Systematic review of the association between rotavirus infection, or rotavirus vaccination and coeliac disease

Background There is some evidence that rotavirus infection leads to an increased risk of coeliac disease (CD), and some immunological and biological plausibility for the human immune system recognising rotavirus particles and gluten proteins in a similar way. It is therefore plausible that rotavirus vaccine could have a role in preventing CD. However, such evidence has not previously been summarised in a systematic way to present a coherent picture. We conducted this systematic literature review to address this gap in the evidence. The aim of this research was to determine the nature of any association between rotavirus infection, or rotavirus vaccination, and risk of CD. Methods We searched Scopus, MEDLINE, Europe PMC and medRxiv for studies published between 01 January 1980 and 31 July 2020, using terms related to CD and rotavirus. Publications were screened independently by two reviewers using exclusion criteria. We extracted data from included papers using a standardized data extraction form and assessed risk of bias using the Newcastle-Ottawa Scale. Outcomes were descriptions of the settings and methods reported in included papers, and any estimates of effect. Results After exclusions, we reviewed five papers of which two used the exposure of rotavirus infection and three used the exposure of rotavirus vaccination. One paper found that rotavirus infection increased the risk of CD and that this was statistically significant. None of the three publications studying the association between rotavirus vaccination and CD were graded as high quality. All found a protective effect of RotaTeq rotavirus vaccination, but this was only statistically significant in two studies. Conclusions Few studies have been published on this research question. Those that have been published are not of sufficient quality and did not use comparable methods. Due to differences in study results there remains uncertainty regarding the relationship between rotavirus infection, vaccination and CD.