Do vaccines cause diabetes?

The relationship between vaccines and diabetes has been the subject of several excellent studies.

The hypothesis that the timing of vaccines either causes or prevents diabetes was tested in 21,421 children who received the Haemophilus influenzae type b (Hib) conjugate vaccine between 1988 and 1990 in the United States. These children were followed for 10 years after receiving the Hib vaccine. The risk of diabetes was indistinguishable from a group of 22,557 children who did not receive the Hib vaccine.

Another excellent study evaluating the relationship between vaccines and diabetes was performed using data from the Vaccine Safety DataLink. Four large health management organizations (HMOs) were used to identify children with diabetes born between 1988 and 1997. All four HMOs maintained registries of children with diabetes and cases were confirmed by means of medical records. Investigators compared 252 cases of diabetes with 768 matched controls. Children who received whole-cell pertussis, MMR, Hib, hepatitis B or varicella vaccines were not at greater risk for diabetes than children who did not receive those vaccines. In accord with the Vaccine Safety DataLink study, several other well-controlled retrospective studies found that immunizations were not associated with an increased risk of developing diabetes.

In 2011 the Institute of Medicine reviewed studies of adverse events related to vaccines. One of the associations studied was whether the tetanus component of the DTaP vaccine caused type 1 diabetes. The committee concluded that development of type 1 diabetes was not caused by receipt of this vaccine. In another study, investigators followed individuals born in 1974 for 20 years who had or had not received the BCG vaccine and found that receipt of vaccine did not increase the risk of diabetes.

Other studies listed below show that children who received the rotavirus, polio, or HPV vaccines were not at greater risk of developing diabetes. In addition, women inoculated with the influenza vaccine during pregnancy were not at increased risk of gestational diabetes.

Therefore, the best available evidence does not support the hypothesis that vaccines cause diabetes.

References

Type 1 diabetes

Klein NP, Goddard K, Lewis E, Ross P, Gee J, et al. Long term risk of developing type-1 diabetes after HPV vaccination in males and females. Vaccine 2019;37(14):1938-1944. 
The authors evaluated whether HPV vaccine was associated with an increased risk of type 1 diabetes over a 10-year period by comparing vaccinated males and females to unvaccinated individuals. They found no increased risk for type 1 diabetes following HPV vaccination in males or females.

Frisch M, Besson A, Clemmensen KKB, Valentiner-Branth P, Molbak K, et al. Quadrivalent human papillomavirus vaccination in boys and risk of autoimmune diseases, neurological diseases and venous thromboembolism. International Journal of Epidemiology 2018;47(2):634-641.
The authors investigated the association of quadrivalent HPV (qHPV) vaccination and the risk of 39 autoimmune diseases, 12 neurological diseases, or venous thromboembolism over a 10-year period in more than 7,000 Danish boys who received at least one dose of qHPV vaccination at the age of 10 to 17 years by comparing them to more than 560,000 boys who did not receive the vaccine. Receipt of qHPV in boys aged 10-17 years was not associated with an elevated risk of neurological diseases, venous thromboembolism, or autoimmune diseases including type 1 diabetes.

Beyerlein A, Strobl AN, Winkler C, et al. Vaccinations in early life are not associated with development of islet autoimmunity in type 1 diabetes high-risk children: results from prospective cohort data. Vaccine 2017;35:1735-1741.
The authors examined the relationship between vaccination and the subsequent development of type 1 diabetes in children with a high familial risk for autoimmune diseases. Vaccination records from more than 1,900 children were evaluated. The authors found no evidence that early vaccinations increased the risk of type 1 diabetes in those at highest risk. 

Vaarala O, Jokinen J, Lahdenkari M, et al. Rotavirus vaccination and the risk of celiac disease or type 1 diabetes in Finnish children at early life. Pediatr Infect Dis 2017;36:674-675.
The authors conducted a nationwide cohort study evaluating whether rotavirus vaccination was associated with the development of type 1 diabetes in Finnish children. In a country that has the highest incidence of type 1 diabetes in the world, researchers found that receipt of the rotavirus vaccine early in life did not alter the risk of type 1 diabetes four to six years after vaccination. 

Morgan E, Halliday SR, Campbell GR, et al. Vaccinations and childhood type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologica 2016;59:237-243.
The authors reviewed studies that compared vaccination rates in 13,000 children with type 1 diabetes with control children, finding no association between receipt of any childhood vaccine and the subsequent development of type 1 diabetes.

Rousseau MC, El-Zein M, Conus F, et al. Bacillus Calmette-Guerin (BCG) vaccination in infancy and risk of childhood diabetes. Paediatr Perinat Epidemiol 2016; 30:141-148.
The authors found no association between receipt of the BCG vaccine in the first year of life and subsequent development of type 1 diabetes during the next 20 years.

