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Association between rotavirus vaccination and intussusception in Australian children: A record linkage study
Parveen Fathima1, Hannah C Moore1, Christopher C Blyth1,2,3,4
1Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
Insights
The incidence of intussusception hospitalizations increased after rotavirus vaccination (RV) introduction in Western Australia. However, the rise was observed across all age groups, suggesting factors other than vaccination may be responsible.
Area of Science:
- Pediatric Gastroenterology
- Vaccinology
- Public Health Surveillance
Background:
- Post-licensure studies indicate a small increased risk of intussusception following rotavirus vaccination (RV).
- Understanding temporal trends and associated factors is crucial for public health policy.
Purpose of the Study:
- To assess temporal trends of intussusception-coded hospitalizations before and after the 2007 universal rotavirus vaccination program in Western Australia.
- To identify perinatal factors and pathogens associated with intussusception hospitalizations.
Main Methods:
- Probabilistically linked hospitalization records of 367,476 Western Australian children (<5 years, 2000-2012) to perinatal and pathology data.
- Calculated age-specific incidence rates pre- (2000-2006) and post-RV introduction (2008-2012).
- Used Cox proportional hazards models to evaluate perinatal risk factors.
Main Results:
- Overall intussusception hospitalization rate was 26.4 per 100,000 child-years.
- Rates were 70% higher in the post-RV period compared to the pre-RV period.
- Adenovirus showed a strong association with intussusception.
Conclusions:
- Intussusception hospitalizations increased post-rotavirus vaccination introduction, but not specifically for procedure-related codes.
- The similar increase across vaccine-eligible and older age groups suggests non-vaccine-related causes.
Background:
Post-licensure surveillance studies have shown a small but increased risk of intussusception among infants in the days following rotavirus vaccination (RV).
Objectives:
We assessed the temporal trends of intussusception-coded hospitalisations before and after the commencement of a universal rotavirus vaccination programme in Western Australia (WA) in 2007. We also assessed the perinatal factors and pathogens associated with these hospitalisations.
Methods:
Intussusception-coded hospitalisations occurring in a cohort of 367 476 WA-born children (2000-2012) aged <5 years were probabilistically linked to perinatal and pathology records. Age-specific incidence rates for overall and pathogen-specific intussusception-coded hospitalisations were calculated before (2000-2006) and after (2008-2012) RV introduction. Adjusted Cox proportional hazards models were used to assess perinatal risk factors for intussusception.
Results:
The overall rate of intussusception-coded hospitalisation was 26.4 per 100 000 child-years (95% confidence interval [CI] 24.0, 29.0) among children aged <5 years, with rates being 70% higher (95% CI 39, 107) in the RV period than in the pre-RV period. Compared with the pre-RV period, rates were higher among those aged 12-23 months (by 55%, 95% CI 5, 127) and 2-4 years (by 84%, 95% CI 20, 182) in the RV period. However, the risk of intussusception-coded hospitalisations associated with intussusception management-related procedure code(s) was similar among all age groups in both birth periods. Among infants aged <12 months, male sex, non-Aboriginal status, birth to multiparous mothers, and birth in RV era were independent risk factors associated with intussusception-coded hospitalisations. Adenovirus was strongly associated with intussusception (6.7 per 100 000 child-years, 95% CI 5.3, 9.3).
Conclusions:
The risk of intussusception-coded hospitalisations was higher post-RV introduction, but not for intussusception-coded hospitalisations associated with procedure code(s). The increase was no higher in the vaccine-eligible age group than in older age groups, suggesting that the apparent increase is likely to be attributable to causes other than vaccination.
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