1
|
Zhang L, Chen X, Huang Y, Wang G, Zhang Z, Song Z. Epidemiological characteristics, treatment, and outcomes of 586 cases of intussusception: a 4-year retrospective study in China. Front Pediatr 2024; 12:1379168. [PMID: 38808103 PMCID: PMC11130396 DOI: 10.3389/fped.2024.1379168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Objective This study aims to retrospectively analyze the epidemiological and clinical characteristics of acute intussusception in a tertiary-care pediatric hospital in China over 4 years and evaluate the effectiveness and recurrence of fluoroscopy-guided pneumatic reduction (FGPR) and ultrasound-guided hydrostatic reduction (UGHR). Methods This retrospective study was conducted from January 2019 to December 2022 involving children admitted and managed for acute intussusception in a tertiary-care pediatric hospital in China. The epidemiology, clinical features, and therapeutic effects were analyzed using IBM SPSS Statistics 20.0. Results The study included 401 boys (68.43%) and 185 girls (31.57%) aged from 2 months to 12 years. The most common symptoms reported were abdominal pain or paroxysmal crying (95.73%), vomiting (45.39%), and bloody stool (7.34%). Vomiting and bloody stool became atypical with increasing age (P < 0.001). The total success cases of reduction accounted for 563 cases (96.08%), and the recurrent cases accounted for 71 cases (12.12%). No significant difference was observed in the success or recurrence rates between FGPR and UGHR (P > 0.05). Abdominal pain was an independent protective factor for successful enema (P < 0.01, OR = 72.46), while bloody stool (P < 0.01, OR = 0.06) and older age were independent risk factors (P < 0.001, OR = 0.51). Of the 71 patients with recurrent intussusception, 29 were successfully reduced by enema, and the other 23 required surgical reduction. Twelve of the surgical cases were secondary intussusception, including three cases of Meckel's diverticulum, five cases of polyps, and four cases of non-Hodgkin lymphoma. Conclusion The epidemiological characteristics of children with intussusception in Xiamen showed peculiarity with a higher male-to-female ratio, older age at diagnosis, and no significant seasonality. Both FGPR and UGHR were effective and safe for intussusception, and surgical reduction was essential for patients with failed enema reduction.
Collapse
Affiliation(s)
- Lianzhi Zhang
- Department of Pediatric Surgery, Children's Hospital of Fudan University at Xiamen (Xiamen Children's Hospital), Xiamen, Fujian, China
| | - Xiaotong Chen
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, China
| | - Yajun Huang
- Department of Pediatric Surgery, Children's Hospital of Fudan University at Xiamen (Xiamen Children's Hospital), Xiamen, Fujian, China
| | - Guimei Wang
- Department of Pediatric Surgery, Children's Hospital of Fudan University at Xiamen (Xiamen Children's Hospital), Xiamen, Fujian, China
| | - Zhongxi Zhang
- Department of Pediatric Surgery, Children's Hospital of Fudan University at Xiamen (Xiamen Children's Hospital), Xiamen, Fujian, China
| | - Zai Song
- Department of Pediatric Surgery, Children's Hospital of Fudan University at Xiamen (Xiamen Children's Hospital), Xiamen, Fujian, China
- Department of Pediatric Surgery, Children’s Hospital of Fudan University, and Shanghai Key Laboratory of Birth Defects, Shanghai, China
| |
Collapse
|
2
|
Nataraja RM, Yin Mar Oo, Ljuhar D, Pacilli M, Nyo Nyo Win, Stevens S, Aye Aye, Nestel D. Long-Term Impact of a Low-Cost Paediatric Intussusception Air Enema Reduction Simulation-Based Education Programme in a Low-Middle Income Country. World J Surg 2022; 46:310-321. [PMID: 34671841 DOI: 10.1007/s00268-021-06345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intussusception is one of the commonest causes of bowel obstruction in infants. Most infants in Low- and Middle-Income Countries (LMICs) undergo an invasive operative intervention. Supported by simulation-based education (SBE), the Air Enema (AE) non-operative technique was introduced in 2016 in Myanmar. This study assesses the long-term outcomes. METHODS Mixed methods study design over 4 years including clinical outcomes and surgeon's attitudes towards the AE technique and SBE. Prospectively collected clinical outcomes and semi-structured