Association between rotavirus vaccination and intussusception in Australian children: A record linkage study

Abstract

Background Post‐licensure surveillance studies have shown a small but increased risk of intussusception among infants in the days following rotavirus vaccination (RV). Objectives We assessed the temporal trends of intussusception‐coded hospitalisations before and after the commencement of a universal rotavirus vaccination programme in Western Australia (WA) in 2007. We also assessed the perinatal factors and pathogens associated with these hospitalisations. Methods Intussusception‐coded hospitalisations occurring in a cohort of 367 476 WA‐born children (2000‐2012) aged <5 years were probabilistically linked to perinatal and pathology records. Age‐specific incidence rates for overall and pathogen‐specific intussusception‐coded hospitalisations were calculated before (2000‐2006) and after (2008‐2012) RV introduction. Adjusted Cox proportional hazards models were used to assess perinatal risk factors for intussusception. Results The overall rate of intussusception‐coded hospitalisation was 26.4 per 100 000 child‐years (95% confidence interval [CI] 24.0, 29.0) among children aged <5 years, with rates being 70% higher (95% CI 39, 107) in the RV period than in the pre‐RV period. Compared with the pre‐RV period, rates were higher among those aged 12‐23 months (by 55%, 95% CI 5, 127) and 2‐4 years (by 84%, 95% CI 20, 182) in the RV period. However, the risk of intussusception‐coded hospitalisations associated with intussusception management‐related procedure code(s) was similar among all age groups in both birth periods. Among infants aged <12 months, male sex, non‐Aboriginal status, birth to multiparous mothers, and birth in RV era were independent risk factors associated with intussusception‐coded hospitalisations. Adenovirus was strongly associated with intussusception (6.7 per 100 000 child‐years, 95% CI 5.3, 9.3). Conclusions The risk of intussusception‐coded hospitalisations was higher post‐RV introduction, but not for intussusception‐coded hospitalisations associated with procedure code(s). The increase was no higher in the vaccine‐eligible age group than in older age groups, suggesting that the apparent increase is likely to be attributable to causes other than vaccination.

Rotavirus vaccination is a protective factor for adverse outcomes in primary intussusception: a single-center retrospective study

“…Rotavirus vaccine has been widely used in the prevention and control of rotavirus-associated gastroenteritis ( 7 ). Since 1999, when the first-generation rotavirus vaccine (RotaShield, Wyeth Laboratories, Marietta, Pennsylvania) was linked to a risk of intussusception following immunization ( 8 ), whether rotavirus vaccination increased the incidence of intussusception has attracted great attention ( 9 - 11 ).…”