Childhood Vaccination and Type 1 Diabetes

Danish Epidemiology Science Centre, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
New England Journal of Medicine (Impact Factor: 55.87). 05/2004; 350(14):1398-404. DOI: 10.1056/NEJMoa032665
Source: PubMed


A link between childhood vaccinations and the development of type 1 diabetes has been proposed.
We evaluated a cohort comprising all children born in Denmark from January 1, 1990, through December 31, 2000, for whom detailed information on vaccinations and type 1 diabetes was available. Using Poisson regression models, we estimated rate ratios according to vaccination status, including the trend associated with the number of doses, among all children and in a subgroup of children who had siblings with type 1 diabetes. Given recent claims of clustering of cases of diabetes two to four years after vaccination, we also estimated rate ratios during the period after vaccination.
Type 1 diabetes was diagnosed in 681 children during 4,720,517 person-years of follow-up. The rate ratio for type 1 diabetes among children who received at least one dose of vaccine, as compared with unvaccinated children, was 0.91 (95 percent confidence interval, 0.74 to 1.12) for Haemophilus influenzae type b vaccine; 1.02 (95 percent confidence interval, 0.75 to 1.37) for diphtheria, tetanus, and inactivated poliovirus vaccine; 0.96 (95 percent confidence interval, 0.71 to 1.30) for diphtheria, tetanus, acellular pertussis, and inactivated poliovirus vaccine; 1.06 (95 percent confidence interval, 0.80 to 1.40) for whole-cell pertussis vaccine; 1.14 (95 percent confidence interval, 0.90 to 1.45) for measles, mumps, and rubella vaccine; and 1.08 (95 percent confidence interval, 0.74 to 1.57) for oral poliovirus vaccine. The development of type 1 diabetes in genetically predisposed children (defined as those who had siblings with type 1 diabetes) was not significantly associated with vaccination. Furthermore, there was no evidence of any clustering of cases two to four years after vaccination with any vaccine.
These results do not support a causal relation between childhood vaccination and type 1 diabetes.

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    • "As a final note, the introduction of childhood immunizations programs and the growing prevalence of T1D in developed countries have also provided rationale for assessing a possible correlation between the two entities. Multiple large-scale studies found no support for any causal relation between childhood vaccination and T1D (Blom et al. 1991; EURODIAB Substudy 2 Study Group 2000; DeStefano et al. 2001; Hviid et al. 2004). As there appears to be no significant association between vaccination and T1D, the risk-benefit ratio as of today balances strongly in favor of continued protection efforts by means of immunization. "
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    ABSTRACT: The precise etiology of type 1 diabetes (T1D) is still unknown, but viruses have long been suggested as a potential environmental trigger for the disease. However, despite decades of research, the body of evidence supporting a relationship between viral infections and initiation or acceleration of islet autoimmunity remains largely circumstantial. The most robust association with viruses and T1D involves enterovirus species, of which some strains have the ability to induce or accelerate disease in animal models. Several hypotheses have been formulated to mechanistically explain how viruses may affect islet autoimmunity and β-cell decay. The recent observation that certain viral infections, when encountered at the right time and infectious dose, can prevent autoimmune diabetes illustrates that potential relationships may be more complex than previously thought. Here, we provide a concise summary of data obtained in mouse models and humans, and identify future avenues toward a better characterization of the association between viruses and T1D.
    Preview · Article · Jan 2012 · Cold Spring Harbor Perspectives in Medicine
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    • "If large shares of the paediatric population are not immunized, it has serious consequences for the efficacy of the programmes and the health of the general public [3]. Problems in achieving high immunization rates in children in Western countries are emerging and doubts have been raised about the benefits of immunization because of reports of serious ADRs such as autism, diabetes and asthma possibly being related to immunization against measles, mumps and rubella (MMR®) [6] [7] [8] [9]. The study published by Wakefield et al. in the Lancet (1998) suggested a link between MMR® vaccine and autism, but in February 2010 the Lancet retracted the paper, as elements from this study had been found to be incorrect [10]. "
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    ABSTRACT: We analysed 2,643 suspected adverse drug reactions (ADRs) in children from birth to 17 years reported for immunization in Denmark over a decade with respect to age and gender, type of vaccines, type and seriousness of ADRs. Eighty percent of ADRs were reported in children below 2 years of age. One half of all reported ADRs were of the type "general disorders and administration site conditions". The largest share of serious ADRs was from the category "nervous system disorders" (33% of serious ADRs). The reported rate of ADRs for children's immunization programmes (MMR® and Ditekipol/Act-Hib®) was 70 per 100,000 vaccine doses and for the serious ADRs, 10 to 25 per 100,000 vaccine doses. More than one half of all suspected ADRs reported for Danish children were related to national immunization programmes and almost one third of these were serious. However, viewed in relation to the large exposure rates and the benefits of avoiding risky child diseases, the numbers are small. Health authorities should put more efforts into enlightening parents about this issue.
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    ABSTRACT: Adverse events following immunisation (AEFI) in the National Vaccination Programme of the Netherlands (RVP) have been monitored through an enhanced passive surveillance system by RIVM since 1962. From 1984 onwards evaluation was done in close collaboration with the Health Council. Reports are received mainly from child health care professionals primarily by telephone through the vaccine information and advisory service. Further data are obtained, if necessary, from such sources as parents, general practitioners and paediatricians. After supplementation and verification of data a (working) diagnosis is made and causality assessed. This annual report for 2002 presents an overview of all reported AEFIs, with classification according to case definitions and causality. Trend analysis, reporting bias, background rates of specific events and possible pathophysiology of symptoms are discussed. From a total of over 2.5 million vaccinations 1332 AEFIs were reported of which 12 (0.9%) were unclassifiable because of missing information. In 80% (1057) of the classifiable events a possible causal relationship with vaccination was established and in 20% (263) the events were judged as coincidental. Compared to 2001 there were no relevant changes in numbers, causality or severity of reported adverse events. Sinds 1962 bewaakt het RIVM de veiligheid van het Rijksvaccinatieprogramma. Vanaf 1964 gebeurt dat in nauwe samenwerking met de Gezondheidsraad. Het merendeel van de meldingen van vermoede bijwerkingen komt binnen via de telefoondienst van het RIVM, waarbij de meeste meldingen afkomstig zijn van de Jeugdgezondheidszorg. Nadere informatie wordt zonodig verkregen van ouders en behandelende artsen. Na aanvulling en verificatie wordt aan de hand van de (werk)diagnose de causaliteit beoordeeld. Alle in 2002 binnengekomen meldingen zijn in dit rapport opgenomen en gerubriceerd naar aard van de gebeurtenis en naar causaal verband. Onderrapportage, vertekening en specifieke beelden worden besproken, met aandacht voor effecten van de vervroeging van het vaccinatieschema. Er zijn 1332 meldingen binnengekomen, op een totaal van meer dan 2,5 miljoen vaccinaties. Hiervan waren 12 (0,9%) meldingen niet te beoordelen vanwege ontbrekende informatie. Bij 80% (1057) van de meldingen werd een mogelijk causaal verband vastgesteld en bij 263 meldingen (20%) werd een oorzakelijk verband onwaarschijnlijk of afwezig geacht. Vergeleken met 2001 waren er geen relevante verschillen in aantal, aard, ernst en mate van oorzakelijk verband van de meldingen.
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