To the Editor We read with interest the Research Letter of Perrett et al1 on the association of rotavirus vaccination with the incidence of type 1 diabetes (T1D) in children in Australia. Comparing the observed or model-based incidence of T1D before and after the introduction of the oral rotavirus vaccination to the Australian National Immunisation Program in 2007, Perrett et al1 provided evidence that the incidence of T1D in the age group 0 to 4 years has declined by 14% after the introduction of routine rotavirus immunization, while there was observed no change in children aged 5 to 14 years. However, it cannot be excluded that the observed association may represent a spurious correlation owing to an ecologic fallacy.2
Rosenbauer J, Castillo K, Bächle C. Role of Rotavirus Vaccination in Decline in Incidence of Type 1 Diabetes. JAMA Pediatr. 2019;173(9):893–894. doi:10.1001/jamapediatrics.2019.2466
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