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Rotavirus vaccine prevents diabetes in children – strong scientific evidence

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Two recent peer-reviewed papers have provided strong evidence that the rotavirus vaccine prevents diabetes in children. Basically, the research shows that a rotavirus infection increases the risk for type 1 diabetes and preventing that infection with the vaccine lowers that risk.

These articles add to previous studies that have established linked between the vaccine and a lower risk of type 1 diabetes. So are we getting close to claiming that the rotavirus vaccine prevents diabetes in children? The evidence is very strong.

 

What is diabetes?

Type 1 diabetes is an autoimmune disease which is characterized by parts of the immune system destroying the pancreatic islet cells, which are critical to glucose metabolism since those cells produce insulin. The immune system mistakenly attacks the islet cells as if they were a foreign body, as they do with a viral or bacterial infection.

Once the pancreatic islet cells are damaged, they no longer produce hormones, especially insulin, that help regulate the levels of blood glucose. Without insulin, the blood glucose levels increase rapidly leading to long-term damage to eyesight, kidneys, limbs, heart and other organs.

It is not known what triggers this autoimmune disease, although there is strong evidence that genetics is the most important factor. However, other environmental triggers may be implicated, like vaccine-preventable diseases and other infections.

Just to be clear, vaccines are not linked to type 1 diabetes.

Currently, there are no known cures for type 1 diabetes. The only treatment for the disease is regular injections of human insulin, manufactured from genetically engineered E. coli cultures. In addition, careful diet and lifestyle management help regulate blood glucose levels, although it cannot replace insulin injections.

Type 1 diabetes can be deadly if the uncontrolled blood sugar leads to a life-threatening condition called diabetic ketoacidosis. Without regular insulin injections, a patient has little chance of living beyond a short period of time, and even then it could be a horrifically painful demise.

Even then, poor glucose control can lead to long-term complications like blindness (diabetic retinopathy), neuropathy, cardiovascular disease, and many other conditions (see Note 1).

Rotavirus and the vaccine

Rotaviruses are the most common cause of diarrheal disease among infants and young children across the world. Nearly every child in the world is infected with one of the nine different species of rotavirus at least once by the age of five.

The virus is transmitted by the fecal-oral route usually from contaminated objects, foods, or unwashed hands. Rotavirus infection is mostly observed in infants and young children. However, even older children and adults are known to become infected with the virus.

The virus infects and damages the cells that line the small intestine, causing gastroenteritis, which some people incorrectly call the “stomach flu,” a disease that does not exist.

Rotavirus is spread easily in schools, daycare, and within houses. Good hygiene (handwashing) and cleanliness are important but are not enough to control the spread of the disease. You can be immaculately clean, but the virus just moves from person to person quickly and easily.

One of the primary issues with the rotavirus is that once a person has been exposed to infection, it takes about 2 days for the symptoms to appear. Thus, the virus can be easily passed between individuals before the infected child becomes symptomatic.

The complications of rotavirus infection are not minor. Children who get infected may have severe watery diarrhea, often with vomiting, fever, and abdominal pain. These symptoms can last for 3-8 days, during which the child has to be closely watched for dehydration and loss of appetite, dangerous conditions for infants and children.

Before the introduction of the vaccine in the USA in 2006, rotavirus infection caused significant morbidity among U.S. children, with an estimated 55,000–70,000 hospitalizations and 410,000 clinic visits annually. According to an analysis of 10 years of rotavirus infections in the USA before the introduction of the vaccine, rotavirus was estimated to be the cause of approximately 2.7 million (yes million) cases of severe gastroenteritis, 60,000 hospitalizations and 37 deaths annually.

Worldwide, more than 450,000 children under five years of age still die from rotavirus infection each year. Think about that–nearly one-half million children die from a disease that could be prevented by a simple vaccine, every single year.

In 2006, the rotavirus vaccine (see Note 2) was first included in the childhood vaccination schedule in the USA. Subsequently, there was a substantial, sustained decline in rotavirus circulation both nationally and regionally, as well as a shift in the epidemiology of this virus.

Rotavirus vaccine prevents diabetes – first paper

As I mentioned above, the cause of type 1 diabetes is related to a complex relationship between many genetic and environmental factors (although, again, not vaccines). However, one of the current hypotheses about the cause is that certain infections in early childhood are the trigger for type 1 diabetes, especially in children who have a genetic disposition to the disease.

One of the leading culprits is rotavirus.

In an article in PLOS Pathogens, Dr. Leonard C. Harrison, of the Walter and Eliza Hall Institute for Medical Research at the University of Melbourne in Australia, and colleagues presented data that support their hypothesis of a link between rotavirus and type 1 diabetes in children. 

The researchers were examining data that showed that there had been a 15% decrease in the incidence of type 1 diabetes in Australian children under four years of age since the introduction of the vaccine in the country. This data suggested that the rotavirus vaccine could contribute to the prevention of not only a rotavirus infection but also type 1 diabetes.

This finding complements a substantial body of human and animal studies that have shown a potential link between rotavirus and type 1 diabetes in genetically susceptible children.

