{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:38:10Z","timestamp":1761061090586,"version":"3.37.3"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006120","name":"Ministry of the Environment","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006120","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Environ Health Prev Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Adjuvants used in inactivated vaccines often upregulate type 2 immunity, which is dominant in allergic diseases. We hypothesised that cumulative adjuvant exposure in infancy may influence the development of allergies later in life by changing the balance of type 1\/type 2 immunity. We examined the relationship between immunisation with different vaccine types and later allergic disease development.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We obtained information regarding vaccinations and allergic diseases through questionnaires that were used in The Japan Environment and Children\u2019s Study (JECS), which is a nationwide, multicentre, prospective birth cohort study that included 103,099 pregnant women and their children. We examined potential associations between the initial vaccination before 6 months of age and symptoms related to allergies at 12 months of age.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Our statistical analyses included 56,277 children. Physician-diagnosed asthma was associated with receiving three (aOR 1.395, 95% CI 1.028\u20131.893) or four to five different inactivated vaccines (aOR 1.544, 95% CI 1.149\u20132.075), compared with children who received only one inactivated vaccine. Similar results were found for two questionnaire-based symptoms, i.e. wheeze (aOR 1.238, 95% CI 1.094\u20131.401; three vaccines vs. a single vaccine) and eczema (aOR 1.144, 95% CI 1.007\u20131.299; four or five vaccines vs. a single vaccine).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our results, which should be cautiously interpreted, suggest that the prevalence of asthma, wheeze and eczema among children at 12 months of age might be related to the amount of inactivated vaccine exposure before 6 months of age. Future work should assess if this association is due to cumulative adjuvant exposure. Despite this possible association, we strongly support the global vaccination strategy and recommend that immunisations continue.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/upload.umin.ac.jp\/cgi-open-bin\/ctr\/ctr_view.cgi?recptno=R000035091\">UMIN000030786<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12199-020-00864-7","type":"journal-article","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T16:04:07Z","timestamp":1594137847000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Cumulative inactivated vaccine exposure and allergy development among children: a birth cohort from Japan"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1288-9620","authenticated-orcid":false,"given":"Kiwako","family":"Yamamoto-Hanada","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyongsun","family":"Pak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayako","family":"Saito-Abe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Limin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miori","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidetoshi","family":"Mezawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatoko","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minaho","family":"Nishizato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mizuho","family":"Konishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazue","family":"Ishitsuka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirohisa","family":"Saito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiro","family":"Ohya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Japan Environment and Children\u2019s Study (JECS) Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukihiro","family":"Ohya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reiko","family":"Kishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuo","family":"Yaegashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chisato","family":"Mori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuichi","family":"Ito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zentaro","family":"Yamagata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidekuni","family":"Inadera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michihiro","family":"Kamijima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeo","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroyasu","family":"Iso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Shima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youichi","family":"Kurozawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narufumi","family":"Suganuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Kusuhara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiko","family":"Katoh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,7]]},"reference":[{"key":"864_CR1","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1016\/S1359-6446(03)02864-2","volume":"8","author":"DJ Marciani","year":"2003","unstructured":"Marciani DJ. Vaccine adjuvants: role and mechanisms of action in vaccine immunogenicity. Drug Discov Today. 