Intussusception in southern India: comparison of retrospective analysis and active surveillance

Surveillance for intussusception is a post marketing requirement for rotavirus vaccines following observation of a small increased risk of intussusception after rotavirus vaccination in some global settings. This study presents the clinical presentation and outcomes of children who presented with intussusception at a large tertiary care facility directly (non-surveillance) as retrospective analysis of a period where rotavirus vaccine was not in routine use, or as part of active surveillance in a phase III oral rotavirus vaccine trial. Hospital records of children under 2 years of age treated for intussusception between 1 January 2010 and 31 August 2013 at the Christian Medical College Hospital, Vellore, India, were reviewed. Sixty-one cases of intussusception in children under two years of age presented at the hospital. An additional 16 cases of ultrasound diagnosed intussusception were identified through the active surveillance of a cohort of 1500 children participating in a rotavirus phase III trial in the same period. In the nonsurveillance group, median age at presentation was 214 days (IQR 153-321) with 52 events (85.3%) occurring in the first year of life. Cases were seen year-round with no definitive evidence of seasonality. Thirty-one (50.8%) intussusceptions required surgical reduction, 26 (42.6%) had pneumatic reduction and 2 (3.3%) barium enema reduction. Two intussusceptions (3.3%) resolved spontaneously. There were no deaths, all children were discharged after recovery. Active surveillance identified 16 children with a median age at event of 375 days (IQR 248-574). Nine (56%) children had small bowel or transient intussusception that resolved spontaneously. Seven intussusceptions were reduced radiologically; none required surgery. In summary, there were significant differences between presentation and outcomes in cases of intussusception identified by passive and active surveillance, likely related to enhanced and early detection of intussusception through active monitoring in the trial. The WHO recommendation of sentinel hospital based surveillance for post-marketing surveillance after rotavirus vaccine introduction is likely to a better approach than active surveillance.