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Comment & Response
June 29, 2020

The Percentage of Children Who Developed Type 1 Diabetes After Rotavirus Vaccination—Reply

Author Affiliations
  • 1Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. Published online June 29, 2020. doi:10.1001/jamapediatrics.2020.1082

In Reply We thank Rogers for her interest in our article.1 The question of whether rotavirus vaccination may affect the risk of type 1 diabetes (T1D) is certainly worthwhile to investigate using a variety of epidemiologic methods. Although information from cohort studies can be analyzed in several different ways, we feel that MarketScan data, which we used in our analysis, is best analyzed with person-time as the denominator,1 as was done by Rogers and colleagues2 in their study on this topic. While the timing of viral challenge with wild-type rotavirus may be unknown in our study population, the timing of vaccination is well documented owing to the use of insurance claims data and the inclusion criterion of continuous enrollment since birth. In contrast, once a child is lost to follow-up, the timing and occurrence of T1D is unknown. Furthermore, loss to follow-up (caused by change in insurance status) may be different in children who are completely unvaccinated compared with children who receive routine vaccinations, which is one reason we subset our main analysis population to those children who had received at least 1 dose of diphtheria-tetanus-pertussis (DTaP) vaccine by age 1 year. Lastly, T1D risk in children is not static and tends to increase with age.3,4

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