2003;8:934\u201343.","journal-title":"Drug Discov Today"},{"key":"864_CR2","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1038\/nri2510","volume":"9","author":"P Marrack","year":"2009","unstructured":"Marrack P, McKee AS, Munks MW. Towards an understanding of the adjuvant action of aluminium. Nat Rev Immunol. 2009;9:287 https:\/\/doi.org\/10.1038\/nri2510.","journal-title":"Nat Rev Immunol"},{"key":"864_CR3","volume-title":"Adjuvants help vaccines work better","author":"Centers for Disease Control and Prevention","year":"2018","unstructured":"Centers for Disease Control and Prevention. Adjuvants help vaccines work better. 2018. https:\/\/www.cdc.gov\/vaccinesafety\/concerns\/adjuvants.html. Accessed 22 July 2019."},{"key":"864_CR4","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1271\/bbb.67.166","volume":"67","author":"R Yamanishi","year":"2003","unstructured":"Yamanishi R, Yusa I, Bando N, TERAO J. Adjuvant activity of alum in inducing antigen specific IgE antibodies in BALB\/c mice: a reevaluation. Biosci Biotechnol Biochem. 2003;67:166\u20139.","journal-title":"Biosci Biotechnol Biochem"},{"key":"864_CR5","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1111\/all.12830","volume":"71","author":"N Kiraly","year":"2016","unstructured":"Kiraly N, Koplin JJ, Crawford NW, Bannister S, Flanagan KL, Holt PG, et al. Timing of routine infant vaccinations and risk of food allergy and eczema at one year of age. Allergy. 2016;71:541\u20139 https:\/\/doi.org\/10.1111\/all.12830.","journal-title":"Allergy."},{"key":"864_CR6","doi-asserted-by":"publisher","first-page":"5156","DOI":"10.1016\/j.vaccine.2017.07.111","volume":"35","author":"M Schlaud","year":"2017","unstructured":"Schlaud M, Schmitz R, Poethko-Muller C, Kuhnert R. Vaccinations in the first year of life and risk of atopic disease\u2014results from the KiGGS study. Vaccine. 2017;35:5156\u201362 https:\/\/doi.org\/10.1016\/j.vaccine.2017.07.111.","journal-title":"Vaccine."},{"key":"864_CR7","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1542\/peds.2008-0115","volume":"123","author":"BD Spycher","year":"2009","unstructured":"Spycher BD, Silverman M, Egger M, Zwahlen M, Kuehni CE. Routine vaccination against pertussis and the risk of childhood asthma: a population-based cohort study. Pediatrics. 2009;123:944\u201350 https:\/\/doi.org\/10.1542\/peds.2008-0115.","journal-title":"Pediatrics."},{"key":"864_CR8","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1542\/peds.2014-0723","volume":"134","author":"H Vogt","year":"2014","unstructured":"Vogt H, Br\u00e5b\u00e4ck L, Kling A-M, Gr\u00fcnewald M, Nilsson L. Pertussis immunization in infancy and adolescent asthma medication. Pediatrics. 2014;134:721.","journal-title":"Pediatrics."},{"key":"864_CR9","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1159\/000355628","volume":"6","author":"J Kleinnijenhuis","year":"2014","unstructured":"Kleinnijenhuis J, Quintin J, Preijers F, Benn CS, Joosten LA, Jacobs C, et al. Long-lasting effects of BCG vaccination on both heterologous Th1\/Th17 responses and innate trained immunity. J Innate Immun. 2014;6:152\u20138 https:\/\/doi.org\/10.1159\/000355628.","journal-title":"J Innate Immun"},{"key":"864_CR10","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/j.jaci.2013.08.007","volume":"133","author":"MF Linehan","year":"2014","unstructured":"Linehan MF, Nurmatov U, Frank TL, Niven RM, Baxter DN, Sheikh A. Does BCG vaccination protect against childhood asthma? Final results from the Manchester Community Asthma Study retrospective cohort study and updated systematic review and meta-analysis. J Allergy Clin Immunol. 2014;133:688\u201395 e14 https:\/\/doi.org\/10.1016\/j.jaci.2013.08.007.","journal-title":"J Allergy Clin Immunol"},{"key":"864_CR11","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.anai.2017.05.013","volume":"119","author":"K Yamamoto-Hanada","year":"2017","unstructured":"Yamamoto-Hanada K, Yang L, Narita M, Saito H, Ohya Y. Influence of antibiotic use in early childhood on asthma and allergic diseases at age 5. Ann Allergy Asthma Immunol. 