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New England Journal of Medicine Volume 350:1398-1404 April 1,
2004 Number 14
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Childhood Vaccination and Type 1 Diabetes
Anders Hviid, M.Sc., Michael Stellfeld, M.D., Jan Wohlfahrt, M.Sc.,
and Mads Melbye, M.D., Ph.D.
ABSTRACT
Background A link between childhood vaccinations and the
development of type 1 diabetes has been proposed.
Methods 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.
Results 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.
Conclusions These results do not support a causal relation
between childhood vaccination and type 1 diabetes.
Source Information
From the Danish Epidemiology Science Centre, Department of Epidemiology
Research (A.H., J.W., M.M.), and the Medical Department (M.S.),
Statens Serum Institut, Copenhagen, Denmark.
Address reprint requests to Mr. Hviid at the Danish Epidemiology
Science Centre, Department of Epidemiology Research, Statens Serum
Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark, or at
aii@ssi.dk.
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