Risk of Celiac Disease Before and After Nationwide Infant Rotavirus Vaccination: A Population-Based Study

Abstract

Objective To study the association between rotavirus vaccination and risk of celiac disease, which remains debated. Study design We conducted a nationwide register-based study including 740 744 children born during 2007-2019 from the Norwegian Birth Registry individually linked to the Norwegian Patient Registry for celiac disease diagnosis. With follow-up until 5 years of age, 2795 were diagnosed with celiac disease. The main analysis was an interrupted time series analysis to assess break in trend of celiac disease incidence before compared with after vaccine introduction in September 2014. Furthermore, we linked the cohort to the Norwegian Immunization Register and compared the risk of celiac disease between fully vaccinated and nonvaccinated children. In sensitivity analyses, we excluded children born 1 year before to 1 year after vaccine introduction to mitigate the effect of herd immunity. Results There was no significant break in trend after rotavirus vaccine introduction (P = .46). Hazard ratio (HR) of celiac disease was 0.96 (95% CI 0.89-1.04) if born after compared with before vaccination started, and 1.00 (95% CI 0.92-1.09) when excluding children born in 2013-2015. In fully vaccinated compared with nonvaccinated the HR was 0.99 (95% CI 0.92-1.07), consistent in robustness analyses. Including a requirement for gluten-free diet support in the celiac disease case definition gave similar results (HR 1.06, 95% CI 0.98-1.15). Conclusions This study did not find an association between rotavirus vaccine and the risk of early-onset celiac disease.