interview with reflexive thematic analysis (RTA). Primary outcome measure was a long-term shift to non-operative intervention. SECONDARY OUTCOMES Length of Stay (LoS), recurrence rates, intestinal resection rates, compared to the operative group. The data was analysed according to intention to treat. Quantitative data analysis with Mann-Whitney U test, Fisher's exact test, Student's T-Test or Wilcoxon Signed-Rank Test utilised. A p-value of <.05 was considered significant. RESULTS A total of 311 infants with intussusception were included. A sustained shift to AE was revealed with high success rates (86.1-91.2%). AE had a reduced LoS (4 vs. 7 days p ≤ 0.0001), Duration of Symptoms (DoS) was lower with AE (1.9/7 vs. 2.5/7, p = 0.002). Low recurrence rates (0-5.8%) and intestinal resection rates stabilised at 30.5-31.8% vs.15.3% pre-intervention. Four RTA themes were identified: Expanding conceptions of healthcare professional education and training; realising far reaching advantages; promoting critical analysis and reflective practice of clinicians; and adapting clinical practice to local context. RTA revealed an overall positive paradigm shift in attitudes and application of SBE. CONCLUSIONS A sustained change in clinical outcomes and appreciation of the value of SBE was demonstrated following the intervention.
Collapse
Affiliation(s)
- R M Nataraja
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Yin Mar Oo
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - D Ljuhar
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - M Pacilli
- Department of Paediatric Surgery, Urology and Surgical Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nyo Nyo Win
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - S Stevens
- Austin Clinical School, University of Melbourne, Melbourne, VIC, Australia
- Austin Precinct, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Aye Aye
- Department of Paediatric Surgery, Yangon Children's Hospital, Yangon, Myanmar
| | - D Nestel
- Austin Precinct, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Tagbo BN, Ezomike UO, Odetunde OA, Edelu BO, Eke BC, Amadi OF, Okeke IB, Ani O, Chukwubuike CM, Mwenda JM, Ekenze SO. Intussusception in children under five years of age in Enugu, Nigeria. Pan Afr Med J 2021; 39:9. [PMID: 34548901 PMCID: PMC8437421 DOI: 10.11604/pamj.supp.2021.39.1.20811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/13/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction intussusception is the invagination of a segment of the bowel into a distal segment. It occurs predominantly in infants worldwide. Following documentation of increased incidence after introduction of the first rotavirus vaccine (Rotashield, Wyeth-Lederle), it has become a standard recommendation to maintain surveillance for intussusception as newer rotavirus vaccines are introduced into EPI. Nigeria plans to introduce rotavirus vaccine in 2020. Pre-vaccine introduction surveillance will serve as a baseline to understand the epidemiology of intussusception in Nigeria. Methods from 2013 to 2017, prospective enrolment of under five children with intussusception was done following the WHO protocol and using the WHO case report form. Only children who met the Pan American Health Organization/World Health Organization (PAHO/WHO) protocol case definition for intussusception were enrolled. These children were monitored until discharge or death. Clinical features and outcome were recorded in the case report form. Results a total of 63 cases were enrolled, with age range of 3 to 42 months (median: 6 months, IQR: 5-9 months). Majority were within 4-6 months and 96% were < 12 months old. There were 41 males and 22 females (male to female ratio of 1.9:1). Duration of symptoms before presentation ranged from 2 hours to 15 days (median: 72 hours). Fifty-seven patients had abdominal ultrasound and 52 patients (83%) had surgery. Case fatality rate was 9% and duration of hospitalization ranged from 1 to 30 days (median 10 days, IQR 8-15 days). Conclusion intussusception occurred most commonly in infants but well beyond the proposed age for rotavirus vaccination in the population studied. Late presentation and surgical intervention were common. This data provides a good baseline description of the epidemiology of intussusception.
