Perrett KP, Jachno K, Nolan TM, et al. Association of rotavirus vaccination with the incidence of type 1 diabetes in children. JAMA Pediatr. 2019;173(3):280-282.
Observational, retrospective analysis
To compare the incidence of newly diagnosed type 1 diabetes mellitus (T1D) in Australian children in the 8 years before and after the introduction of routine oral rotavirus vaccination
This was a nationwide study conducted in Australia. The study included data from Australian children diagnosed with T1D between 2000 and 2015. During this period, 16,159 new cases of T1D were diagnosed. This equates to a mean rate of 12.7 (95% confidence interval [CI]: 11.0-14.8) cases per 100,000 children.
Vaccination against rotavirus for all infants aged 6 weeks and older began in Australia in May 2007. Children are vaccinated between 2 and 4 months of age.
Study Parameters Assessed
In Australia, the National Diabetes Services Scheme provides subsidized supplies for glucose testing and insulin to patients. This registry was used to identify newly diagnosed cases of T1D.
Primary Outcome Measure
Incidence of T1D in children before and after routine vaccination
In children aged 0 to 4 years, the number of incident cases of T1D decreased by 14% (rate ratio: 0.86; 95% CI: 0.74-0.99; P=0.04) after the introduction of the oral rotavirus vaccine in 2007.
The incidence of T1D has increased steadily in recent years both in Australia1 and in the rest of the world.2 In the last few years the rate of diagnosed cases has slowed for the first time since the 1980s and may have even leveled off in Australia.3
This report may be the first evidence that the declining incidence coincides with the introduction of routine rotavirus vaccinations. The decline in diagnosis of diabetes occurred only in the age cohort of children born after the vaccine was introduced, results that are consistent with the hypothesis that this vaccine is protective against development of T1D. Older children who had not been vaccinated did not exhibit a similar drop in disease incidence.
The decline in diagnosis of diabetes occurred only in the age cohort of children born after the vaccine was introduced, results that are consistent with the hypothesis that this vaccine is protective against development of T1D.
Rotavirus infection is generally associated with gastrointestinal symptoms, but there is a growing consensus that its effects are systemic and include increased risk of autoimmune disease.4 Seizures are the most common extra-intestinal symptom of infection. A full course of rotavirus vaccination is associated with an 18% to 21% reduction in seizures that require hospitalization during the year following vaccination.5
In 1998 Len Harrison was the first to report that immune markers of diabetes appeared in children after they had a rotavirus infection.6 More recent studies in laboratory models suggest that rotavirus infection of the pancreas triggers an immune attack on the insulin-producing cells, similar to the pathogenesis of T1D.7
If rotavirus infection increases risk of diabetes, it is only fair to wonder if the vaccine might do the same. Researchers in Finland did ask this question and reported in May that the rotavirus vaccine does not appear to increase diabetes risk. A large placebo-controlled trial showed no indication of increased risk of diabetes among children who received the rotavirus vaccine. In fact, there was a trend toward lower risk (about 7%) but this difference did not reach statistical significance. Their data did show a statistically significant lower risk for developing celiac disease; children who received the rotavirus vaccination had a 50% lower relative risk of celiac disease compared with the placebo group.8
In the May issue of Natural Medicine Journal, Jody Stanislaw, ND, CDE, introduced us to a concept that she calls “beta cell preservation.”9 In early diabetes, or in latent autoimmune diabetes of adults (LADA), there is a period of time during which partial pancreatic function remains. Stanislaw contends that this function can be preserved through judicious use of diet, exercise, and supplements. One must wonder whether this rotavirus vaccine might also prove useful in protecting the pancreas and slowing loss of function from further autoimmune attack.
- Catanzariti L, Faulks K, Moon L, Waters AM, Flack J, Craig ME. Australia’s national trends in the incidence of type 1 diabetes in 0-14-year-olds, 2000-2006. Diabet Med. 2009;26(6):596-601.
- EURODIABACE Study Group. Variation and trends in incidence of childhood diabetes in Europe. Lancet. 2000;355(9207):873-876.
- Haynes A, Bulsara MK, Jones TW, Davis EA. Incidence of childhood onset type 1 diabetes in Western Australia from 1985 to 2016: evidence for a plateau. Pediatr Diabetes. 2018;19(4):690-692.
- Van der Werf N, Kroese FG, Rozing J, Hillebrands JL. Viral infections as potential triggers of type 1 diabetes. Diabetes Metab Res Rev. 2007;23(3):169-183.
- Gómez-Rial J, Sánchez-Batán S, Rivero-Calle I, et al. Rotavirus infection beyond the gut. Infect Drug Resist. 2018;12:55-64.
- Honeyman MC, Stone NL, Harrison LC. T-cell epitopes in type 1 diabetes autoantigen tyrosine phosphatase IA-2: potential for mimicry with rotavirus and other environmental agents. Mol Med. 1998;4(4):231-239.
- Honeyman MC, Coulson BS, Stone NL, et al. Association between rotavirus infection and pancreatic islet autoimmunity in children at risk of developing type 1 diabetes. Diabetes. 2000;49(8):1319-1324.
- Hemming-Harlo M, Lähdeaho ML, Mäki M, Vesikari T. Rotavirus vaccination does not increase type 1 diabetes and may decrease celiac disease in children and adolescents. Pediatr Infect Dis J. 2019;38(5):539-541.
- Stanislaw J. The importance of beta cell preservation in newly diagnosed type 1 diabetes. Natural Medicine Journal. 2019;11(5).