BMJ 1999;318:1169-1172 ( 1 May )

Papers

Association between type 1 diabetes and Haemophilus influenzae type b vaccination: birth cohort study

Editorial by Elliman

Marjatta Karvonen, senior researcher,  Zygimantas Cepaitis, researcher,  Jaakko Tuomilehto, research professor. 

Diabetes and Genetic Epidemiology Unit, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland

Correspondence to: Dr Karvonen Marjatta.karvonen{at}ktl.fi

Objectives: To determine the effect of Haemophilus influenzae type b vaccination and its timing on the risk of type 1 diabetes in Finnish children.
Design: Cumulative incidence and relative risk of type 1 diabetes was compared among three birth cohorts of Finnish children: those born during the 24 months before the H influenzae type b vaccination trial, those in the trial cohort who were vaccinated at 3 months of age and later with a booster vaccine, and those in the trial cohort who were vaccinated at 24 months of age only. The probability of type 1 diabetes was estimated using regression analysis assuming that there were no losses to 10 year follow up and no competing risks.
Setting: Finland (total population 5 million and annual birth rate 1.3%).
Subjects: 128 936 children born from 1 October 1983 to 1 September 1985, and 116 352 children born from 1 October 1985 to 31 August 1987.
Main outcome measures: Probability of type 1 diabetes among children vaccinated with H influenzae type b and non-vaccinated children.
Results: No statistically significant difference was found at any time during the 10 year follow up in the risk of type 1 diabetes between the children born before the vaccination period and those vaccinated at the age of 24 months only (relative risk 1.01). The difference in the risk between the cohort vaccinated first at the age of 3 months and the cohort vaccinated at the age of 24 months only was not statistically significant either (1.06).
Conclusion: It is unlikely that H influenzae type b vaccination or its timing cause type 1 diabetes in children.


Key messages

  • The gradual increase in vaccination programmes does not permit any particular one to be pinpointed as being responsible for the increase in type 1 diabetes in Finland

  • There is no difference in the risk of type 1 diabetes between children not vaccinated against H influenzae type b and those vaccinated at the age of 24 months only

  • The difference in risk between children vaccinated against H influenzae type b at the age of 3 months and those vaccinated at the age of 24 months was not statistically significant

  • It is very unlikely that H influenzae type b vaccination or its timing causes type 1 diabetes in Finnish children




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