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 [2].

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.