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Åke Lernmark

Principal investigator

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A method for reporting and classifying acute infectious diseases in a prospective study of young children: TEDDY

Author

  • Maria Lönnrot
  • Kristian Lynch
  • Helena Larsson
  • Åke Lernmark
  • Marian Rewers
  • William Hagopian
  • Jin-Xiong She
  • Olli Simell
  • Anette-G Ziegler
  • Beena Akolkar
  • Jeffrey Krischer
  • Heikki Hyöty

Summary, in English

Background: Early childhood environmental exposures, possibly infections, may be responsible for triggering islet autoimmunity and progression to type 1 diabetes (T1D). The Environmental Determinants of Diabetes in the Young (TEDDY) follows children with increased HLA-related genetic risk for future T1D. TEDDY asks parents to prospectively record the child's infections using a diary book. The present paper shows how these large amounts of partially structured data were reduced into quantitative data-sets and further categorized into system-specific infectious disease episodes. The numbers and frequencies of acute infections and infectious episodes are shown. Methods: Study subjects (n = 3463) included children who had attended study visits every three months from age 3 months to 4 years, without missing two or more consecutive visits during the follow-up. Parents recorded illnesses prospectively in a TEDDY Book at home. The data were entered into the study database during study visits using ICD-10 codes by a research nurse. TEDDY investigators grouped ICD-10 codes and fever reports into infectious disease entities and further arranged them into four main categories of infectious episodes: respiratory, gastrointestinal, other, and unknown febrile episodes. Incidence rate of infections was modeled as function of gender, HLA-DQ genetic risk group and study center using the Poisson regression. Results: A total of 113,884 ICD-10 code reports for infectious diseases recorded in the database were reduced to 71,578 infectious episodes, including 74.0% respiratory, 13.1% gastrointestinal, 5.7% other infectious episodes and 7.2% febrile episodes. Respiratory and gastrointestinal infectious episodes were more frequent during winter. Infectious episode rates peaked at 6 months and began declining after 18 months of age. The overall infectious episode rate was 5.2 episodes per person-year and varied significantly by country of residence, sex and HLA genotype. Conclusions: The data reduction and categorization process developed by TEDDY enables analysis of single infectious agents as well as larger arrays of infectious agents or clinical disease entities. The preliminary descriptive analyses of the incidence of infections among TEDDY participants younger than 4 years fits well with general knowledge of infectious disease epidemiology. This protocol can be used as a template in forthcoming time-dependent TEDDY analyses and in other epidemiological studies.

Department/s

  • Diabetes and Celiac Unit
  • Paediatric Endocrinology
  • EXODIAB: Excellence in Diabetes Research in Sweden

Publishing year

2015

Language

English

Publication/Series

BMC Pediatrics

Volume

15

Document type

Journal article

Publisher

BioMed Central (BMC)

Topic

  • Pediatrics

Keywords

  • Childhood infections
  • Prospective study
  • Type 1 diabetes

Status

Published

Research group

  • Diabetes and Celiac Unit
  • Paediatric Endocrinology

ISBN/ISSN/Other

  • ISSN: 1471-2431