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

Abstract

Background In some countries that have introduced oral rotavirus vaccines, a small but elevated risk of intussusception—a rare bowel disorder—has been reported. Updated estimates on the global epidemiology of intussusception are needed to help predict the potential number of intussusception cases that could be caused by the vaccine in different settings. Methods We estimated incidence rates, age distributions and case-fatality ratios (CFRs) for intussusception hospital admissions among children aged &lt;5 years, before the introduction of rotavirus vaccines. We included all articles identified in a systematic review between January 2002 and January 2018, and contacted authors for more granular unpublished data on age distributions. Results We identified 128 articles containing 227 country datasets (61 age distributions, 71 incidence rates and 95 CFRs). The median age of intussusception ranged from 29 weeks in Africa (83% of cases in the first year of life) to 70 weeks in the Western Pacific region (35% of cases in the first year of life). The median (range) annual incidence of intussusception hospital admissions per 100 000 aged &lt;1 year ranged from 34 (13–56) in Africa to 90 (9–380) in the Western Pacific region. We found extreme differences between the CFRs in Africa (1 death in every 10 hospital admissions) and the rest of the world (fewer than 1 death in every 100–2000 hospital admissions). Conclusion Intussusception epidemiology varies by country and region. Understanding and recognizing these differences will be important when assessing the potential number of intussusception cases associated with rotavirus vaccines.

Association between rotavirus gastroenteritis and intussusception: suggested evidence from a retrospective study in claims databases in the United States

“…2 Incidence rates in Europe and United States (US) are consistently similar, ranging from 20 to 66 cases per 100,000 person-years. 2,4,5 To date, the etiology of IS remains unclear. Studies assessing potential risk factors for pediatric IS point toward lipomas, neuronal intestinal dysplasia, Celiac or Chron's diseases, cystic fibrosis, malignancies, gastroenteritis, and parasitic or viral infections.…”

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

“…Estimates of IS incidence vary broadly across geographical regions, with the highest rates observed in Asia (2). Incidence rates in Europe and United States (US) are consistently similar, ranging from 20 to 66 cases per 100,000 person-years (2,4,5).…”

Rotavirus vaccination and intussusception: a paradigm shift?

“…2 The incidence rates of IS hospital admission vary largely across geographical regions. 3 Between 2002 and 2018, the median (range) annual incidence of IS hospital admissions per 100 000 ranged from 34 in Africa to 90 (9-380) in the Western Pacific region for children <1 year of age. 3 While pediatric IS is usually idiopathic, predisposing factors, such as infections (including adenoviruses and rotavirus [RV]) and anatomical variations, have been identified.…”

“…3 Between 2002 and 2018, the median (range) annual incidence of IS hospital admissions per 100 000 ranged from 34 in Africa to 90 (9-380) in the Western Pacific region for children <1 year of age. 3 While pediatric IS is usually idiopathic, predisposing factors, such as infections (including adenoviruses and rotavirus [RV]) and anatomical variations, have been identified. 4 RV is one of the leading causes of severe childhood gastroenteritis in children <5 years of age, accounting for substantial morbidity globally and high mortality in resource-limited countries.…”