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Association Between Rotavirus Vaccination and Type 1 Diabetes in Children
Jason M Glanz1,2, Christina L Clarke1, Stanley Xu1
1Institute for Health Research, Kaiser Permanente Colorado, Aurora.
Insights
Rotavirus vaccination does not appear to increase or decrease the risk of type 1 diabetes in children. This large study found no significant association between rotavirus immunization and type 1 diabetes incidence.
Area of Science:
- Immunization and Public Health
- Pediatric Endocrinology
- Vaccine Safety Research
Background:
- Rotavirus infection is a suspected risk factor for type 1 diabetes.
- Live attenuated rotavirus vaccination's impact on type 1 diabetes risk is unknown.
Purpose of the Study:
- To investigate the association between rotavirus vaccination and the incidence of type 1 diabetes in children.
- To determine if rotavirus immunization affects type 1 diabetes risk.
Main Methods:
- Retrospective cohort study of 386,937 children aged 8 months to 11 years.
- Children categorized into fully, partially, or unexposed rotavirus vaccination groups.
- Cox proportional hazards regression models used to analyze type 1 diabetes incidence.
Main Results:
- No significant association was found between rotavirus vaccination and type 1 diabetes incidence.
- Adjusted hazard ratios for fully and partially exposed groups were 1.03 and 1.50, respectively, with wide confidence intervals.
- The study included a large cohort with extensive follow-up time.
Conclusions:
- Rotavirus vaccination does not appear to be associated with an increased or decreased risk of type 1 diabetes in children.
- Findings suggest current rotavirus vaccination schedules are safe regarding type 1 diabetes risk.
Importance:
Because rotavirus infection is a hypothesized risk factor for type 1 diabetes, live attenuated rotavirus vaccination could increase or decrease the risk of type 1 diabetes in children.
Objective:
To examine whether there is an association between rotavirus vaccination and incidence of type 1 diabetes in children aged 8 months to 11 years.
Design, Setting, And Participants:
A retrospective cohort study of 386 937 children born between January 1, 2006, and December 31, 2014, was conducted in 7 US health care organizations of the Vaccine Safety Datalink. Eligible children were followed up until a diagnosis of type 1 diabetes, disenrollment, or December 31, 2017.
Exposures:
Rotavirus vaccination for children aged 2 to 8 months. Three exposure groups were created. The first group included children who received all recommended doses of rotavirus vaccine by 8 months of age (fully exposed to rotavirus vaccination). The second group had received some, but not all, recommended rotavirus vaccines (partially exposed to rotavirus vaccination). The third group did not receive any doses of rotavirus vaccines (unexposed to rotavirus vaccination).
Main Outcomes And Measures:
Incidence of type 1 diabetes among children aged 8 months to 11 years. Type 1 diabetes was identified by International Classification of Diseases codes: 250.x1, 250.x3, or E10.xx in the outpatient setting. Cox proportional hazards regression models were used to analyze time to type 1 diabetes incidence from 8 months to 11 years. Hazard ratios and 95% CIs were calculated. Models were adjusted for sex, race/ethnicity, birth year, mother's age, birth weight, gestational age, number of well-child visits, and Vaccine Safety Datalink site.
Results:
In a cohort of 386 937 children (51.1% boys and 41.9% non-Hispanic white), 360 169 (93.1%) were fully exposed to rotavirus vaccination, 15 765 (4.1%) were partially exposed to rotavirus vaccination, and 11 003 (2.8%) were unexposed to rotavirus vaccination. Children were followed up a median of 5.4 years (interquartile range, 3.8-7.8 years). The total person-time follow-up in the cohort was 2 253 879 years. There were 464 cases of type 1 diabetes in the cohort, with an incidence rate of 20.6 cases per 100 000 person-years. Compared with children unexposed to rotavirus vaccination, the adjusted hazard ratio was 1.03 (95% CI, 0.62-1.72) for children fully exposed to rotavirus vaccination and 1.50 (95% CI, 0.81-2.77) for children partially exposed to rotavirus vaccination.
Conclusions And Relevance:
The findings of this study suggest that rotavirus vaccination does not appear to be associated with type 1 diabetes in children.
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