The article by Harrison et al., the researchers reviewed biochemical evidence that supported their hypothesis which included the association between rotavirus infection and the auto-antibodies that are implicated in damaging the insulin-producing cells in the pancreas.

Harrison et al. also examined the possibility that the rotavirus infection may have a direct effect on pancreatic pathology which could be an additional causal factor for type 1 diabetes.

Of course, further research is necessary to determine the mechanism by which rotavirus is linked to diabetes, but there are several biologically plausible mechanisms.

For example, during the 1970s, the practice of mothers “rooming-in” with their newborns was introduced in Australia. This practice entailed the mother and baby remaining together after birth rather than taking the baby to a communal nursery (watch some older TV shows or movies with a newborn, and you’ll see the communal nursery, which happened way before the birth of my own children, who were in the room with the mother and me almost full-time).

Rotavirus infections were relatively common in the newborn nurseries, so the child was exposed to the disease early on. Today, those babies stay with mothers reducing the risk of the disease until later.

The researchers suggested that the timing of the rotavirus infection was important – babies who were infected soon after birth (or never were infected) had a lower risk of developing diabetes than those who were infected at a later time.

This type of study is critical to determining if correlation implies causation – it provides powerful biologically plausible reasons for a correlation between the rotavirus vaccine and a lowered risk of type 1 diabetes mellitus.

Rotavirus vaccine prevents diabetes – second paper

In a second article published in Nature Scientific Reports, by Dr. Mary AM Rogers of the Department of Internal Medicine at the University of Michigan and colleagues, the researchers examined the link between the rotavirus vaccine and type 1 diabetes in children. The designed a cohort study of nearly 1.5 million infants born in the USA from 2001-2017. The data was from a nationwide health insurer, one of the best ways to track the healthcare of individuals over time.

Here are the most important results of this study:

  • The was a 33% lower risk of type 1 diabetes after the completion of the monovalent rotavirus vaccine (Rotarix) series compared to unvaccinated children.
  • There was a 37% lower risk after the pentavalent rotavirus vaccine (RotaTeq) series. 
  • Importantly, there was no change in the incidence of diabetes after an incomplete series of either vaccine.
  • There was a 31% reduction in hospitalizations in the 60-day period after either vaccination. In other words, other than preventing type 1 diabetes, the vaccine reduced hospitalizations from the disease itself.

Across the USA there has been a 3.4% annual decrease in the incidence of type 1 diabetes in children ages 0-4 from 2006 through 2017, which coincides with the introduction of the rotavirus vaccines in the USA. Although population-level data is not definitive of a causal relationship, when combined with the data from these two papers, the evidence becomes much more powerful.

One bad study

As we all know, anti-vaxxers tend to ignore powerful, well-designed studies to cherrypick weak, unrepeated studies that support their predetermined conclusions about any vaccine. In an article, by Chodick et al., published in a low impact factor journal that’s not even indexed in PubMed (which indexes every medical journal, unless it’s really bad), the researchers try to claim that the rotavirus vaccine is linked to a higher risk of type 1 diabetes.

I won’t spend much time discussing this article since it is laughably poor. It only includes 16 (yes, 16) patients, and then try to claim that they have DATA!!!

Please compare this to the Perret et al. and Rogers et al. studies that include millions of patients. These are robust studies that provide powerful evidence of a correlation between the vaccine and the reduction of type 1 diabetes.

On the other hand, the Chodick et al. article provides us with no evidence of a correlation between the rotavirus vaccine and an increase in type 1 diabetes. And if you can’t show correlation, you absolutely cannot show causation.

Summary

These two papers present powerful, well-designed research that provides strong evidence that the rotavirus vaccine prevents diabetes. So, the vaccine not only prevents a dangerous disease that causes the hospitalization of hundreds of thousands of children, but it may reduce the risk of a chronic disease that is even more dangerous.

Does it prevent all cases of type 1 diabetes? No. That’s because diabetes is very complex, but we do appear to have identified one causal factor.

I’m sure that some anti-vaxxer is going to say, “well I’ll just let my precious child catch rotavirus naturally, and I’ll protect her from diabetes.” No, it doesn’t work that way.

First, it appears that timing matters. Getting vaccinated earlier reduces the risk of type 1 diabetes. And you can’t control the timing of a “natural” rotavirus infection, because you might know where it is.

Second, rotavirus infections are dangerous. They are deadly. 

So, get the vaccine for the child. Because the rotavirus vaccine prevents diabetes. 

Notes

  1. In case the reader is wondering, type 2 diabetes is a substantially different disease from type 1. Mostly, type 2 diabetics produce insulin, just an insufficient amount to regulate glucose levels, or their cells have become resistant to insulin because of lifestyle issues (obesity, lack of physical activity, and diet) and genetic predisposition. There is almost no relationship between type 1 and most forms of type 2 diabetes, except they share the same symptoms of high blood sugar. There are also other diseases called “diabetes,” including diabetes insipidus and gestational diabetes that share some similar symptoms to type 1 and 2 diabetes, but have different pathophysiologies. 
  2. Dr. Paul Offit co-developed one of the rotavirus vaccines, RotaTeq. We should thank him for helping prevent the deaths of hundreds of thousands of children across the world. The end.

Citations

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