Intussusception hospitalizations before rotavirus vaccine introduction: Retrospective data from two referral hospitals in Tamil Nadu, India

Srinivasan, Rajan; Kumar, C P Girish; Naaraayan, Sridevi A; Jehangir, Susan; Thangaraj, Jeromie Wesley Vivian; Venkatasubramanian, S.; Kang, Gagandeep

doi:10.1016/j.vaccine.2017.11.043

Cited by 12 publications

(17 citation statements)

References 17 publications

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“…This proxy could be useful for comparison across the sites or regions and tracking in future studies. Three-fourth of the diagnosed cases were during the first year of life, with a majority of male patients aged 4–8 months, which was similar to other reports from India [12] , [14] , [16] , [27] and globally [1] , [12] , [14] , [16] , [17] , [27] , [29] , [30] . The variations in the symptoms and signs may be due to the interval between onset and admission time, longer in north and east regions.…”

Section: Discussionsupporting

confidence: 87%

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Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

Das

Arora

Gupta

et al. 2020

Vaccine

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Objective Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children. Methods Intussusception in children 2–23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected. Results Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2–6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients’ died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions. Conclusion Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.

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Section: Discussionsupporting

confidence: 87%

“…Additionally presence of pediatric surgeon and management facility could be the other reasons for higher referral to some of these hospitals. Higher case load and case ratio were observed during March to June, as previously reported from India [14] , [16] , [27] , [28] .…”

Section: Discussionsupporting

confidence: 83%

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

Das

Arora

Gupta

et al. 2020

Vaccine

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“…We observed regional variances in the intussusception case load and case rate per 1000 paediatric surgery admission, high in the South region and low in the West region. Higher number of cases were observed during March to June months, which was comparable to other reports from India [14,15,17,24,25]. The male predominance (65.7%), median age at 8 months and high case load at 4-7 months of age (40.0%) were similar to other reports from India and globally (proportion of male: 63.0-77.2%; median age: 5-8 months and high case load age: 4-9 months) [14,15,17,18,21,24,26,27].…”

Section: Discussionsupporting

confidence: 88%

“…There were significant variations in the clinical features among the children across the regions, which may be due to the interval for presentation or clinical practices followed at the hospitals (Table 2 ). Death was observed in 1.7% cases, which was comparable to reports from India (1.0%) and other countries from Asia (0.25–6.0%), Latin America (1.0–5.0%), but lower than the African countries (2.0–25.0%) [ 17 , 18 , 24 , 28 , 29 , 31 – 33 ]. Level 1 BCCD was met by 89.1% of the cases, similar to other reports from India [ 5 , 7 , 14 ].…”

Section: Discussionsupporting

confidence: 74%

“…There were significant variations for several sociodemographic and dietary practice parameters across the regions ( Table 1). The classical triad was documented in 34.8% cases, which was higher than reports from India (19.0%) and South Korea (7.6%), but lower than Tanzania (42.5%) [15,24,28]. The regional variation in the classical triad appeared to parallel with the interval between illness onset and hospitalization.…”

Section: Discussionmentioning

confidence: 58%

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Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals

Das¹,

Arora²,

Gupta³

et al. 2020

BMC Pediatr

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Background: India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasiil™) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 2-23 months in India. Methods: The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Along with descriptive analysis, key parameters between four regions were compared using Chi-Square/Fisher's exact/Mann-Whitney U/Kruskal-Wallis tests. The pre-and post-RVV periods were compared to estimate the risk ratios. Results: Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Majority (n = 465, 74.8%) were infants (40.0% aged 4-7 months) with median age 8 months (IQR 5, 13 months), predominantly males (n = 408, 65.7%) and half (n = 311, 50.0%) occurred during March-June months. A shorter interval between weaning and intussusception was observed for ragi based food (median 1 month, IQR 0-4.2 months) compared to rice (median 4 months, IQR 1-9 months) and wheat (median 3 months, IQR 1-7 months) based food (p < 0.01). Abdominal pain or excessive crying (82.8%), vomiting (72.6%), and bloody stool (58.1%) were the leading symptoms. Classical triad (abdominal pain, vomiting and bloody stool) was observed in 34.8% cases (24.4 to 45.8% across regions). 95.3% of the cases were diagnosed by ultrasound. 49.3% (10.5 to 82.4% across regions) cases were managed by reduction, 39.5% (11.5 to 71.1% across regions) cases underwent surgery and 11.1% spontaneously resolved. Eleven (1.8%) cases died. 89.1% cases met Brighton criteria level 1 and 7.6% met Level 2. RVV was received by 12 cases within 1-21 days prior to intussusception. No increase in case load (RR = 0.44; 95% CI 0.22-1.18) or case ratio (RR = 0.5; 95% CI 0.3-1.2) was observed after RVV introduction in select sites. Conclusions: Intussusception cases were observed across all sites, although there were variations in cases, presentation and mode of management. The high case load age coincided with age of the RVV third dose. The association with ragi based weaning food in intussusception needs further evaluation.

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Clinical Characteristics of Intussusception with Surgical Reduction: a Single-Center Experience with 568 Cases

Liu

et al. 2019

Journal of Gastrointestinal Surgery

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Intussusception hospitalizations before rotavirus vaccine introduction: Retrospective data from two referral hospitals in Tamil Nadu, India

Abstract: Retrospective data from referral hospitals is sufficient to classify cases of intussusception by the Brighton criteria. These baseline data will be useful for monitoring when rotavirus vaccination is introduced.

Cited by 12 publications

References 17 publications

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals

Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals

Clinical Characteristics of Intussusception with Surgical Reduction: a Single-Center Experience with 568 Cases

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