Xu ZR, Xi L, Wu J, Ni JW, Luo FH, Zhang MY. COVID-19 infection and inactivated vaccination: Impacts on clinical and immunological profiles in Chinese children with type 1 diabetes. World J Diabetes 2024; 15(12): 2276-2284 [DOI: 10.4239/wjd.v15.i12.2276]
Corresponding Author of This Article
Miao-Ying Zhang, MD, Doctor, Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children's Hospital of Fudan University, No. 399 Wan Yuan Road, Minhang District, Shanghai 201102, China. miaoyingzhang@126.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Zhen-Ran Xu, Li Xi, Jing Wu, Jin-Wen Ni, Fei-Hong Luo, Miao-Ying Zhang, Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
Co-corresponding authors: Fei-Hong Luo and Miao-Ying Zhang.
Author contributions: Luo FH and Zhang MY contribute equally to this study as co-corresponding authors. Zhang MY, Xu ZR and Luo FH designed the study, analyzed and interpreted data, wrote and revised the manuscript; Xi L contributed to patient management and data collection; Wu J and Ni JW contributed to acquisition of data and drafting the article; all authors contributed to final approval of the version to be published.
Supported byNational Key Research and Development Program of China, No. 2021YFC2701900 and No. 2016YFC1305300.
Institutional review board statement: This study was approved by the Ethics Commission of Children’s Hospital of Fudan University (No. 2022-183).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data retrospectively. All included patients signed informed consent forms during hospitalization and agreed to use their clinical data for future research.
Conflict-of-interest statement: No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.
Data sharing statement: Data of the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miao-Ying Zhang, MD, Doctor, Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children's Hospital of Fudan University, No. 399 Wan Yuan Road, Minhang District, Shanghai 201102, China. miaoyingzhang@126.com
Received: July 1, 2024 Revised: August 27, 2024 Accepted: October 22, 2024 Published online: December 15, 2024 Processing time: 139 Days and 16.7 Hours
Abstract
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis (DKA). However, the relationship between COVID-19 infection and progression to type 1 diabetes (T1D) in children has not been well defined.
AIM
To evaluate the influence of COVID-19 infection and inactivated vaccine administration on the progression of T1D among Chinese children.
METHODS
A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Fudan University between September 2020 and December 2023. The patients were divided into three groups based on their history of COVID-19 infection and vaccination: the infection group, the vaccination-only group, and the non-infection/non-vaccination group. Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.
RESULTS
The incidence of DKA was significantly higher in the COVID-19 infection group (70.2%) compared to the non-infection/non-vaccination group (62.5%) and vacscination-only group (45.6%; P = 0.015). Prior COVID-19 infection was correlated with increased DKA risk (OR: 1.981, 95%CI: 1.026-3.825, P = 0.042), while vaccination was associated with a reduced risk (OR: 0.558, 95%CI: 0.312-0.998, P = 0.049). COVID-19 infection mildly altered immune profiles, with modest differences in autoantibody positivity, lymphocyte distribution, and immunoglobulin levels. Notably, HLA-DR3 positive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection (both P < 0.05).
CONCLUSION
COVID-19 infection predisposes children to severe T1D, characterized by enhanced DKA risk. Inactivated vaccination significantly lowers DKA incidence at T1D onset. These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.
Core Tip: Much remains unknown regarding the association between the infection and vaccination of coronavirus disease 2019 (COVID-19) and the progression of type 1 diabetes (T1D). In this study, we analyzed the features of newly diagnosed T1D children after COVID-19 infection and inactivated vaccination in China. A history of COVID-19 infection was associated with a greater risk of DKA at the onset of T1D, whereas inactivated vaccination significantly lowered DKA incidence. Furthermore, HLA-DR3 positive children with COVID-19 infection had earlier T1D onset and lower fasting C-peptide levels, suggesting that COVID-19 infection predisposes HLA-DR3 positive children to severe T1D.
