COVID-19 infection and inactivated vaccination: Impacts on clinical and immunological profiles in Chinese children with type 1 diabetes.

IF 4.2 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

World Journal of Diabetes Pub Date : 2024-12-15 DOI:10.4239/wjd.v15.i12.2276

Zhen-Ran Xu, Li Xi, Jing Wu, Jin-Wen Ni, Fei-Hong Luo, Miao-Ying Zhang

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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.

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背景：冠状病毒病2019（COVID-19）大流行与糖尿病和糖尿病酮症酸中毒（DKA）发病率增加有关。目的：评估COVID-19感染和接种灭活疫苗对中国儿童T1D进展的影响：方法：回顾性纳入2020年9月至2023年12月期间复旦大学附属儿童医院新确诊的197例T1D患者。根据COVID-19感染史和疫苗接种史将患者分为三组：感染组、仅接种疫苗组和未感染/未接种疫苗组。对这些组别进行了全面的临床评估和详细的免疫学评价，以确定其特征和免疫反应：结果：与未感染/未接种组（62.5%）和仅接种组（45.6%；P = 0.015）相比，COVID-19感染组（70.2%）的DKA发病率明显更高。之前感染 COVID-19 与 DKA 风险增加相关（OR：1.981，95%CI：1.026-3.825，P = 0.042），而接种疫苗与风险降低相关（OR：0.558，95%CI：0.312-0.998，P = 0.049）。COVID-19 感染轻微改变了免疫特征，自身抗体阳性率、淋巴细胞分布和免疫球蛋白水平差异不大。值得注意的是，与HLA-DR3阴性且有感染史的儿童相比，HLA-DR3阳性且有COVID-19感染史的儿童T1D发病更早，空腹C肽水平更低（P均<0.05）：结论：COVID-19感染易使儿童患上严重的T1D，其特点是DKA风险增加。结论：COVID-19 感染易导致儿童患上严重的 T1D，其特征是 DKA 风险增加。灭活疫苗接种可显著降低 T1D 发病时的 DKA 发生率。这些发现对指导未来在普通儿科人群中流行病情况下的疫苗接种和T1D风险监测策略很有价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

自引率

2.40%

发文量

909

期刊介绍： The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.