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Association Between Rotavirus Vaccination and Type 1 Diabetes in Children
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2020-05-01 , DOI: 10.1001/jamapediatrics.2019.6324
Jason M Glanz 1, 2 , Christina L Clarke 1 , Stanley Xu 1 , Matthew F Daley 1 , Jo Ann Shoup 1 , Emily B Schroeder 1, 3 , Bruno J Lewin 4 , David L McClure 5 , Elyse Kharbanda 6 , Nicola P Klein 7 , Frank DeStefano 8
Affiliation  

Importance Because rotavirus infection is a hypothesized risk factor for type 1 diabetes, live attenuated rotavirus vaccination could increase or decrease the risk of type 1 diabetes in children. Objective To examine whether there is an association between rotavirus vaccination and incidence of type 1 diabetes in children aged 8 months to 11 years. Design, Setting, and Participants A retrospective cohort study of 386 937 children born between January 1, 2006, and December 31, 2014, was conducted in 7 US health care organizations of the Vaccine Safety Datalink. Eligible children were followed up until a diagnosis of type 1 diabetes, disenrollment, or December 31, 2017. Exposures Rotavirus vaccination for children aged 2 to 8 months. Three exposure groups were created. The first group included children who received all recommended doses of rotavirus vaccine by 8 months of age (fully exposed to rotavirus vaccination). The second group had received some, but not all, recommended rotavirus vaccines (partially exposed to rotavirus vaccination). The third group did not receive any doses of rotavirus vaccines (unexposed to rotavirus vaccination). Main Outcomes and Measures Incidence of type 1 diabetes among children aged 8 months to 11 years. Type 1 diabetes was identified by International Classification of Diseases codes: 250.x1, 250.x3, or E10.xx in the outpatient setting. Cox proportional hazards regression models were used to analyze time to type 1 diabetes incidence from 8 months to 11 years. Hazard ratios and 95% CIs were calculated. Models were adjusted for sex, race/ethnicity, birth year, mother's age, birth weight, gestational age, number of well-child visits, and Vaccine Safety Datalink site. Results In a cohort of 386 937 children (51.1% boys and 41.9% non-Hispanic white), 360 169 (93.1%) were fully exposed to rotavirus vaccination, 15 765 (4.1%) were partially exposed to rotavirus vaccination, and 11 003 (2.8%) were unexposed to rotavirus vaccination. Children were followed up a median of 5.4 years (interquartile range, 3.8-7.8 years). The total person-time follow-up in the cohort was 2 253 879 years. There were 464 cases of type 1 diabetes in the cohort, with an incidence rate of 20.6 cases per 100 000 person-years. Compared with children unexposed to rotavirus vaccination, the adjusted hazard ratio was 1.03 (95% CI, 0.62-1.72) for children fully exposed to rotavirus vaccination and 1.50 (95% CI, 0.81-2.77) for children partially exposed to rotavirus vaccination. Conclusions and Relevance The findings of this study suggest that rotavirus vaccination does not appear to be associated with type 1 diabetes in children.

中文翻译:

轮状病毒疫苗接种与儿童 1 型糖尿病的关系

重要性 因为轮状病毒感染是 1 型糖尿病的一个假设风险因素,所以轮状病毒减毒活疫苗接种可以增加或降低儿童 1 型糖尿病的风险。目的检查轮状病毒疫苗接种与 8 个月至 11 岁儿童的 1 型糖尿病发病率之间是否存在关联。设计、设置和参与者 在疫苗安全数据链的 7 个美国卫生保健组织中对 2006 年 1 月 1 日至 2014 年 12 月 31 日之间出生的 386 937 名儿童进行了回顾性队列研究。对符合条件的儿童进行随访,直至诊断出 1 型糖尿病、退出注册或 2017 年 12 月 31 日。 暴露 2 至 8 个月大的儿童接种轮状病毒疫苗。创建了三个暴露组。第一组包括在 8 个月大之前接种了所有推荐剂量的轮状病毒疫苗的儿童(完全暴露于轮状病毒疫苗接种)。第二组接受了一些(但不是全部)推荐的轮状病毒疫苗(部分暴露于轮状病毒疫苗接种)。第三组未接种任何剂量的轮状病毒疫苗(未接种轮状病毒疫苗)。主要结果和措施 8 个月至 11 岁儿童 1 型糖尿病的发病率。1 型糖尿病由国际疾病分类代码确定:门诊环境中的 250.x1、250.x3 或 E10.xx。Cox 比例风险回归模型用于分析 1 型糖尿病发病时间从 8 个月到 11 年。计算了风险比和 95% CI。模型根据性别、种族/民族、出生年份、母亲年龄、出生体重、胎龄、健康儿童就诊次数和疫苗安全数据链接站点。结果 在 386 937 名儿童(51.1% 男孩和 41.9% 非西班牙裔白人)的队列中,360 169 名(93.1%)完全暴露于轮状病毒疫苗接种,15 765 名(4.1%)部分暴露于轮状病毒疫苗接种,11 003 (2.8%) 未暴露于轮状病毒疫苗接种。儿童的中位随访时间为 5.4 年(四分位距,3.8-7.8 年)。该队列的总人时随访时间为 2 253 879 年。队列中1型糖尿病464例,发病率为20.6例/10万人年。与未接种轮状病毒疫苗的儿童相比,完全接种轮状病毒疫苗的儿童的调整后风险比为 1.03(95% CI,0.62-1.72)和 1.50(95% CI,0.81-2)。77) 部分暴露于轮状病毒疫苗接种的儿童。结论和相关性 本研究的结果表明,轮状病毒疫苗接种似乎与儿童 1 型糖尿病无关。
更新日期:2020-05-01
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