Intussusception, Infection, and Immunization: Summary of a Workshop on Rotavirus

Abstract

ABSTRACT. This article summarizes the proceedings of a workshop sponsored by the National Institutes of Health and the National Vaccine Program Office, and held in Bethesda, Maryland, on January 21, 2000. The objective of the meeting was to focus research toward an understanding of the basis for the possible association between intussusception and the reassortant rhesus-human rotavirus vaccine tetravalent (RRV-TV). After numerous reports of intussusception after administration of RRV-TV, the manufacturers of this vaccine voluntarily withdrew it from the United States market. The American Academy of Pediatrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians also withdrew their original recommendations for administration of RRV-TV to children at 2, 4, and 6 months of age. These actions will have global implications for the prevention of morbidity and mortality attributable to rotavirus infection. Benefit-cost ratios for the use of RRV-TV will be substantially different in developing countries compared with developed countries. Therefore, extensive research is needed in both of these settings, to further our understanding of the epidemiology, pathogenesis, and pathology of both rotavirus disease and intussusception to enable optimal prevention. The workshop reviewed the current understanding of the possible association between RRV-TV and intussusception, as well as the possible association between a variety of viral infections and intussusception. The workshop also identified critical areas of research regarding this possible association. This research will be essential not only for the development of safe and effective rotavirus vaccines, but for the development of other oral vaccines as well. Pediatrics 2001;108(2). URL: http://www. pediatrics.org/cgi/content/full/108/2/e37; rotavirus, intussusception, rhesus rotavirus vaccine tetravalent, workshop.

Molecular Epidemiology of Adenovirus Isolates from Patients Diagnosed with Intussusception in Melbourne, Australia

“…It has been speculated that adenoviral infection may predispose infants to development of acute IS. Idiopathic cases are believed to arise from hypertrophy of (8,10). If adenoviral infection is in fact a precursor to IS, it can be hypothesized from our findings that susceptible children will acquire commonly circulating community strains.…”

Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines

“…Some theorized that RRV-TV might have unmasked a previously unrecognized wild-type rotavirus association by inducing a cluster of intussusception cases at a specific time (because of rotavirus in the vaccine) [2,7,8]. The long-term rates of intussusception in this scenario would then be the same in vaccinated and unvaccinated children.…”

Intussusception, Rotavirus, and Oral Vaccines: Summary of a Workshop

“…The workshop identified critical areas of research regarding the association between RRV-TV and intussusception, which "will be essential not only for the development of safe and effective rotavirus vaccines but also for other oral vaccines." 1 On September [5][6][7]2001, a second workshop was held in Arlington, Virginia, by the National Vaccine Advisory Committee (NVAC) and the NVPO to review this research. The objectives of the 2001 workshop were as follows:…”