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

Abstract

The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0-11 months had a hospitalization rate higher than 12-59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.

Association between rotavirus gastroenteritis and intussusception: suggested evidence from a retrospective study in claims databases in the United States. Corresponding author: Corinne Willame, MPH, GSK, 20 Avenue Fleming, Wavre, Belgium

“…A prospective case-control study showed that experiencing gastroenteritis during the 30 days before an IS diagnosis was associated with IS in children aged 0-59 months (odds ratio: 11.6; 95% CI: 3.2-41.2; p-value<0.001) (20). Although other risk factors for gastroenteritis were not explored in that study, results are consistent with other studies that identified bacterial and viral gastroenteritis as major risk factors for developing IS (21)(22)(23)(24)(25). While adenovirus is the primary causative agent frequently detected in IS cases, some studies demonstrated an association with rotavirus (8-10).…”

Universal rotavirus vaccination program in Sicily: Reduction in health burden and cost despite low vaccination coverage

“…20 , 21 Moreover, Italian data on intussusception in the absence of RV vaccination, as well as a study conducted in Sicily before RV vaccination was introduced, showed a similar increasing trend in intussusception among children aged 12–59 months, indicating a role of other risk factors for intussusception. 22-26 …”

“…34 The estimate of the health and economic burden of RVGE emergency room and outpatient visits adopted in this work was performed using methodology of a multicenter study conducted in seven European countries, including Italy (Padua). 22 …”

Fourteen years’ clinical experience and the first million babies protected with human live-attenuated vaccine against rotavirus disease in Italy

“…5,59 The risk of intussusception remained highest in children <1 year, however, there was a significant increasing trend of intussusception hospitalizations in some older age groups (1-2 years and 2-6 years) between 2005 and 2014, 57 with another study reporting increasing incidence rates of 18% overall and 40% in ages 1-5 years. 58 From the national hospital discharge database, overall incidence in children <16 years of age, however, was stable from 2005 to 2012. 60 The reported increased post-vaccination risk is low, at around 1-6 additional cases per 100,000, and occurs mostly within 7 days of the first dose.…”