2017;119:54\u20138 https:\/\/doi.org\/10.1016\/j.anai.2017.05.013.","journal-title":"Ann Allergy Asthma Immunol"},{"key":"864_CR12","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s40413-017-0157-0","volume":"10","author":"K Yamamoto-Hanada","year":"2017","unstructured":"Yamamoto-Hanada K, Yang L, Ishitsuka K, Ayabe T, Mezawa H, Konishi M, et al. Allergic profiles of mothers and fathers in the Japan Environment and Children\u2019s Study (JECS): a nationwide birth cohort study. World Allergy Organ J. 2017;10:24 https:\/\/doi.org\/10.1186\/s40413-017-0157-0.","journal-title":"World Allergy Organ J"},{"key":"864_CR13","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/1471-2458-14-25","volume":"14","author":"T Kawamoto","year":"2014","unstructured":"Kawamoto T, Nitta H, Murata K, Toda E, Tsukamoto N, Hasegawa M, et al. Rationale and study design of the Japan environment and children\u2019s study (JECS). BMC Public Health. 2014;14:25 https:\/\/doi.org\/10.1186\/1471-2458-14-25.","journal-title":"BMC Public Health"},{"key":"864_CR14","doi-asserted-by":"publisher","first-page":"452","DOI":"10.2188\/jea.JE20140186","volume":"25","author":"T Michikawa","year":"2015","unstructured":"Michikawa T, Nitta H, Nakayama SF, Ono M, Yonemoto J, Tamura K, et al. The Japan Environment and Children\u2019s Study (JECS): a preliminary report on selected characteristics of approximately 10000 pregnant women recruited during the first year of the study. J Epidemiol. 2015;25:452\u20138 https:\/\/doi.org\/10.2188\/jea.JE20140186.","journal-title":"J Epidemiol"},{"doi-asserted-by":"publisher","unstructured":"Yang L, Yamamoto-Hanada K, Ishitsuka K, Ayabe T, Mezawa H, Konishi M, et al. Medical and surgical complications in pregnancy and obstetric labour complications in the Japan Environment and Children\u2019s Study (JECS) cohort: a birth cohort study. J Obstet Gynaecol. 2019; https:\/\/doi.org\/10.1080\/01443615.2019.1673709.1-7, https:\/\/doi.org\/10.1080\/01443615.2019.1673709.","key":"864_CR15","DOI":"10.1080\/01443615.2019.1673709.1-7 10.1080\/01443615.2019.1673709"},{"key":"864_CR16","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1183\/09031936.95.08030483","volume":"8","author":"M Asher","year":"1995","unstructured":"Asher M, Keil U, Anderson H, Beasley R, Crane J, Martinez F, et al. International study of asthma and allergies in childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8:483\u201391.","journal-title":"Eur Respir J"},{"key":"864_CR17","volume-title":"Immunization Schedule, Japan 2011 (for those under 20 years of age)","author":"The National Institute of Infectious Diseases (NIID) Japan","year":"2011","unstructured":"The National Institute of Infectious Diseases (NIID) Japan. Immunization Schedule, Japan 2011 (for those under 20 years of age). 2011. https:\/\/idsc.niid.go.jp\/vaccine\/dschedule\/2011\/Imm11EN.pdf. Accessed 22 July 2019."},{"key":"864_CR18","volume-title":"Routine and voluntary vaccinations in Japan (Under 20 years old) (Effective Since November 1, 2012)","author":"The National Institute of Infectious Diseases (NIID) Japan","year":"2012","unstructured":"The National Institute of Infectious Diseases (NIID) Japan. Routine and voluntary vaccinations in Japan (Under 20 years old) (Effective Since November 1, 2012). 2012. https:\/\/www.niid.go.jp\/niid\/images\/vaccine\/schedule\/2012\/ImmEN121101.pdf. Accessed 22 July 2019."},{"key":"864_CR19","first-page":"1","volume":"45","author":"K Groothuis-Oudshoorn","year":"2011","unstructured":"Groothuis-Oudshoorn K, Van Buuren S. Mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1\u201367.","journal-title":"J Stat Softw"},{"key":"864_CR20","volume-title":"R package version 2.17.3","author":"Team SD: RStan: the R interface to Stan","year":"2018","unstructured":"Team SD: RStan: the R interface to Stan. R package version 2.17.3. 2018. URL http:\/\/mc-stan.org\/. Accessed July 22 2019."},{"key":"864_CR21","volume-title":"R: A language and environment for statistical computing","author":"Team RC","year":"2018","unstructured":"Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2018. https:\/\/www.R-project.org\/. Accessed 22 July 2019."},{"issue":"3","key":"864_CR22","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.jaci.2007.11.034","volume":"121","author":"KL McDonald","year":"2008","unstructured":"McDonald KL, Huq SI, Lix LM, Becker AB, Kozyrskyj AL. Delay in diphtheria, pertussis, tetanus vaccination is associate with a reduced risk of childhood asthma. J Allergy Clin Immunol. 