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Researchers found that kids exposed to enteroviruses are more likely to develop the autoimmune disease.

January 10, 2017

A new study suggests that a common virus may increase children’s risk for developing type 1 diabetes, raising the possibility that a vaccine may one day help prevent the lifelong disease. The research is not the first to make a connection between enteroviruses and diabetes, but the authors say it’s the largest and most definitive study to date. 

Enteroviruses are a group of viruses that usually cause mild illnesses, like the common cold. Certain strains of enterovirus—such as the poliovirus, enterovirus-D68, and coxackievirus (also known as hand, foot, and mouth disease)—can cause more serious symptoms.

Previous research has also suggested that children exposed to enteroviruses are more likely to develop type 1 diabetes, an autoimmune disease that damages insulin-producing cells in the pancreas, than those who have not. To further study this link, researchers at the University of Tampere in Finland tested more than 1,600 stool samples from 129 children who had recently developed diabetes and 282 non-diabetic children for enterovirus RNA—a marker of previous infection. They found a significant difference between the groups: Only 60% of the control group showed signs of prior infection, versus 80% of the newly diabetic group.

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The results, published in the journal Diabetologica, also showed that enterovirus infection typically occurred more than a year before children tested positive for islet autoantibodies, the first sign of type 1 diabetes. Taking this time lag into account, the researchers determined that children with diabetes have roughly three times more enterovirus infections than those without the disease.

The study could not prove a cause-and-effect relationship between enteroviruses and diabetes. But the authors say that large, international studies are in progress to better understand how these viruses—and which strains, specifically—may damage the pancreas. They are hopeful that one day, a vaccine might be developed to protect against those strains associated with diabetes.

“One could assume that such vaccine would give efficient protection against these viruses; in fact, this has already been demonstrated in mouse studies,” lead author Hanna Honkanen, PhD, a researcher in the department of virology, told Health via email. “In [an] optimal situation we could have results from human trials after 10 years.”

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Jessica Dunne, PhD, director of discovery research at JDRF (formerly the Juvenile Diabetes Research Foundation), agrees that the potential for a new enterovirus vaccine is exciting.

“Enteroviruses are not the only trigger for diabetes, so it’s important to note that even if we prevented all enterovirus infections we probably wouldn’t be able to prevent all cases of type 1 diabetes,” says Dunne, who was not involved in the new research. “But even if we could prevent 30% or 50% of cases, I think it would go a long way.”

For now, Honkanen says parents shouldn’t worry about their children being exposed to enteroviruses. “All children will have several enterovirus infections,” she wrote. “Thus, it is clear that additional factors—e.g. genetic factors—are needed for the development of diabetes.” 

It makes sense to safeguard kids against these viruses the same way one would against cold and flu: Encourage them to wash their hands frequently and keep their distance from others who are sick. But besides that, there’s no practical way to avoid infection. “We don’t want to keep our kids in bubbles,” Dunne says.

Overall, she adds, there appear to be multiple pathways to developing type 1 diabetes. “In some way, enterovirus may be a trigger to going down the path to autoimmunity,” she says. “But even for kids who may be at risk for developing type 1 diabetes, there are probably a lot of other things that have to happen to go all the way down that path.”