Diabetologia

, Volume 34, Issue 3, pp 176–181 | Cite as

The Swedish childhood diabetes study

Vaccinations and infections as risk determinants for diabetes in childhood
  • L. Blom
  • L. Nyström
  • G. Dahlquist
Originals

Summary

In a nationwide incident case referent study we have evaluated vaccinations, early and recent infections and the use of medicines as possible risk determinants for Type 1 (insulin-dependent) diabetes mellitus in childhood. A total of 339 recently onset diabetic and 528 referent children, age 0–14 years, were included. Information about infections was collected from a mailed questionnaire and about vaccinations from childhood health care centres and schools. When vaccinations were considered as possible risk factors for diabetes, a significant decrease in relative risk estimated as odds ratio (OR) was noted for measles vaccination (OR=0.69; 95% confidence limits 0.48–0.98). For vaccination against tuberculosis, smallpox, tetanus, whooping cough, rubella and mumps no significant effect on OR for diabetes was found. The odds ratios for Type 1 diabetes for children exposed to 0, 1–2 or over 2 infections during the last year before diagnosis of diabetes revealed a linear increase (OR = 1.0,1.96 and 2.55 for 0, 1–2 and over 2 infections, respectively). The trend was still significant when standardized for possible confounders such as age and sex of the children, maternal age and education and intake of antibiotics and analgetics. In conclusion, a protective effect of measles vaccination for Type 1 diabetes in childhood is indicated as well as a possible causal relationship between the onset of the disease and the total load of recent infections.

Key words

Type 1 (insulin-dependent) diabetes mellitus childhood medicines infectious disease vaccinations epidemiology 

