Preparing for rotavirus vaccine introduction – A retrospective assessment of the epidemiology of intussusception in children below 2 years of age in Nepal. Issue 51 (14th December 2018)

• Record Type: Journal Article
• Authors: Rayamajhi, Ajit; Thapa, Anupama; Kumar, Manoj; Yen, Catherine; Tate, Jacqueline E.; Parashar, Umesh D.; Rayamajhi, Anjana Karki
• Is Part Of: Vaccine. Volume 36:Issue 51(2018)
• Page Start: 7836
• Page End: 7840
• Publication Date: 2018-12-14
• Subjects: Intussusception -- Rotavirus vaccine; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2017.11.022
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: This is the first study to evaluate intussusception epidemiology in children < 24 months in Nepal. Results were similar to other places; mortality was low despite high surgery rates. Few intussusception hospitalizations occurred in children under four months of age. Rotavirus vaccine impact could be great in Nepal where diarrhea mortality is high. These intussusception data are useful for vaccine introduction safety monitoring. Abstract: Background: Rotavirus is the most common cause of severe diarrhea in Nepali children, accounting for 25–33% of childhood diarrhea hospitalizations. Two rotavirus vaccines recommended for inclusion in national immunization programs have been associated with a low risk of intussusception in post-marketing studies conducted in several countries. Data on the epidemiology of intussusception hospitalizations are lacking in Nepal. Thus, we aimed to describe the epidemiology of intussusception-associated hospitalizations among Nepali children in preparation for rotavirus vaccine introduction. Methods: A retrospective review of intussusception hospitalizations for a three year period was conducted at two major pediatric hospitals in Kathmandu, Nepal. Possible intussusception cases were identified through admission, discharge, and operation theater logs and ultrasound registers. Cases with a diagnosis of possible intussusception were selected for medical record review and classified as confirmed if they met the Brighton Collaboration level 1 criteria of diagnostic certainty and the child was aged < 24 months. Data on demographics, clinical course, and outcome were abstracted and analyzed. Results: Eight-five confirmed intussusception cases were identified; most (96%) were confirmed at surgery. The number of intussusception cases peaked between ages 4–7 months; no cases occurred in children 0–2 months. Fifty-nine (64%) case-patients were male. The median duration of symptoms before admission was 2 days (range: 0–14). Abdominal pain, bloody stool, and vomiting were the most common clinical features. All cases underwent surgical treatment; there was only one death. Conclusions: This is the first study to evaluate the epidemiology of intussusception hospitalizations among children aged < 24 months in Nepal. Because the public health impact of rotavirus vaccination could be substantial in Nepal, where childhood diarrhea-related morbidity and mortality are high, this baseline knowledge of intussusception prior to introduction of rotavirus vaccine in the national immunization schedule will provide useful information for post-vaccine introduction safety monitoring.