Grimaldi-Bensouda L, Guillemot D, Godeau B, et al. Autoimmune disorders and quadrivalent human papillomavirus vaccination of young female subjects. J Int Med 2014;275(4): 398-408.  
The authors reviewed the records of female patients 14-26 years of age to determine if HPV vaccine (Gardasil®) increased the risk of autoimmune disorders. They found no evidence for an increase in the risk of type 1 diabetes, idiopathic thrombocytopenic purpura, multiple sclerosis, Guillain-Barre syndrome, systemic lupus erythematosus (SLE), rheumatoid arthritis, juvenile arthritis, or autoimmune thyroiditis.

Hviid A, Stellfeld M, Wohlfahrt J, et al. Childhood vaccination and type 1 diabetes. New Engl J Med 2004;350:1398-1404.
The authors evaluated all children born in Denmark over a 10-year period to determine if there was a causal relation between childhood vaccinations and development of type 1 diabetes. The authors found no correlation with any vaccine studied, including Hib, DT plus inactivated polio virus (IPV), DTaP + IPV, whole cell pertussis, MMR, or oral polio. In addition, development of type 1 diabetes in genetically predisposed children (e.g. siblings with type 1 diabetes) was not significantly associated with vaccination. 

Black SB, Lewis E, Shinefield HR, et al. Lack of association between receipt of conjugate Haemophilus influenzae type b vaccine (HbOC) in infancy and risk of type 1 (juvenile onset) diabetes: long-term follow-up of the HbOC efficacy trial cohort. Pediatr Infect Dis J 2002; 21(6):568-569. 
The authors performed a 10-year follow-up study of 40,000 children to evaluate the incidence of type 1 diabetes in those who did or didn’t receive the Hib vaccine. The authors found no differences in the rates of type 1 diabetes between these two groups.

DeStefano F, Mullooly JP, Okoro CA, et al. Childhood vaccinations, vaccination timing, and risk of type 1 diabetes mellitus. Pediatrics 2001;108(6).
The authors conducted a large-scale epidemiologic study to determine if the receipt of various childhood vaccines, or the timing of vaccines, increased the risk of developing type 1 diabetes.  Investigators found no evidence for an increased risk of type 1 diabetes among those who received the DTaP, DTP, MMR, Hib, hepatitis B, or varicella vaccines when compared with those who didn’t. Further, the authors found no differences in the risk of type 1 diabetes in babies who received the hepatitis B vaccine at birth as compared with 2 months of age or older.

Karvonen M, Cepaitis Z, Tuomilehto J. Association between type 1 diabetes and Haemophilus influenzae type b vaccination: birth cohort study. BMJ 1999;318:1169-1172. 
The authors investigated the relationship between the timing of Hib vaccination and subsequent development of type 1 diabetes. Patients who did not receive the Hib vaccine were compared to those who received the vaccine at 3 months of age and a booster at 14 to 18 months of age, and those who were vaccinated at 24 months of age only. The authors found no significant differences in the risk of type 1 diabetes among these groups during a 10-year follow-up.

Graves PM, Barriga KJ, Norris JM, et al. Lack of association between early childhood immunizations and β-cell autoimmunity. Diabetes Care 1999;22:1694-1697.
The authors investigated the relationship between vaccination and subsequent development of type 1 diabetes in children ≤ 12 years of age with a first-degree relative with the disease. Investigators found no relationship between receipt of hepatitis B, Hib, polio, or DTP vaccines before 9 months of age and the development of type 1 diabetes.

Heijbel H, Chen RT, Dahlquist G. Cumulative incidence of childhood-onset IDDM is unaffected by pertussis immunization. Diabetes Care 1997;20(2):173-175.
The authors found no differences in the incidence of type 1 diabetes in children within the first 12 years of life between those born before or after pertussis vaccination was excluded from the Swedish national immunization program.

Gestational diabetes

Naleway AL, Irving SA, Henninger ML, et al. Safety of influenza vaccination during pregnancy: a review of subsequent maternal obstetric events and findings from two recent cohort studies. Vaccine 2014;32(26): 3122-3127.
The authors evaluated pregnant women for pregnancy-related complications, including gestational diabetes, to determine if development of these conditions was associated with receipt of inactivated influenza vaccine (IIV). Influenza vaccination during pregnancy did not differ between those who developed gestational diabetes and those who did not. 

Kharbanda EO, Vazquez-Benitez G, Lipkind H, et al. Inactivated influenza vaccine during pregnancy and risks for adverse obstetric events. Obstet Gynecol 2013;122(3):659-667.
The authors compared 74,000 vaccinated females with 140,000 unvaccinated females to determine if vaccination increased the risk for adverse obstetric events. They found no increase in the risk of any obstetric event, including gestational diabetes.