Preparing for rotavirus vaccine introduction – a retrospective assessment of the epidemiology of intussusception in children below 2 years of age in Nepal

Details

• Alternative Title:
  Vaccine
• Personal Author:
  Rayamajhi, Ajit ; Thapa, Anupama ; Kumar, Manoj ; Yen, Catherine ; Tate, Jacqueline E. ; Parashar, Umesh D. ; Rayamajhi, Anjana Karki
• Description:
  Background:
  
  Rotavirus is the most common cause of severe diarrhea in Nepali children, accounting for 25%−33% of childhood diarrhea hospitalizations. Two rotavirus vaccines recommended for inclusion in national immunization programs have been associated with a low risk of intussusception in post-marketing studies conducted in several countries. Data on the epidemiology of intussusception hospitalizations are lacking in Nepal. Thus, we aimed to describe the epidemiology of intussusception-associated hospitalizations among Nepali children in preparation for rotavirus vaccine introduction.
  
  Methods:
  
  A retrospective review of intussusception hospitalizations for a three year period was conducted at two major pediatric hospitals in Kathmandu, Nepal. Possible intussusception cases were identified through admission, discharge, and operation theater logs and ultrasound registers. Cases with a diagnosis of possible intussusception were selected for medical record review and classified as confirmed if they met the Brighton Collaboration level 1 criteria of diagnostic certainty and the child was aged <24 months. Data on demographics, clinical course, and outcome were abstracted and analyzed.
  
  Results:
  
  Eight-five confirmed intussusception cases were identified; most (96%) were confirmed at surgery. The number of intussusception cases peaked between ages 4–7 months; no cases occurred in children 0–2 months. Fifty-nine (64%) case-patients were male. The median duration of symptoms before admission was 2 days (range: 0–14). Abdominal pain, bloody stool, and vomiting were the most common clinical features. All cases underwent surgical treatment; there was only one death.
  
  Conclusions:
  
  This is the first study to evaluate the epidemiology of intussusception hospitalizations among children aged <24 months in Nepal. Because the public health impact of rotavirus vaccination could be substantial in Nepal, where childhood diarrhea-related morbidity and mortality are high, this baseline knowledge of intussusception prior to introduction of rotavirus vaccine in the national immunization schedule will provide useful information for post-vaccine introduction safety monitoring.
  
  
• Subjects:
  Article Diarrhea Female Hospitalization Humans Immunization Programs Infant Infant, Newborn Intussusception Male Nepal Retrospective Studies Rotavirus Infections Rotavirus Vaccine Rotavirus Vaccines Vaccination

  More +
• Source:
  Vaccine. 36(51):7836-7840
• Pubmed ID:
  29169894
• Pubmed Central ID:
  PMC6534114
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Place as Subject:
  Nepal
• Volume:
  36
• Issue:
  51
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ee8c984fd9fb5469d4d85002adb9c91984e715f724a0a14a68e77ea64390bb4c
• Download URL:
  https://stacks.cdc.gov/view/cdc/79023/cdc_79023_DS1.pdf
• File Type:
  [PDF - 208.68 KB ]