.00644"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyy011"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2017.301"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006395"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181cf6ec0"},{"key":"e_1_2_10_30_1","unstructured":"Namaka M Ethans K Esfahani F. CPS Therapeutic Choices Multiple Sclerosis. Therapeutics [Internet]. Ottawa (ON): Canadian Pharmacist Association; c2019 [cited 2019 03 06]. Available from:https:\/\/www.myrxtx.ca\/print\/new\/documents\/CHAPTER\/fr\/multiple_sclerosis. Also available in paper copy from the publisher."},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-14-2"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.06.064"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/JLB.5MA0118-027R"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000135174.63482.43"},{"key":"e_1_2_10_35_1","volume-title":"Causal Inference: What If","author":"Hern\u00e1n MA","year":"2020"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007043"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.53.7.1588"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coi.2018.09.016"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000438216.93319.ab"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd3030"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00298"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.celrep.2016.11.011"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2017.12.010"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2019.04.020"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102016"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01882-2"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.15290","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ene.15290","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.15290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T10:13:11Z","timestamp":1692871991000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.15290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":46,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1111\/ene.15290"],"URL":"https:\/\/doi.org\/10.1111\/ene.15290","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]},"assertion":[{"value":"2021-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}