Analysis of hospitalizations due to intussusception in Sicily in the pre-rotavirus vaccination era (2003–2012)

Abstract

BackgroundIntussusception is the most common cause of bowel obstruction in infants with an incidence ranging from 9–328 cases per 100,000 infants aged 0–11 months. Causes underlining this clinical manifestation are still unknown. Possible relationship with a withdrawn tetravalent rotavirus vaccine was not confirmed by post-licensure studies and actually no increased risk of intussusception was found between infants vaccinated with both the recently licensed rotavirus vaccines. Aim of this study is to analyze the intussusception hospitalizations in Sicily from 2003 to 2012 before the introduction of rotavirus universal vaccination and its possible relation with rotavirus gastroenteritis trend.MethodsWere collected data from hospital discharge records occurred from 1st January 2003 to 31st December 2012 in Sicily.Intussusception cases were defined as all hospitalizations with an ICD-9-CM code of 560.0 on any discharge diagnoses. As a proxy for the severity of cases were considered ICD-9-CM procedure codes accounting for surgical or radiologic reduction.ResultsA total of 340 intussusception cases were hospitalized in Sicily from 2003 to 2012 in children aged 0–59 months. 46.8 % occurred in the age class 0–11 months.Hospitalization rate for intussusception was 11.4 cases per 100,000 per year (32.6 cases per 100,000 among 0–11 months children; 7.3 cases per 100,000 among 12–59 months children), with a M:F sex ratio of 1.8.During hospitalization only 25 % of intussusceptions had a spontaneous resolution, 56.5 % of cases required a surgical intervention.From 2003 to 2012 intussusception cases were equally distributed during the year without any seasonality, while gastroenteritis hospitalizations due to rotavirus infection have a typically late winter and spring distribution.ConclusionsIn Sicily from 2003 to 2012 hospitalizations due to intestinal invagination were higher among children aged 0–11 months with observed rates similar to other European countries. Regional baseline data analysis of intussusception among 0–59 children is recognized as an evidence-based public health strategy by international health authorities. Indeed, this strategy is necessary to compare any post-licensure age or sex-related change in intussusception trend after universal rotavirus vaccination introduction.

Hospitalization rates for intussusception in children aged 0–59 months from 2009 to 2014 in Italy

“…23 Furthermore, Italian data according to other studies, demonstrate a major risk of intussusception hospitalization among children 0-11 months than 12-59 months. 2,24 In detail, hospitalization rate of 0-11 months children with a value of 36.5 per 100,000 was similar to value reported in Switzerland (38 per 100,000), 3 but slightly increased than hospitalization rate reported in Germany and the UK (26.2 and 24.8 per 100,000 respectively). 4,25 Overall, these data confirm that intussusception is a relatively frequent disease during the first year of life probably due to a higher exposure to risk factors and the higher frequency of atypical clinical manifestation leading to a delay in healthcare treatment.…”

“…Furthermore, hospitalizations for intussusception occurred among Sicilian children were excluded from this study because there was already implemented a UMV against rotavirus from 2013 and intussusception hospitalization was already analyzed. 24,38,39,40…”

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

“…Our findings are consistent with other reports from the United Kingdom, Republic of Ireland, Australia, and Malaysia that have described the peak age of intussusception incidence occurring in the first year of life, with a very low incidence in the first 2–3 months of life [17–19]. Also consistent is the male predominance of cases [20–22]. This male predominance is not completely understood, but could suggest genetic predisposition to having intussusception and/or differences in access to health care.…”

Update on the global epidemiology of intussusception: a systematic review of incidence rates, age distributions and case-fatality ratios among children aged <5 years, before the introduction of rotavirus vaccination

“…Our analysis excludes children without access to hospital. Most children with intussusception will die if left untreated, but an uncertain proportion will spontaneously resolve without treatment 31–35 . Better estimates of access to hospital, and spontaneous recovery without treatment, would be needed to generate realistic estimates of the CFR among all cases of intussusception 36 .…”