A Case-Control Study of Group B Coxsackievirus Immunoglobulin M Antibody Prevalence and HLA-DR Antigens in Newly Diagnosed Cases of Insulin-dependent Diabetes Mellitus

• Published in: American journal of epidemiology 1992-06, Vol.135 (12), p.1331-1338
• Main Author: D'ALESSIO, D. J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antibodies, Viral - blood; Biological and medical sciences; Case-Control Studies; Chi-Square Distribution; Child; Child, Preschool; Coxsackie B viruses; Coxsackievirus Infections - complications; Coxsackievirus Infections - epidemiology; diabetes mellitus; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 1 - microbiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enterovirus B, Human - immunology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; HLA-DR antigens; HLA-DR Antigens - blood; Humans; IgM; Immunoglobulin M - blood; Infant; insulin-dependent; Male; Medical sciences; Prevalence; Seroepidemiologic Studies; Wisconsin - epidemiology
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/oxfordjournals.aje.a116244

From July 1984 through June 1987, we sought referral of all newly diagnosed cases of insulin-dependent diabetes mellitus aged 0–29 years in a 14-county area of southern Wisconsin. Each case was asked to identify an age- and sex-matched friend control. Blood specimens were obtained for group B Coxsackievirus immunoglobulin M (IgM) neutralizing antibody titer on cases and controls and HLA-DR typing of cases. There were 225 cases referred, of whom 194 participated. Of these, 134 had both HLA-DR typing and an initial serum specimen drawn within 59 days of diagnosis. Only two of 50 insulin-dependent diabetes mellitus cases less than age 9 years had positive (≥1: 16) group B Coxsackievirus IgM titers. Fifteen of 84 cases aged 10–29 years (17.8%) were group B Coxsackievirus IgM positive, compared with five of 71 controls (7.0%). However, group B Coxsackievirus IgM antibody positivity was concentrated in HLA-DR3-positive cases (10 of 39, odds ratio = 4.55, 95% confidence interval 1.26–18.27, p< 0.01). HLA-DR3-negative cases were not different from controls in group B1 Coxsackievirus IgM prevalence. Eighty-three percent of the cases and 86% of the group B Coxsackievirus IgM-positive cases were referred in the first 24 months of study. These data demonstrate an association between group B Coxsackievirus infections and onset of insulin-dependent diabetes mellitus only in HLA-DR3-positive persons aged 10 years or older. The data also suggest that diabetogenic group B Coxsackievirus strains may circulate only periodically; however, a longer period of study is needed to examine this possibility. Am J Epidemiol 1992; 135: 1331–8