Intussusception rates increased in young infants after rotavirus vaccine introduction

Last Updated: 2016-08-25

By Will Boggs MD

NEW YORK (Reuters Health) - Intussusception hospitalization rates increased in the years following the introduction of rotavirus vaccine among children aged 8 to 11 weeks, researchers report.

"Our results are consistent with previous findings of a short-term temporal increased risk of intussusception in the first week after the first dose of rotavirus vaccine," Dr. Jacqueline E. Tate from Centers for Disease Control and Prevention, Atlanta, Georgia told Reuters Health by email.

She continued, "Given the comparatively low background rate of intussusception in children 8-11 weeks of age, when the majority of first doses of vaccine are given, no overall increased risk of intussusception was observed among all children <12 months of age."

Previous analyses suggested that rotavirus vaccine administration was associated with an estimated 1 to 5 excess cases of intussusception per 100,000 children vaccinated.

Dr. Tate's team updated an earlier analysis (covering 2007 through 2009) with four additional years of postvaccine introduction data from 2010 through 2013 to examine trends in intussusception hospitalization rates among all children <12 months of age, as well as among children in the age groups for which doses of rotavirus vaccine are recommended.

For every 100,000 children <12 months of age, intussusception hospitalization rates ranged from 33.9 to 37.2 before rotavirus vaccine introduction, increased significantly to 40.7 in 2007 and to 40.3 in 2010, but were not different from the prevaccine baseline in the other postvaccine introduction years.

Among children 6 to 14 weeks of age, who had the lowest overall rates of intussusception hospitalization, rates were significantly elevated in five postvaccine introduction years: 43% higher in 2007, 50% higher in 2008, 25% higher in 2009, 42% higher in 2010, and 42% higher in 2012.

Intussusception hospitalization rates were significantly elevated in all postvaccine introduction years in the 8- to 11-week age group, according to the August 24th Pediatrics online report.

Among children 15 to 24 weeks and 25 to 34 weeks of age, when the second and third doses of virus vaccine are usually given, intussusception hospitalization rates were generally similar pre- and postvaccine introduction.

"After introduction of rotavirus vaccines into the national immunization schedule in the United States, rates of rotavirus disease have declined sharply, resulting in the prevention of >176,000 hospitalizations, 242,000 emergency department visits, and 1.1 million outpatients visits from 2007 to 2011," the researchers note.

"Rotavirus vaccines have had a tremendous public health impact in terms of reductions of hospitalizations, emergency department visits, and outpatient visits, and these benefits far outweigh the small increased risk of intussusception," Dr. Tate concluded. "Physicians should continue administering rotavirus vaccines to infants according to current Advisory Committee on Immunization Practices guidelines."

"When discussing rotavirus vaccine with parents, pediatricians should acknowledge and discuss any potential risks, including intussusception, noting that the risk is low but can be serious when it occurs," write Dr. Emmanuel B. Walter from Duke University School of Medicine, Durham, North Carolina and Dr. Mary Allen Staat from University of Cincinnati College of Medicine, Cincinnati, Ohio in an editorial.

"The discussion should be couched in terms that, independent of rotavirus vaccination, intussusception is the most common abdominal emergency in children younger than 2 years of age, and parents should be advised to seek urgent medical care for symptoms and signs where the diagnosis is suspect," they conclude. "While acknowledging vaccination risks, it is paramount as pediatricians that we also communicate to parents and families the enormous benefits of rotavirus vaccination in preventing rotavirus disease in the United States."

SOURCE: http://bit.ly/2bjdOCR and http://bit.ly/2bJvwPu

Pediatrics 2016.