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Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care
Manoja Kumar Das1, Narendra Kumar Arora1, Bini Gupta1
1The INCLEN Trust International, New Delhi, India.
Insights
Intussusception surveillance in Indian children identified 1588 cases, predominantly in boys, with a median age of 8 months. This study provides crucial epidemiology data for rotavirus vaccine introduction and highlights low fatality rates.
Area of Science:
- Pediatric Gastroenterology
- Vaccine Adverse Events
- Epidemiology
Background:
- Intussusception is a rare adverse event associated with rotavirus vaccine (RVV).
- Limited background data on intussusception exists in India.
- Surveillance was needed prior to RVV introduction.
Purpose of the Study:
- To establish a surveillance network for intussusception in Indian children.
- To document the epidemiology of intussusception cases.
- To inform rotavirus vaccine policy.
Main Methods:
- Retrospective surveillance of intussusception cases in children aged 2-23 months.
- Data collected from 19 sentinel hospitals across India (July 2010 - March 2016).
- Clinical, hospital course, treatment, and outcome data were recorded.
Main Results:
- 1588 intussusception cases identified; 54.5% from South India, 66.3% boys.
- Median age 8 months; peak incidence March-June.
- Vomiting and bloody stools were common symptoms; ultrasound diagnosed 96.4% of cases.
- Reduction (50.8%) and surgery (41.1%) were primary treatments; case fatality was 1%.
Conclusions:
- Intussusception occurs nationwide in children with low case fatality.
- Increasing case numbers may reflect improved diagnosis and awareness.
- Epidemiological data supports vaccine safety monitoring.
Objective:
Intussusception has been linked with rotavirus vaccine (RVV) as a rare adverse reaction. In view of limited background data on intussusception in India and in preparation for RVV introduction, a surveillance network was established to document the epidemiology of intussusception cases in Indian children.
Methods:
Intussusception in children 2-23 months were documented at 19 nationally representative sentinel hospitals through a retrospective surveillance for 69 months (July 2010 to March 2016). For each case clinical, hospital course, treatment and outcome data were collected.
Results:
Among the 1588 intussusception cases, 54.5% were from South India and 66.3% were boys. The median age was 8 months (IQR 6, 12) with 34.6% aged 2-6 months. Seasonal variation with higher cases were documented during March-June period. The most common symptoms and signs were vomiting (63.4%), bloody stool (49.1%), abdominal pain (46.9%) and excessive crying (42.8%). The classical triad (vomiting, abdominal pain, and blood in stools) was observed in 25.6% cases. 96.4% cases were diagnosed by ultrasound with ileocolic location as the commonest (85.3%). Management was done by reduction (50.8%) and surgery (41.1%) and only 1% of the patients' died. 91.1% cases met Brighton criteria level 1 and 3.3% Level 2. Between 2010 and 2015, the case load and case ratio increased across all regions.
Conclusion:
Intussusception cases have occurred in children across all parts of the country, with low case fatality in the settings studied. The progressive rise cases could indicate an increasing awareness and availability of diagnostic facilities.
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