Bacille Calmette-Guérin Vaccination and Incidence of IDDM in Montreal, Canada

OBJECTIVE To describe the association between Bacille Calmette-Guérin (BCG) vaccination and IDDM development in two different case-control series (A and B) in Montreal. RESEARCH DESIGN AND METHODS Case-control series A comprised 93 IDDM cases and 2,903 control subjects who participated in a community-based tuberculin reactivity survey and who belonged to the same birth cohorts and areas of residence as the IDDM cases, Case-control series B comprised 249 IDDM cases and 431 age- and sex-matched friends and neighborhood control subjects. RESULTS In series A, the BCG vaccination prevalence among cases and control subjects was 21.5% (95% CI 13.2–29.8%) and 22.3% (95% CI 20.8–23.8%), respectively. The odds ratio (OR) for IDDM associated with BCG vaccination was 1.09 (95% CI 0.62–1.91), after adjusting for the birth cohorts and areas of residence. The vaccination prevalence in series B was 17.7% (95% CI 13.0–22.4%) among cases and 15.1% (95% CI 11.7–18.5%) among control subjects. The OR for IDDM due to BCG vaccination was 1.26 (95% CI 0.79–2.02), taking into account the matched sets. Only one case (3.3%) from series B who had been vaccinated at birth was diagnosed by age 5, compared with 52 cases (24.5%) who had not been vaccinated (P < 0.01). CONCLUSIONS The lower proportion of birth-vaccinated IDDM cases diagnosed at a very young age, compared with nonvaccinated cases, possibly reflects a temporary boost of the immune functions after vaccination. However, as a whole, results from these analyses fail to support a protective role of BCG vaccination against juvenile-onset IDDM.

[1]  P. Avner,et al.  The immunology of diabetes mellitus , 1991, Nature.

[2]  J. Siemiatycki.  Friendly control bias. , 1989, Journal of clinical epidemiology.

[3]  R Menzies,et al.  Effect of bacille Calmette-Guérin vaccination on tuberculin reactivity. , 1992, The American review of respiratory disease.

[4]  Secular Trends in Incidence of Childhood IDDM in 10 Countries , 1990, Diabetes.

[5]  G. Eisenbarth,et al.  Type-I diabetes: a chronic autoimmune disease of human, mouse, and rat. , 1990, Annual review of immunology.

[6]  M. Belmonte,et al.  Prospective Study of Insulin-dependent Diabetes Mellitus , 1981, Diabetes.

[7]  K. Lafferty,et al.  Altered cytokine activity in adjuvant inhibition of autoimmune diabetes. , 1993, Journal of autoimmunity.

[8]  M. Harada,et al.  Prevention of overt diabetes and insulitis in NOD mice by a single BCG vaccination. , 1990, Diabetes research and clinical practice.

[9]  M. Belmonte,et al.  Epidemiologic Survey of Juvenile-Onset Diabetes in Montreal , 1979, Diabetes.

[10]  A. Frappier,et al.  BCG vaccination and pulmonary tuberculosis in Quebec. , 1971, Canadian Medical Association journal.

[11]  G. Draper,et al.  B.C.G. vaccination and leukaemia mortality. , 1971, Lancet.

[12]  M. Matsumoto,et al.  Possible mechanism of the preventive effect of BCG against diabetes mellitus in NOD mouse. II. Suppression of pathogenesis by macrophage transfer from BCG-vaccinated mice. , 1991, Cellular immunology.

[13]  J. Lakey,et al.  BCG immunotherapy prevents recurrence of diabetes in islet grafts transplanted into spontaneously diabetic NOD mice. , 1994, Transplantation.

[14]  G. Warnock,et al.  Prevention of Recurrence of IDDM in Islet-Transplanted Diabetic NOD Mice by Adjuvant Immunotherapy , 1992, Diabetes.

[15]  M. Sadelain,et al.  Prevention of Type I Diabetes in NOD Mice by Adjuvant Immunotherapy , 1990, Diabetes.

[16]  F. Calcinaro,et al.  Effect of adjuvant therapy on development of diabetes in mouse and man , 1994, The Lancet.

[17]  A. Drash,et al.  Initial Pathogenic Events in IDDM , 1989, Diabetes.

[18]  A. Green,et al.  Concordance rates of insulin dependent diabetes mellitus: a population based study of young Danish twins , 1995, BMJ.

[19]  S. Pek,et al.  Prevention of Insulitis and Diabetes Onset by Treatment With Complete Freund's Adjuvant in NOD Mice , 1991, Diabetes.

[20]  J Siemiatycki,et al.  Case-Control Study of IDDM , 1989, Diabetes Care.

[21]  Y. Tochino.  The NOD mouse as a model of type I diabetes. , 1987, Critical reviews in immunology.

[22]  R. Misaki,et al.  Possible mechanism of the preventive effect of BCG against diabetes mellitus in NOD mouse. I. Generation of suppressor macrophages in spleen cells of BCG-vaccinated mice. , 1991, Cellular immunology.

[23]  Gareth Williams.  IDDM: long honeymoon, sweet ending , 1994, The Lancet.

[24]  A. Cooke,et al.  Mycobacteria precipitate an SLE-like syndrome in diabetes-prone NOD mice. , 1994, Immunology.

[25]  J. Lakey,et al.  Prevention of recurrence of insulin-dependent diabetes mellitus in islet cell-transplanted diabetic NOD mice using adjuvant therapy. , 1992, Transplantation proceedings.

[26]  M. Belmonte,et al.  Incidence of IDDM in Montreal by Ethnic Group and by Social Class and Comparisons With Ethnic Groups Living Elsewhere , 1988, Diabetes.

[27]  M. Belmonte,et al.  The distribution of type I (insulin-dependent) diabetes mellitus by age, sex, secular trend, seasonality, time clusters, and space-time clusters: evidence from Montreal, 1971-1983. , 1986, American journal of epidemiology.