What do you make of the latest reports about the association between type 1 diabetes and Hib vaccine?

For some time of course it has been acknowledged that Type�1A diabetes is an autoimmune disease and also that some environmental factor is needed to trigger this autoimmune process in genetically susceptible subjects. There have been many suggestions as to the nature of this elusive factor, early exposure to certain specific beta caseins in cows milk has been in fashion; but ever since the recognition of the link between maternal rubella and childhood diabetes has been acknowledged there has been a constant search for other viruses that might play a similar role. There is also the basic observation that any antigen given either orally or parenterally may produce either the usual conventional immune response in lymphocytes and in the production of antibodies or on occasion may provoke autoimmunity. It was exactly this risk that for a time held up the implementation of the DPT-1, the national Diabetes Prevention Trial.

In these circumstances when there has been a significant increase in immunisation procedures, it is appropriate that Dr. Classen should question the timing and cost-benefit of childhood immunisation. The BMJ paper makes a case against flu vaccine. The Diabetes Care (22 (10): 1760, 1999) letter looks at another aspect of the problem by suggesting that immunisations be given early as a means of preventing maternally transmitted viruses from initiating the autoimmune process. To offset these proposals there is the study by Graves et al in Diabetes Care (22:1694) concluding that “changing the early childhood immunisation program would not affect the risk of developing beta cell autoimmunity….” So far neither the American Academy of Pediatrics nor the Communicable Disease Center have thought that there is enough convincing evidence to suggest altering the present immunisation schedules.

If we are to comment I think it should be to reassure families that there is no special risk to immunisation in children that already have diabetes. For children who might be presumed to be at risk because of first degree relatives with Type 1A diabetes, I think that you can truthfully say that at this time there insufficient evidence to show that the risks of immunisation offset the very clear benefits. They should be immunised; but strictly in accord with the Academy of Pediatrics schedule.

DOB

[Editor’s comment: Dr. Classen’s reports related to immunizations can be found on his vaccines.net web site. The web site is run by Classen Immunotherapies, Inc., owned by John Barthelow Classen, M.D., and author of the reports. Also, see our page about immunizations and Questions and Answers about Diabetes and Vaccines from the Centers for Disease Control web site.

JSH]