Collapse
Affiliation(s)
- Beckie Nnenna Tagbo
- Institute of Child Health & Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | | | | | | | | | | | - Okechukwu Ani
- Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | | | | |
Collapse
|
4
|
Park IK, Cho MJ. Clinical Characteristics According to Age and Duration of Symptoms to Be Considered for Rapid Diagnosis of Pediatric Intussusception. Front Pediatr 2021; 9:651297. [PMID: 33869118 PMCID: PMC8044523 DOI: 10.3389/fped.2021.651297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/05/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: The purpose of this study was to evaluate whether clinical findings in children with ileocolic intussusception differ based on age and duration of symptoms and to assess the clinical characteristics of diagnosed and undiagnosed patients to determine which symptoms make diagnosis more difficult. Methods: We reviewed 536 medical records of <15-year-old children diagnosed with ileocolic intussusception between 2008 and 2019. We divided the children into three categories according to age (<1 year, 1-2 years, and ≥2 years). The children were also divided into two groups based on whether symptoms lasted for more or <6 h. Diagnosed and undiagnosed children were assessed separately during for the initial evaluation. Results: Following analysis of the three age groups, bloody stool, post-enema bloody stool, diarrhea, vomiting, poor oral intake, and lethargy were more frequent in children aged <1 year. In children aged ≥2 years, non-specific abdominal pain was more frequent and the undiagnosed rate was higher. Following analysis of the duration of symptoms, paroxysmal pain was significantly more frequent in the early group (<6 h), and bloody stool and fever were significantly more frequent in the late group (≥6 h). Nonspecific abdominal pain was more frequent and the door-to-diagnosis time was significantly longer in the undiagnosed group than in the diagnosed group. Conclusions: Clinical findings of ileocolic intussusception vary depending on the age and duration of symptoms. Younger children with paroxysmal pain, vomiting, bloody stool, poor oral intake, or lethargy should be suspected of having intussusception. In older children, non-specific abdominal pain without bloody stool may be a symptom of intussusception. Glycerin enema is helpful in diagnosing intussusception in children with no typical symptoms.
Collapse
Affiliation(s)
- In Kyu Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Min Jeng Cho
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| |
Collapse
|
5
|
Tang XB, Hu DY, Mu XQ, Bai YZ. Association of air temperature with pediatric intussusception in northeastern China: A 10-year retrospective study. Am J Emerg Med 2020; 42:211-216. [PMID: 33191045 DOI: 10.1016/j.ajem.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine whether an association existed between intussusception and air temperature. METHODS A retrospective study was performed between March 2006 and February 2016 to determine the relationship between pediatric primary intussusception (PPI) and air temperature. Information from hospital records of 5922 cases of PPI and Mean daily temperatures of Shenyang were obtained. Pearson correlation analysis was used to examine the association between monthly PPI cases and monthly mean temperature. Factorial analysis-of-variance was used to examine differences in the numbers of seasonal PPI cases during different seasons. RESULTS Monthly PPI cases fluctuated throughout the year, with a peak in June, and a trough in February. Pearson correlation analysis showed that monthly PPI cases was associated with the monthly mean temperature (p < 0.01). Factorial analysis-of-variance showed there was significant difference in the numbers of seasonal PPI cases during different seasons. Multiple comparison showed a significant difference in seasonal PPI cases between spring and summer, spring and winter, summer and autumn, summer and winter, autumn and winter (p < 0.01). CONCLUSIONS Monthly PPI cases were positively associated with monthly mean temperature in Shenyang. The incidence of intussusception shows a seasonal trend, with a peak in summer (May to July).
Collapse
Affiliation(s)
- Xiao Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Yan Hu
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xian Qing Mu
- Department of Pediatric Surgery, Shenyang Children's Hospital, Shenyang, Liaoning, China
| | - Yu Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
| |
Collapse
|
6
|
Das MK, Arora NK, Gupta B, Sharan A, Kameswari K, Padmalatha P, Prasad GR, Shad J, Shyamala J, Harish Kumar S, Nagender Y, Sharmila K, Shad R, Garge S, Bharadia L, Gupta A, Goswami JK, Lahiri K, Sankhe L, Mane S, Patwari YP, Ajayakumar MK, Santhosh Kumar A, Sarangi R, Tripathy BB, Mohapatra SSG, Sahoo SK, Kumar V, Kumar R, Sarkar S, Sarkar R, Sarkar NR, Wakhlu A, Ratan SK, Dubey AP, Mohan N, Luthra M, Vyas BR, Trivedi H, Mathai J, Sam CJ, Jothilakshmi K, Arunachalam P, Bhat JI, Mufti G, Charoo BA, Jena PK, Debbarma SK, Ghosh SK, Aggarwal MK, Haldar P, Zuber PLF, Maure C, Bonhoeffer J, Ray A. Intussusception in children aged under two years in India: Retrospective surveillance at nineteen tertiary care hospitals. Vaccine 2020; 38:6849-6857. [PMID: 32553492 PMCID: PMC7528221 DOI: 10.1016/j.vaccine.2020.04.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
| | | | - Bini Gupta
- The INCLEN Trust International, New Delhi, India.
