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Risk of Celiac Disease Before and After Nationwide Infant Rotavirus Vaccination: A Population-Based Study
Maria Östman1, Lars C Stene2, German Tapia2
1Faculty of Medicine, University of Oslo, Oslo, Norway.
Insights
This study found no link between rotavirus vaccination and the risk of early-onset celiac disease in children. Rotavirus vaccines do not appear to increase the likelihood of developing celiac disease.
Area of Science:
- Pediatric Gastroenterology
- Vaccinology
- Epidemiology
Background:
- The relationship between rotavirus vaccination and celiac disease risk is a subject of ongoing scientific debate.
- Understanding potential links is crucial for public health recommendations and parental guidance.
Purpose of the Study:
- To investigate the association between rotavirus vaccination and the incidence of celiac disease in a large pediatric cohort.
- To determine if rotavirus vaccine introduction altered the trend of celiac disease diagnoses.
Main Methods:
- A nationwide register-based cohort study in Norway included over 740,000 children.
- Interrupted time series analysis and comparative risk assessment were used to evaluate vaccine impact.
- Data linkage with birth, patient, and immunization registries provided comprehensive follow-up.
Main Results:
- No significant change in the trend of celiac disease incidence was observed after rotavirus vaccine introduction.
- The hazard ratio for celiac disease was not significantly different between vaccinated and unvaccinated children.
- Sensitivity analyses and alternative case definitions yielded consistent results, showing no association.
Conclusions:
- This study provides robust evidence that rotavirus vaccination is not associated with an increased risk of early-onset celiac disease.
- Findings support the safety of rotavirus vaccines concerning celiac disease development.
Objective:
To study the association between rotavirus vaccination and risk of celiac disease, which remains debated.
Study Design:
We conducted a nationwide register-based study including 740 744 children born during 2007-2019 from the Norwegian Birth Registry individually linked to the Norwegian Patient Registry for celiac disease diagnosis. With follow-up until 5 years of age, 2795 were diagnosed with celiac disease. The main analysis was an interrupted time series analysis to assess break in trend of celiac disease incidence before compared with after vaccine introduction in September 2014. Furthermore, we linked the cohort to the Norwegian Immunization Register and compared the risk of celiac disease between fully vaccinated and nonvaccinated children. In sensitivity analyses, we excluded children born 1 year before to 1 year after vaccine introduction to mitigate the effect of herd immunity.
Results:
There was no significant break in trend after rotavirus vaccine introduction (P = .46). Hazard ratio (HR) of celiac disease was 0.96 (95% CI 0.89-1.04) if born after compared with before vaccination started, and 1.00 (95% CI 0.92-1.09) when excluding children born in 2013-2015. In fully vaccinated compared with nonvaccinated the HR was 0.99 (95% CI 0.92-1.07), consistent in robustness analyses. Including a requirement for gluten-free diet support in the celiac disease case definition gave similar results (HR 1.06, 95% CI 0.98-1.15).
Conclusions:
This study did not find an association between rotavirus vaccine and the risk of early-onset celiac disease.
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