Association between subsequent autoimmune disease and prior enterovirus infection in children: A population-based study in Taiwan

Purpose: Infection events can trigger autoimmune responses in several chronic inflammatory diseases; however, no study has focused on their effects in patients with enterovirus (EV) infection. We aimed to investigate the association between EV infection and the risk of autoimmune diseases. Materials and Methods: We used insurance claims data from Taiwan’s National Health Insurance Research Database (NHIRD) to investigate autoimmune disease (AD) incidence with or without a diagnosis of EV infection from January 1, 2006, to December 31, 2015. Incidence rate ratios (IRR) and hazard ratios (HRs) of ADs for EV infection were estimated using Cox’s proportional hazard regression model. Results: Overall AD incidence was higher in the EV-infection cohort (37.68 per 100,000 person-years) than in the non-EV-infection cohort (25.78 per 100,000 person-years). The AD incidence rate ratio in the EV-infection cohort was 1.46 (95% CI: 1.34 to 1.60) with an adjusted HR of 1.57 (95% CI: 1.43 to 1.72) compared with the non-EV-infection cohort. The adjusted hazard ratio (aHR) of the EV group was higher for particular organ-specific ADs, such as Type 1 diabetes mellitus (aHR = 1.30, 95% CI: 1.0 to 1.62) and Henoch-Schönlein purpura (2.14, 1.84-2.49). Furthermore, the adjusted hazard ratio of the EV group was also higher for particular systemic ADs, such as juvenile ankylosing spondylitis (1.85, 1.33-2.59) and systemic vasculitis (1.25, 1.01-1.54). Conclusion: The risk of autoimmune disease in the EV-infection cohort is higher than the non-EV-infection cohort.