| | | | - K Kameswari
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | - P Padmalatha
- Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India.
| | | | - Jimmy Shad
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | - J Shyamala
- Apollo Hospitals, Chennai, Tamil Nadu, India.
| | | | | | - K Sharmila
- Apollo Hospital, Hyderabad, Telengana, India.
| | - Rashmi Shad
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | - Saurabh Garge
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India.
| | | | - Atul Gupta
- Fortis Escorts Hospital, Jaipur, Rajasthan, India.
| | | | | | - Lalit Sankhe
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | - Sushant Mane
- Grant Medical College & JJ Hospital, Mumbai, Maharashtra, India.
| | | | - M K Ajayakumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - A Santhosh Kumar
- Government Medical College & SAT Hospital, Thiruvananthapuram, Kerala, India.
| | - Rachita Sarangi
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - S S G Mohapatra
- IMS & SUM Medical College & Hospital, Bhubaneswar, Odisha, India.
| | | | - Vijayendra Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Rakesh Kumar
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
| | - Suman Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ruchirendu Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Nihar Ranjan Sarkar
- Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
| | - Ashish Wakhlu
- King George's Medical University, Lucknow, Uttar Pradesh, India.
| | | | | | | | | | - Bhadresh R Vyas
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - Harsh Trivedi
- MP Shah Government Medical College, Jamnagar, Gujarat, India.
| | - John Mathai
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - Cenita J Sam
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | - K Jothilakshmi
- PSG Institute of Medical Sciences, Coimbatore, Tamil Nadu, India.
| | | | - Javeed Iqbal Bhat
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Gowhar Mufti
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Bashir Ahmad Charoo
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India.
| | - Pradeep K Jena
- SCB Medical College and SVP Postgraduate Institute of Paediatrics, Cuttack, Odisha, India.
| | | | - Sunil K Ghosh
- Agartala Government Medical College, Agartala, Tripura, India.
| | - Mahesh K Aggarwal
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India.
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland.
| | - Arindam Ray
- Bill and Melinda Gates Foundation, India Country Office, New Delhi, India.
| |
Collapse
|
7
|
Hwang S, Kim J, Jung JY, Ham EM, Park JW, Kwon H, Kim DK, Kwak YH. The epidemiology of childhood intussusception in South Korea: An observational study. PLoS One 2019; 14:e0219286. [PMID: 31860649 PMCID: PMC6924652 DOI: 10.1371/journal.pone.0219286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/20/2019] [Indexed: 11/19/2022] Open
Abstract
Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.