References

  1. 1.
    Harris HF (1899) A case of diabetes mellitus quickly following mumps. Boston Med Surg J 140: 465–469Google Scholar
  2. 2.
    Craighead JE, Higgins DA (1974) Genetic influences affecting the occurrence of a diabetes-mellitus-like disease in mice infected with the encephalomyocarditis virus. J Exp Med 139: 414–415Google Scholar
  3. 3.
    Yoon JW, Onodera T, Notkins AL (1977) Virus-induced diabetes mellitus VIII: passage of encephalomyocarditis virus and severity of diabetes in susceptible and resistant strains of mice. J Gen Virol 37: 225–232Google Scholar
  4. 4.
    Menser MA, Forrest JM, Bransby RD (1978) Rubella infection and diabetes mellitus. Lancet 1: 57–60Google Scholar
  5. 5.
    Gamble DR, Kinsley ML, Fitzgerald MG, Bolton R, Taylor KW (1969) Viral antibodies in diabetes mellitus. Br Med J 3: 627–630Google Scholar
  6. 6.
    Yoon JW, Austin M, Onodera T, Notkins AL (1979) Virus-induced diabetes mellitus. Isolation of a virus from the pancreas of a child with diabetic keto-acidosis. N Engl J Med 300: 1173–1179Google Scholar
  7. 7.
    Gamble DR, Taylor KW, Cumming H (1973) Coxsackie viruses and diabetes mellitus. Br Med J 4: 260–262Google Scholar
  8. 8.
    King ML, Shaikh A, Bidwell D, Voller A, Banatvala JE (1983) Coxsackie-B-virus-specific IgM responses in children with insulin-dependent (juvenile-onset; type 1) diabetes mellitus. Lancet I: 1397–1399Google Scholar
  9. 9.
    Mertens T, Gruneklee D, Eggers HJ (1983) Neutralizing antibodies against Coxsackie B viruses in patients with recent onset of type 1 diabetes. Eur J Pediatr 140: 293–294Google Scholar
  10. 10.
    Orchard TJ, Kuller LH, Eberhardt M et al. (1982) Approaches to the environmental etiologies of insulin dependent diabetes mellitus. In: Eschwege E (ed) Advances in diabetes epidemiology. INSERM Symposium No22. Elsevier Biomedical, Amsterdam pp 41–48Google Scholar
  11. 11.
    Tuvemo T, Dahlquist G, Blom L, Friman G, Landin-Olsson M, Diderholm H (1989) The Swedish childhood diabetes study III: IgM against coxsackie B viruses in newly diagnosed Type 1 (insulin-dependent) diabetic children — no evidence of increased antibody frequency. Diabetologia 32: 745–747Google Scholar
  12. 12.
    Sultz HA, Hart BA, Zielezny M, Schlesinger ER (1975) Is mumps virus an etiologic factor in juvenile diabetes mellitus? J Pediatr 86: 654–656Google Scholar
  13. 13.
    Prince GA, Jenson AB, Billups LC Notkins AL (1978) Infection of human pancreatic beta cell cultures with mumps virus. Nature 271: 158–161Google Scholar
  14. 14.
    Sinaniotis CA, Dackalopoulon E, Lapatsanis P, Poxiadis S (1975) Diabetes mellitus after mumps vaccination. Arch Dis Child 30: 749–750Google Scholar
  15. 15.
    Helmke K, Otten A, Willems WR et al. (1986) Islet cell antibodies and the development of diabetes mellitus in relation to mumps infection and mumps vaccination. Diabetologia 29: 30–33Google Scholar
  16. 16.
    Vanndrager GJ, Molenaar JL, Bruining GJ, Plantinga AD, Ruitenberg EJ (1986) Islet cell antibodies, mumps infection and mumps vaccination. Diabetologia 29: 406Google Scholar
  17. 17.
    Dahlquist G, Blom L, Holmgren G, Hägglöf B, Larsson Y, Sterky G, Wall S (1985) The epidemiology of diabetes in Swedish children 0–14 years — a six-year prospective study. Diabetologia 28: 802–808Google Scholar
  18. 18.
    Nyström L, Dahlquist G, Rewers M, Wall S (1990) The Swedish childhood diabetes study — an analysis of the temporal variation in diabetes incidence 1978–1987. Int J Epidemiol 19: 141–146Google Scholar
  19. 19.
    Dahlquist G, Blom L, Tuvemo T, Nyström L, Sandström A, Wall S (1989) The Swedish childhood diabetes study — Results from a nine year case register and a one year case-referent study indicating that Type 1 (insulin-dependent) diabetes mellitus is associated with both Type 2 (non-insulin-dependent) diabetes mellitus and autoimmune disorders. Diabetologia 32: 2–6Google Scholar
  20. 20.
    Miettinen O (1972) Components of the crude risk ratio. Am J Epidemiol 96: 168–172Google Scholar
  21. 21.
    Miettinen O (1976) Estimability and estimation in case-referent studies. Am J Epidemiol 103: 226–235Google Scholar
  22. 22.
    Daniel WW (1983) Hypothesis testing In: Daniel WW (ed) Biostatistics: a foundation for analysis in the health sciences. 3rd ed. Wiley & Sons, New York Chichester Brisbane pp 192–193Google Scholar
  23. 23.
    Blom L, Dahlquist G, Nyström L, Sandström A, Wall S (1989) The Swedish childhood diabetes study — social and perinatal determinants for diabetes in childhood. Diabetologia 32: 7–13Google Scholar
  24. 24.
    Cooppan R (1985) Infection and diabetes. In: Marble A, Krall LP, Bradley RF, Christlieb AR (eds) Joslin's diabetes mellitus. Lea & Febiger, Philadelphia, pp 737–747Google Scholar
  25. 25.
    Rasmussen F, Smedby B (1989) Life table methods applied to use of medical care and of prescription drags in early childhood. J Epidemiol Community Health 43: 140–146Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • L. Blom
    • 1
  • L. Nyström
    • 2
  • G. Dahlquist
    • 1
  1. 1.Department of Paediatrics, Karolinska InstituteSachs' Children's HospitalStockholm
  2. 2.Department of Epidemiology and Health Care ResearchUniversity of UmeåUmeåSweden

Personalised recommendations