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: 5.47). 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 Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important.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.

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Available from: Lone Simonsen, Aug 23, 2014
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    • "The relationship was suggested for the first time in 1998 when a tetravalent rotavirus vaccine (RotaShield) was withdrawn because of a significant excess risk of intussusception among US infants during the weeks following receipt of vaccine [3] [4]. Postlicensure surveillance studies in the United States have not confirmed the previous finding and no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines (RotaTeq, 2006; Rotarix, 2008) [5] [6]. More recently, in Countries with implemented Rotavirus Universal Mass Vaccination (UMV), some authors have described a small increased risk of intussusceptions for infants receiving rotavirus vaccine, although it was evident that the vaccines' benefits outweigh this risk [7] [8] [9]. "
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    ABSTRACT: Background: Intussusception is the most common cause of bowel obstruction in infants with an incidence ranging from 9-328 cases per 100,000 infants aged 0-11 months. Causes underlining this clinical manifestation are still unknown. Possible relationship with a withdrawn tetravalent rotavirus vaccine was not confirmed by post-licensure studies and actually no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines. Aim of this study is to analyze the intussusception hospitalizations in Sicily from 2003 to 2012 before the introduction of rotavirus universal vaccination and its possible relation with rotavirus gastroenteritis trend. Methods: Were collected data from hospital discharge records occurred from 1(st) January 2003 to 31(st) December 2012 in Sicily. Intussusception cases were defined as all hospitalizations with an ICD-9-CM code of 560.0 on any discharge diagnoses. As a proxy for the severity of cases were considered ICD-9-CM procedure codes accounting for surgical or radiologic reduction. Results: A total of 340 intussusception cases were hospitalized in Sicily from 2003 to 2012 in children aged 0-59 months. 46.8 % occurred in the age class 0-11 months. Hospitalization rate for intussusception was 11.4 cases per 100,000 per year (32.6 cases per 100,000 among 0-11 months children; 7.3 cases per 100,000 among 12-59 months children), with a M:F sex ratio of 1.8. During hospitalization only 25 % of intussusceptions had a spontaneous resolution, 56.5 % of cases required a surgical intervention. From 2003 to 2012 intussusception cases were equally distributed during the year without any seasonality, while gastroenteritis hospitalizations due to rotavirus infection have a typically late winter and spring distribution. Conclusions: In Sicily from 2003 to 2012 hospitalizations due to intestinal invagination were higher among children aged 0-11 months with observed rates similar to other European countries. Regional baseline data analysis of intussusception among 0-59 children is recognized as an evidence-based public health strategy by international health authorities. Indeed, this strategy is necessary to compare any post-licensure age or sex-related change in intussusception trend after universal rotavirus vaccination introduction.
    Full-text · Article · Aug 2015 · Italian Journal of Pediatrics
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    • "Also, Elebute and Adesola [27] reported a high incidence of intussusception in children older than one year of age. This study showed that males were more affected than females with a male to female ratio of 3.3:1 which is comparable to the results of other workers [1,2,16,17,20,28-30]. Other authors reported female predominance [31]. "
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    ABSTRACT: Intussusception remains a common cause of bowel obstruction in children and results in significant morbidity and mortality if not promptly treated. There is a paucity of prospective studies regarding childhood intussusception in Tanzania and particularly the study area. This study describes the pattern, clinical presentations and management outcomes of childhood intussusception in our setting and highlights the challenging problems in the management of this disease. This was a prospective descriptive study of patients aged < 10 years operated for intussusception at Bugando Medical Centre. Ethical approval to conduct the study was obtained from relevant authorities. Data was analyzed using SPSS version 17.0. A total of 56 patients were studied. The male to female ratio was 3.3: 1. The median age was 6 months. Three-quarter of patients were < 1 year. Etiology was mainly idiopathic in 91.1% of cases. The classic triad of bloody stool, vomiting and abdominal distention/abdominal pain was found in 24 (42.5%) patients. The diagnosis of intussusception was mainly clinically in 71.4% of cases. All patients were treated surgically. Ileo-colic was the most frequent type of intussusception (67.9%). Twenty-six (46.4%) patients required bowel resection. The rate of bowel resection was significantly associated with late presentation > 24 hour (p = 0.001). Complication rate was 32.1% and surgical site infection (37.5%) was the most frequent complication. The median length of hospital stay was 7 days. Patients who had bowel resection and those who developed complications stayed longer in the hospital and this was statistically significant (p < 0.001). Mortality rate was 14.3%. Age < 1 year, delayed presentation, associated peritonitis, bowel resection and surgical site infection were the main predictors of mortality (p < 0.001). The follow up of patients was generally poor CONCLUSION: Intussusception in our setting is characterized by late presentation, lack of specialized facilities and trained personnel for nonsurgical reduction. Therefore, surgery remains the main stay of treatment in our centre. A high index of suspicion and proper evaluation of patients is essential for an early diagnosis and timely definitive treatment, in order to decrease the morbidity and mortality associated with this disease.
    Full-text · Article · Mar 2014 · Italian Journal of Pediatrics
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    • "5 {Hilal , 2002 #42} Russia 1994 – 2005 Hospital 280 , 14 {Shapkina , 2006 #86} Spain unspecified Hospital 151 , 12 {Rubi , 2002 #78} Switzerland 2003 – 2006 National 294 , 18 {Buettcher , 2007 #17} Turkey 1991 – 2007 Hospital 105 , 15 {Sonmez , 2012 #91} Turkey 1993 – 2003 Hospital 179 NR {Yalcin , 2009 #107} UK / Ireland 2008 – 2009 National 261 , 1 {Samad , 2012 #83} UK / Ireland 1997 – 1998 Hospital 32 , 1 . 5 {Willetts , 2001 #104} England 1993 – 1995 National 833 , 1 {Gay , 1999 #113} North America 16425 Canada 1993 – 2001 Regional 961 , 6 {Somme , 2006 #90} US 2000 – 2009 National 10 , 836 , 1 {Yen , 2012 #108} US 2001 – 2005 National c 22 , 1 {Eng , 2012 #34} US 2002 – 2012 Hospital 405 , 7 {Fike , 2012 #38} US 1996 – 2007 Regional 188 , 17 {Shekherdimian , 2011 #87} US 2002 – 2005 Military hospitals 293 , 5 {Nylund , 2010 #68} US 2001 – 2006 3 Hospitals 183 , 1 {Cortese , 2009 #28} US 1993 – 2004 National 3463 , 1 {Tate , 2008 #97} US 2001 – 2004 Hospital 26 , 14 {Burjonrappa , 2007 #18} Mexico 1999 – 2001 Regional 48 , 1 {Velazquez , 2004 #100} Oceania 2761 Australia 2001 – 2009 Regional 197 , 2 {Lloyd - Johnsen , 2012 #59} Australia 2002 – 2004 Hospital 51 , 2 {Bines , 2006 #9} Australia 1994 – 2004 Regional 147 , 12 {Blanch , 2007 #11} Australia 1993 – 2003 Regional 23 , 18 {Webby , 2006 #101} Australia 1994 – 2000 National 1794 , 1 {Justice , 2006 #49} New Zealand 1998 – 2007 Hospital 189 , 14 {Kodikara , 2010 #52} New Zealand 1998 – 2003 National 277 , 3 {Chen , 2005 #25} New Zealand 1987 – 1998 Regional 83 NR {Reid , 2001 #76} "
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    ABSTRACT: Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality. We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9-328) among children <1 year of age, with peak incidence among infants 5-7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13-29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions. This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.
    Full-text · Article · Jul 2013 · PLoS ONE
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