Collapse
Affiliation(s)
- Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan-si, Gyeonggi-do, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
8
|
Epidemiology study of pediatric primary intussusception aged ≤24 months in pre-rotavirus vaccine era of Jinan, China. Vaccine 2019; 37:1436-1442. [DOI: 10.1016/j.vaccine.2019.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022]
|
9
|
Burnett E, Van Trang N, Rayamajhi A, Yousafzai MT, Satter SM, Anh DD, Thapa A, Qazi SH, Heffelfinger JD, Hung PH, Rayamajhi AK, Saddal N, Flora MS, Canh TM, Ali SA, Gurley ES, Tate JE, Yen C, Parashar UD. Preparing for safety monitoring after rotavirus vaccine introduction - Assessment of baseline epidemiology of intussusception among children <2 years of age in four Asian countries. Vaccine 2018; 36:7593-7598. [PMID: 30414781 PMCID: PMC10983083 DOI: 10.1016/j.vaccine.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022]
Abstract
Intussusception is the invagination of one segment of the bowel into a distal segment, characterized by symptoms of bloody stool, vomiting, and abdominal pain. Previous studies have found regional differences in incidence but the etiology of most intussusception cases is unknown. Rotavirus vaccines were associated with a slightly of increased risk of intussusception in post-licensure evaluations in high- and middle-income countries, but not in low income African countries. To describe the baseline epidemiology of intussusception in young children prior to rotavirus vaccine implementation, active sentinel hospital surveillance for intussusception in children < 2 years of age was conducted in 4 low income Asian countries (Bangladesh, Nepal, Pakistan and Vietnam). Over a 24-month period, 15 sites enrolled 1,415 intussusception cases, of which 70% were enrolled in Vietnam. Overall, 61% of cases were male and 1% (n = 16) died, ranging from 8% in Pakistan to 0% in Vietnam. The median age of cases enrolled ranged from 6 months in Bangladesh and Pakistan to 12 months in Vietnam. The proportion of cases receiving surgical management was 100% in Bangladesh, 88% in Pakistan, 61% in Nepal, and 1% in Vietnam. The high proportion of males and median age of cases around 6 months of age found in this regional surveillance network are consistent with previous descriptions of the epidemiology of intussusception in these countries and elsewhere. Differences in management and the fatality rate of cases between the countries likely reflect differences in access to healthcare and availability of diagnostic modalities. These baseline data will be useful for post-rotavirus vaccine introduction safety monitoring.
Collapse
Affiliation(s)
- Eleanor Burnett
- CDC Foundation for the US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nguyen Van Trang
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Ajit Rayamajhi
- Janek Medical and Research Center, Kathmandu, Nepal; Kanthi Children's Hospital, Kathmandu, Nepal
| | | | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | | | - Saqib Hamid Qazi
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Nasir Saddal
- Department of Surgery, National Institute of Child Health, Karachi, Pakistan
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Syed Asad Ali
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Catherine Yen
- Centers for Disease Control and Prevention, Atlanta, USA
| | | |
Collapse
|
10
|
Gupta M, Kanojia R, Singha R, Tripathy JP, Mahajan K, Saxena A, Bansal A, Muralidharan J, Kumar R. Intussusception Rate Among Under-Five-Children Before Introduction of Rotavirus Vaccine in North India. J Trop Pediatr 2018; 64:326-335. [PMID: 29040742 DOI: 10.1093/tropej/fmx073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Baseline data on intussusception are needed to compare the intussusception rates following introduction of rotavirus vaccine. METHODS A hospital-based bidirectional surveillance (retrospective from 2009 to 2012; and prospective from 2013 to 2015) was set up in a tertiary care hospital in Chandigarh, India, to enrol children <5 years of age admitted with intussusception as per Brighton's classification, to estimate the hospital admission rate. Incidence of intussusception among infants and children <5 years of age was also estimated. RESULTS A total of 277 intussusception cases (96 retrospective; 181 prospective) were reported. Majority of cases were males (69.7%) and infants (72%). Median age at diagnosis was 10 months (interquartile range 6-12 months). Nearly 62% cases were treated surgically and 33% radiologically. Incidence was estimated to be 20/100 000 infants, and 5/100 000 children <5 years of age per year, in Chandigarh. CONCLUSION Intussusception surveillance system provided background hospital admission and incidence rate before rotavirus vaccine introduction in North India.
