Vaccine
Volume 30, Issue 43, Pages 6111-6224 (21 September 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/43

Disability among US Army Veterans vaccinated against anthrax
Original Research Article
Pages 6150-6156
Sandra I. Sulsky, Rose Luippold, Patrick Garman, Hayley Hughes, Edward J. Boyko, Charles Maynard, Paul J. Amoroso

Abstract
Context
To protect troops against the use of anthrax as a biological weapon, the US Department of Defense began an anthrax vaccination program in 1998. 14 years after the inception of the vaccination program, there is no evidence suggesting vaccination against anthrax carries long-term health risks for Active Duty Soldiers.

Objective
To investigate the association between Anthrax Vaccine Adsorbed (AVA) received while on Active Duty and subsequent disability determined by the Veterans Benefits Administration.

Design, setting and participants
Case–control study nested in the cohort of all Active Duty personnel known to have separated from the US Army between December 1, 1997 and December 31, 2005. Cases were ≥10% disabled, determined either by the Army prior to separation (N = 5846) or by the Veterans Benefits Administration (VBA) after separation (N = 148,934). Controls (N = 937,705) separated from the Army without disability, and were not receiving pensions from the VBA as of April 2007. Data were from the Total Army Injury and Health Outcomes Database and the VBA Compensation and Pension and Benefits database.

Main outcomes
Disability status (yes/no); for primary disability, percent disabled (≥ 10%, 20%, >20%) and type of disability.

Results
Vaccination against anthrax was four times more likely among disabled Veterans with hostile fire pay records (HFP, a surrogate for deployment). Vaccinated Soldiers with HFP had lower odds of disability separation from the Army 0.89 (0.80, 0.98); there was no association between vaccine and receiving Army disability benefits among those without HFP (OR = 1.05, CI: 0.96, 1.14). Vaccination was negatively associated with receiving VA disability benefits for those with HFP (OR = 0.66, CI: 0.65, 0.67), but there was little or no association between vaccine and receipt of VA disability benefits for those without HFP (OR = 0.95, CI: 0.93, 0.97).

Conclusions
Risk of disability separation from the Army and receipt of disability compensation from the VA were not increased in association with prior exposure to AVA. This study provides evidence that vaccination against anthrax is not associated with long term disability.