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American Journal of Epidemiology Vol. 135, No. 12: 1331-1338
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health

research-article

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

Donn J. D'Alessio

From the Departments of Preventive Medicine and Medicine, University of Wisconsin Medical School Madison Wl

Reprint requests to Dr. Donn J. D'Alessio, Department of Preventive Medicine, University of Wisconsin Medical School, 504 N. Walnut Street, Madison, Wl 53705–2368.

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

case-control studies; Coxsackie B viruses; diabetes mellitus, insulin-dependent; HLA-DR antigens; IgM


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