Collapse
Affiliation(s)
- Madhu Gupta
- Department of Community Medicine, School of Public Health, PGIMER, Sector 12, Chandigarh 160012, India
| | - Ravi Kanojia
- Department of Pediatric Surgery, Advanced Pediatric Center, PGIMER, Sector 12, Chandigarh 160012, India
| | - Ritesh Singha
- Department of Community Medicine, School of Public Health, PGIMER, Sector 12, Chandigarh 160012, India
| | - Jaya Prasad Tripathy
- Department of Community Medicine, School of Public Health, PGIMER, Sector 12, Chandigarh 160012, India.,International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, C6, Qutub Institutional Area, New Delhi 110016, India
| | - Kamlesh Mahajan
- Department of Community Medicine, School of Public Health, PGIMER, Sector 12, Chandigarh 160012, India
| | - Akshay Saxena
- Department of Radiodiagnosis, PGIMER, Sector 12, Chandigarh 160012, India
| | - Arun Bansal
- Advanced Pediatric Center, PGIMER, Sector 12, Chandigarh 160012, India
| | | | - Rajesh Kumar
- Department of Community Medicine, School of Public Health, PGIMER, Sector 12, Chandigarh 160012, India
| |
Collapse
|
11
|
Epidemiology of intussusception before and after rotavirus vaccine introduction in Fiji. Sci Rep 2018; 8:11194. [PMID: 30046133 PMCID: PMC6060119 DOI: 10.1038/s41598-018-29515-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
In 2012, Fiji introduced rotavirus vaccine (Rotarix, GSK) into the national immunisation schedule. We describe the intussusception epidemiology prior to rotavirus vaccine, temporal association of intussusception cases to administration of rotavirus vaccine, and estimate the additional number of intussusception cases that may be associated with rotavirus vaccine. A retrospective review of intussusception cases for children aged <24 months old was undertaken between January 2007 and October 2012 pre-vaccine. All admissions and deaths with a discharge diagnosis of intussusception, bowel obstruction, paralytic ileus, or intussusception ICD10-AM codes were extracted from national databases and hospital records. Nationwide active intussusception surveillance was established for three years post-vaccine (2013–2015). There were 24 definite intussusception cases in the pre-rotavirus vaccine period, 96% were confirmed by surgery. The median age was 6.5 months. The incidence rate was 22.2 (95% CI: 13.9–33.7) per 100,000 infants. There were no deaths. Active surveillance identified 25 definite intussusception cases, 96% of which were among children who were age-eligible for rotavirus vaccine. None were potentially vaccine related. We estimated one to five additional cases of intussusception every five years. The incidence of intussusception pre-rotavirus vaccine in Fiji is low. Intussusception associated with rotavirus vaccine is likely a rare event in Fiji.
Collapse
|
12
|
Trang NV, Burnett E, Ly LH, Anh NP, Hung PH, Linh HM, Trang NCT, Canh TM, Minh VT, Tate JE, Yen C, Anh DD, Parashar UD. Recurrent intussusception among infants less than 2 years of age in Vietnam. Vaccine 2018; 36:7901-7905. [PMID: 29478753 DOI: 10.1016/j.vaccine.2018.02.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
Abstract
In some settings, rotavirus vaccines have been associated with a low-level risk of intussusception, the most common cause of bowel obstruction in infants. As Vietnam prepares to introduce rotavirus vaccine into the national immunization program, we sought to better characterize the epidemiology of recurrent intussusception. We enrolled children <2 years of age who were hospitalized for intussusception retrospectively from January 2013 through December 2014 and prospectively from January 2015 through December 2016 at 2 hospitals in Vietnam. We enrolled 2477 children. Nearly all children were successfully treated by enema with low surgery rate (1%). We found 10% of children (n = 254) experienced at least once recurrence (range: 1-6) and 57% of first recurrences happened within the first 12 weeks after treatment of the first episode. The median age at first intussusception was 13 months for children without a recurrent episode and 10 months for children with a recurrence. The symptoms of the recurrent cases were milder with less vomiting (67%), bloody stool (7%) and fever (10%) compared to the initial cases (p < 0.01). We found the rate of recurrences following enema reduction of intussusception to be similar to that reported from other countries. Due to the high rate of intussusception and recurrent episodes in Vietnam, a better understanding of the cause of recurrent intussusception will be critical in assessing intussusception cases after rotavirus introduction.
