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Natural rotavirus infection has been found to be a likely cause of type 1 diabetes in children. Several factors are consistent with this observation. First, rotavirus infections have been shown to cause pancreatic cell apoptosis, or programmed cell death, in insulin-producing cells. Second, rotavirus peptides display molecular mimicry with T-cell epitopes on the surface of insulin-producing cells. Because of this potential, several research groups were interested to see what would happen following widespread use of rotavirus vaccine. Would the incidence of type 1 diabetes increase, decrease, or remain unchanged?
In March 2019, a research group in Australia examined the incidence of type 1 diabetes in the eight years before and the eight years after rotavirus vaccine was introduced, which was in 2007 (Perrett, KP, et al. Association of rotavirus vaccination with the incidence of type 1 diabetes in children, JAMA Pediatrics. 2019 Jan. 22;173(3):280-282). National coverage for the vaccine was estimated to be about 84%.
The authors found that between 2000 and 2015, 16,159 cases of newly diagnosed type 1 diabetes were reported. In children 0 to 4 years of age, the number of incident cases of type 1 diabetes decreased by 14% (95% confidence intervals, 0.74-0.99, p=0.04). This protective effect wasn’t observed in children 5 to 9 or 10 to 14 years of age; both of these groups were born before the rotavirus vaccine became available.
Why did rotavirus vaccination decrease the incidence of type 1 diabetes? The following sequence of events is likely: 1) Circulating natural rotavirus causes type 1 diabetes; 2) Natural rotaviruses drive immune, including autoimmune, responses greater than vaccination; 3) Rotavirus vaccine replaced natural rotavirus infection, thereby lessening the incidence of type 1 diabetes.
The authors concluded, “We report what is to our knowledge the first evidence of a decline in the incidence of type 1 diabetes after the introduction of oral rotavirus vaccine into a routine immunization schedule. This occurred in the age cohort of children born after the introduction of rotavirus vaccine and is consistent with the hypothesis that oral rotavirus vaccine may be protective against the development of type 1 diabetes in early childhood.”
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