A High Incidence of Intussusception Revealed by a Retrospective Hospital-Based Study in Nha Trang, Vietnam between 2009 and 2011

Abstract

Rotavirus is a leading cause of severe diarrhea among children worldwide. Thus, the World Health Organization recommended including rotavirus vaccines in national immunization programs. One concern about rotavirus vaccine, however, is a possible association with intussusception. Thus, it is crucial to know the baseline incidence of intussusception in the first year of life. A study conducted in Hanoi, Vietnam showed that the incidence of intussusception was the highest in the world. This retrospective cross-sectional study was undertaken to determine the incidence of intussusception among children <5 years of age in Nha Trang, Vietnam. Hospital charts between 2009 and 2011 were reviewed in Khanh Hoa Provincial General Hospital where virtually all cases of intussusception occurring in the city were assumed to have been encountered. The incidence of intussusception among children <1 year of age was 296 per 100,000 person-years (95% confidence interval [CI]: 225–382), and that among children <5 years of age was 196 per 100,000 person-years (95% CI: 169–226), confirming the high incidence of intussusception in Vietnam. Nevertheless, there was no intussusception in the first three months of life. We therefore recommend that the first dose of any rotavirus vaccine be administered to infants between 6 and 12 weeks of age.

Intussusception among children less than 2 years of age: Findings from pre-vaccine introduction surveillance in Pakistan

“…We observed only few cases during the first three months of life. This finding is consistent with earlier studies in Bangladesh [18] and Vietnam [19] which also reported either very few cases or no cases at all during the first 3 months of age. This finding is crucial from a programmatic point of view.…”

“…Moreover, they found increasing trend of intussusception with a peak at 11 and 12 months of age following by a persistent higher number of cases till 23 months of age and then a gradual decline until 3 years of life and beyond. The study in Vietnam also observed higher number of intussusception even after 2 years of age [19].…”

Is every intussusception treatment an emergency intervention or surgery?

“…[12] In spite of such dire consequences, possibility of spontaneous reduction of SBIs should be considered. [16,24,25] Of the 81 patients in the present study, 17 had SBI (15 IL, 2 JJ) that reduced spontaneously.…”

“…The authors also noted the potential mistake of recording surgically treated intussusception cases in diagnosis databases with codes for gastrointestinal diseases rarely associated with intussusceptions or for potential complications of intussusception, such as "intestinal obstruction." [16] While the majority (51 cases, 63%) were diagnosed at least 24 hours after onset of the symptoms, 23.5% of cases required surgery. Of the 19 patients who underwent surgery, only 4 (4.9% of the total patient population) required resection of necrotic intussuscepted intestinal segments.…”

Reaching every child with rotavirus vaccine: Report from the 10th African rotavirus symposium held in Bamako, Mali

“…In the US and Europe, there is a low level risk of intussusception with the current licensed rotavirus vaccines, Rotarix® and RotaTeq®. The incidence of intussusception, which occurs naturally in infants, begins to increase at 2–3 months of age and peaks at 4–8 months of age [18] , coinciding with the administration of rotavirus vaccines. Thus, temporal associations with vaccines are not necessarily causal.…”