Article

Trends in intussusception hospitalizations among US infants, 1993-2004: Implications for monitoring the safety of the new rotavirus vaccination program

Division of Viral Diseases, Epidemiology Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
PEDIATRICS (Impact Factor: 5.3). 05/2008; 121(5):e1125-32. DOI: 10.1542/peds.2007-1590
Source: PubMed

ABSTRACT In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management.
By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993-2004 and from 35 states representing 85% of the birth cohort in 2002-2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data.
Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at approximately 35 cases per 100,000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100,000) then increased rapidly, peaking at approximately 62 per 100,000 at 26 to 29 weeks, before declining gradually to 26 per 100,000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100,000), rates were greater among non-Hispanic black infants (37 per 100,000) and Hispanic infants (45 per 100,000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks.
This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination.

0 Bookmarks
 · 
75 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 1999, the first rotavirus vaccine licensed in the USA was withdrawn 9 months after introduction due to an association with intussusception that was detected in post-licensure surveillance. This association prompted large clinical trials designed to ensure the safety of two current live oral rotavirus vaccines, RotaTeq and Rotarix, which have since been recommended for use worldwide. Following their introduction, post-licensure studies have focused not only on the effectiveness and impact of these vaccines, but also on continued surveillance for intussusception. Most recent evidence from several countries shows a small increased risk of intussusception following vaccination with Rotarix and RotaTeq within the context of their demonstrated benefits. This review summarizes the available data on the safety of rotavirus vaccines with regards to intussusception.
    Expert Review of Vaccines 07/2014; 13(11). DOI:10.1586/14760584.2014.942223 · 4.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Determining the background incidence of intussusception is important in countries implementing rotavirus immunization. Rotavirus immunization was introduced into the routine infant immunization program in Israel during late 2010. Incidence and risk factors for intussusception were examined in children aged less than five years between 1992 and 2009.
    BMC Pediatrics 08/2014; 14(1):218. DOI:10.1186/1471-2431-14-218 · 1.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rotavirus immunization has been limited to young infants due to intussusception events noted with a prior rotavirus vaccine, RotaShield. Dramatic declines occurred in rotavirus-related disease beginning in 2008 following implementation of rotavirus vaccination in young infants. These declines occurred in vaccinated children and unvaccinated children and adults (through indirect protection). Despite these declines, reasons for concern exist about the durability of these declines. These reasons include an incomplete immune response that is not life-long and rotavirus immunization completion rates that have plateaued at <70% of eligible children. Current rotavirus infant vaccination strategies and indirect protection of unvaccinated children will result in a large population of immunologically susceptible people who will be at risk of rotavirus disease. Expansion of US rotavirus vaccination outside the current Advisory Committee on Immunization Practices recommended immunization age limits would provide important benefits that outweigh intussusception-related risk.
    Clinical Infectious Diseases 06/2014; 59(7). DOI:10.1093/cid/ciu475 · 9.42 Impact Factor

Full-text (2 Sources)

Download
12 Downloads
Available from
Aug 23, 2014