from 7 European centers with population-based diabetes registers

tetanus, diphtheria, pertussis,* rubella, measles, mumps, and Hib

of childhood onset diabetes

Diphtheria = 1.27 (0.63-2.56)

Pertussis = 0.83 (0.63-1.09)

Rubella = 1.27 (0.93-1.72)

Measles = 1.10 (0.84-1.42)

Mumps = 1.03 (0.82-1. 30)

Hib = 0.75 (0.30-0.92)


of any vaccine

Karvonen et al. (1999a)


10-year followup of three cohorts of Finnish children:

Cohort 1 = 128,936 (born 1983–1985);

Cohort 2 = 59,238

Cohort 3 = 57, 114 (born 1985–1987), assignment to cohort 2 or 3 based on odd (2) or even (3) day of birth

3 Vaccine exposure cohorts: 1) born before Hib availability; 2) participating in Hib efficacy trial, vaccination at 3, 4, 6, and 14–18 months; and 3) Hib at 24 months only Children assumed to also have received BCG, diphtheria-tetanus-pertussis,* polio, and measles-mumps-rubella vaccines

New IDDM cases in each cohort, reported in nationwide hospital disease registry (1983–1986) or nationwide prospective childhood diabetes registry (post-1987)

RR of diabetes by age 10 (P-value):

Cohort 3 vs. Cohort 1 = 1.01 (p=0.228)

Cohort 2 vs. Cohort 3 = 1.06 (p=0.545)

Vaccine exposure and diabetes cases based on aggregate data from three cohorts and from population. Interpretation at level of individual is difficult

Weak evidence relevant to causality. Favors no effect of adding Hib to the vaccine schedule

Heijbel et al. (1997)


Birth cohorts of Swedish children with and without routine pertussis vaccination for the following years: 1977(n = 96,057), 1978 (n =

Exposure to diphtheria-tetanus or diphtheria-tetanus-pertussis* determined from yearly vaccination reports from child health centers. Pertussis vaccine exposure based on reported released doses of vaccines

Cumulative incidence of IDDM to age 12 in each birth cohort, determined from national registry

No difference in cumulative IDDM incidence in birth cohorts

Immunization data population-only. Not known if children received other vaccines besides DT or DTP. No statistical analysis

Weak evidence relevant to causality. Favors no effect of pertussis vaccine

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