2008;121(3):626\u201331.","journal-title":"J Allergy Clin Immunol"},{"key":"864_CR23","doi-asserted-by":"publisher","first-page":"20143085","DOI":"10.1098\/rspb.2014.3085","volume":"282","author":"AK Simon","year":"2015","unstructured":"Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015;282:20143085 https:\/\/doi.org\/10.1098\/rspb.2014.3085.","journal-title":"Proc Biol Sci"},{"issue":"6","key":"864_CR24","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1111\/pai.12917","volume":"29","author":"L Yang","year":"2018","unstructured":"Yang L, Narita M, Yamamoto-Hanada K, Sakamoto N, Saito H, Ohya Y. Phenotypes of childhood wheeze in Japanese children: A group-based trajectory analysis. Pediatr Allergy Immunol. 2018;29(6):606\u201311 https:\/\/doi.org\/10.1111\/pai.12917.","journal-title":"Pediatr Allergy Immunol"},{"key":"864_CR25","doi-asserted-by":"publisher","first-page":"677","DOI":"10.4161\/hv.27264","volume":"10","author":"Y Kashiwagi","year":"2014","unstructured":"Kashiwagi Y, Miyata A, Kumagai T, Maehara K, Suzuki E, Nagai T, et al. Production of inflammatory cytokines in response to diphtheria-pertussis-tetanus (DPT), haemophilus influenzaetype b (Hib), and 7-valent pneumococcal (PCV7) vaccines. Hum Vaccin Immunotherapeutics. 2014;10:677\u201385 https:\/\/doi.org\/10.4161\/hv.27264.","journal-title":"Hum Vaccin Immunotherapeutics"},{"key":"864_CR26","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1016\/S0091-6749(99)70015-1","volume":"104","author":"L von Hertzen","year":"1999","unstructured":"von Hertzen L, Klaukka T, Mattila H, Haahtela T. Mycobacterium tuberculosis infection and the subsequent development of asthma and allergic conditions. J Allergy Clin Immunol. 1999;104:1211\u20134.","journal-title":"J Allergy Clin Immunol"},{"key":"864_CR27","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1126\/science.275.5296.77","volume":"275","author":"T Shirakawa","year":"1997","unstructured":"Shirakawa T, Enomoto T, Shimazu S-I, Hopkin JM. The inverse association between tuberculin responses and atopic disorder. Science. 1997;275:77\u20139.","journal-title":"Science."},{"key":"864_CR28","doi-asserted-by":"publisher","first-page":"406","DOI":"10.3389\/fimmu.2012.00406","volume":"3","author":"H HogenEsch","year":"2013","unstructured":"HogenEsch H. Mechanism of immunopotentiation and safety of aluminum adjuvants. Front Immunol. 2013;3:406.","journal-title":"Front Immunol"},{"key":"864_CR29","doi-asserted-by":"publisher","first-page":"2673","DOI":"10.4049\/jimmunol.1402027","volume":"194","author":"M Onishi","year":"2015","unstructured":"Onishi M, Ozasa K, Kobiyama K, Ohata K, Kitano M, Taniguchi K, et al. Hydroxypropyl-beta-cyclodextrin spikes local inflammation that induces Th2 cell and T follicular helper cell responses to the coadministered antigen. J Immunol. 2015;194:2673\u201382 https:\/\/doi.org\/10.4049\/jimmunol.1402027.","journal-title":"J Immunol"},{"key":"864_CR30","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1016\/j.jaci.2013.12.1082","volume":"133","author":"AM Sonnenschein-van der Voort","year":"2014","unstructured":"Sonnenschein-van der Voort AM, Arends LR, de Jongste JC, Annesi-Maesano I, Arshad SH, Barros H, et al. Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children. J Allergy Clin Immunol. 2014;133:1317\u201329 https:\/\/doi.org\/10.1016\/j.jaci.2013.12.1082.","journal-title":"J Allergy Clin Immunol"}],"container-title":["Environmental Health and Preventive Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12199-020-00864-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12199-020-00864-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12199-020-00864-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T23:04:51Z","timestamp":1625612691000},"score":1,"resource":{"primary":{"URL":"https:\/\/environhealthprevmed.biomedcentral.com\/articles\/10.1186\/s12199-020-00864-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,7]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["864"],"URL":"https:\/\/doi.org\/10.1186\/s12199-020-00864-7","relation":{},"ISSN":["1342-078X","1347-4715"],"issn-type":[{"type":"print","value":"1342-078X"},{"type":"electronic","value":"1347-4715"}],"subject":[],"published":{"date-parts":[[2020,7,7]]},"assertion":[{"value":"5 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study protocol was approved by the Ministry of the Environment\u2019s Institutional Review Board on Epidemiological Studies as well as the ethics committees of all participating institutions. All the participants provided written informed consent.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"27"}}