Enterovirus Infection Increases Type 1 Diabetes Risk

Enterovirus infection increases a child’s risk of developing type 1 diabetes mellitus (T1DM), according to a study by researchers in Taiwan.

Published online on October 17, 2014, in Diabetologia, the study examined insurance claims from a national database to determine the diabetes incidence rate among children aged 18 years and under, with or without an enterovirus infection, from 2000 to 2008. The researchers found the overall incidence rate for T1DM was 5.73 per 100,000 person-years in the enterovirus infection cohort, compared with an incidence rate of 3.89 per 100,000 person-years in the non-enterovirus infection cohort.

The authors noted an accelerating epidemic of T1DM across different geographical regions of the world that genetic factors cannot explain away.

“Genetic predisposition may explain the high incidence of type 1 diabetes in Finland. However, in Asia, Africa, and South America, which have a low but increasing incidence of type 1 diabetes and a high prevalence of enterovirus infection, environmental factors such as enterovirus infection may play a vital role,” the authors wrote. "We believe that the marked escalation of the said incidence in recent decades can be largely attributed to the highly endemic spread of enterovirus infection in Taiwanese children, given that there has been little gene flow and genetic drift in such a short period.”

In the study, the T1DM incidence rate was consistently lower in the non-enterovirus cohort, except among children aged 10 years or older and those with allergic rhinitis or bronchial asthma. Compared with the non-enterovirus group, the enterovirus cohort also had significantly higher prevalence of atopic dermatitis, allergic rhinitis, and bronchial asthma.

Enterovirus infection, which includes polioviruses, coxsackieviruses, and echoviruses, is usually benign and occurs in limited epidemics during the summer and fall months. The current outbreak of enterovirus D68 in the United States has infected 922 people in 46 states with 2 fatalities as of October 20, 2014.

In light of the positive correlation found between the incidence of enterovirus and T1DM, the study authors concluded that further research and a proactive vaccination strategy should be explored.

“Whilst the evidence of an association between enterovirus infection and pathogenesis is observational, the conclusions are solid enough to guide further research on this association,” the researchers wrote. “The findings suggest that a vaccination strategy against enterovirus infection might slow the rising incidence of type 1 diabetes.”