Collapse
Affiliation(s)
- Nguyen V Trang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | | - Le H Ly
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Nguyen P Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Pham H Hung
- Pediatric Center, Hue Central Hospital, Hue, Viet Nam
| | - Hoang M Linh
- Pediatric Center, Hue Central Hospital, Hue, Viet Nam
| | | | - Tran M Canh
- Hai Phong Children Hospital, Hai Phong, Viet Nam
| | - Vu T Minh
- Hai Phong Children Hospital, Hai Phong, Viet Nam
| | | | | | - Dang D Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | | |
Collapse
|
13
|
Intussusception-related Hospitalizations Among Infants Before and After Private Market Licensure of Rotavirus Vaccines in Taiwan, 2001-2013. Pediatr Infect Dis J 2017; 36. [PMID: 28640005 PMCID: PMC6501187 DOI: 10.1097/inf.0000000000001644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rotavirus is a leading cause of acute gastroenteritis among Taiwanese children. Two globally licensed rotavirus vaccines recommended for inclusion in routine immunization programs that have been available for private market use in Taiwan since 2006 have been associated with a low risk of intussusception in postmarketing studies conducted in several countries. Our objective was to examine trends and characteristics of intussusception hospitalizations in Taiwan among children <12 months of age before and after rotavirus vaccine licensure to provide updated baseline and early postlicensure data. METHODS We extracted data on intussusception-related hospitalizations among children <12 months of age during 2001-2013 from the National Health Insurance Research Database. We examined patient demographics, clinical outcome and hospitalization trends, focusing on recommended ages for rotavirus vaccination (6-14, 15-24 and 25-34 weeks). We compared mean hospitalization rates for prevaccine licensure years 2001-2005 with those for postvaccine licensure years 2007-2013 using Poisson regression analysis. RESULTS During 2001-2013, 1998 intussusceptions hospitalizations were recorded. The mean age of hospitalization was 33 weeks. Almost all children recovered; 3 deaths occurred. The overall intussusception hospitalization rate was 75.1 per 100,000; seasonality was not evident. Hospitalization rates were greatest in children ≥25 weeks of age and occurred more frequently in boys. Prevaccine and postvaccine licensure trends in annual hospitalization rates did not significantly differ. However, mean hospitalization rates were lower during the postvaccine licensure period for children <12 months of age (rate ratio: 0.84, 95% confidence interval: 0.76-0.92) with the greatest decline among children 25-34 weeks of age (rate ratio: 0.66, 95% confidence interval: 0.55-0.78). CONCLUSIONS Infant intussusception in Taiwan occurs at a rate within the range of other Asian countries is rare among children <3 months of age, has a male predominance and does not have a clear seasonality pattern. We did not observe a postlicensure increase in intussusception hospitalization rates in children 6-14 weeks of age.
Collapse
|
14
|
Satter SM, Aliabadi N, Yen C, Gastañaduy PA, Ahmed M, Mamun A, Islam K, Flora MS, Rahman M, Zaman K, Rahman M, Heffelfinger JD, Luby SP, Gurley ES, Parashar UD. Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012-2016. Vaccine 2017; 36:7805-7810. [PMID: 28941622 PMCID: PMC5864564 DOI: 10.1016/j.vaccine.2017.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Rotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction. METHODS We conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described. RESULTS Overall 153 cases of intussusception among children <2years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2years of age. One hundred twelve cases (73%) were male; the median age was 7months; and the median duration of hospitalization was 7days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died. CONCLUSIONS Confirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.
Collapse
Affiliation(s)
| | - Negar Aliabadi
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Catherine Yen
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | - Makhdum Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Khaleda Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | | | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, USA
| | | | | |
Collapse
|
15
|
Yousafzai MT, Thobani R, Qazi SH, Saddal N, Yen C, Aliabadi N, Ali SA. Intussusception among children less than 2years of age: Findings from pre-vaccine introduction surveillance in Pakistan. Vaccine 2017; 36:7775-7779. [PMID: 28709556 DOI: 10.1016/j.vaccine.2017.06.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/23/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Rotavirus vaccination introduction in routine immunization is under consideration in Pakistan. Data on the baseline epidemiology of intussusception will inform surveillance strategies for intussusception after rotavirus vaccine introduction in Pakistan. We describe the epidemiology of intussusception-associated hospitalizations among children <2years of age in Karachi, Pakistan. METHODS We conducted a retrospective chart review for July 01, 2012 through June 30, 2015 at the National Institute of Child Health (NICH) and Aga Khan University Hospital (AKUH) Karachi. At AKUH, the International Classification of Disease, ninth revision, code 560.0 for intussusception was used to retrieve intussusception case records. At NICH, daily Operation Theater, Emergency Room, and surgical daycare log sheets and surgical ward census sheets were used to identify cases. Records of children who fulfilled eligibility criteria and the Brighton Collaboration level one case definition of intussusception were selected for data analysis. We used structured case report forms to extract data for the descriptive analysis. RESULTS We identified 158 cases of confirmed intussusception; 30 cases (19%) were from AKUH. More than half (53%) of the cases occurred in children aged 6-12months, followed by 35% among those aged <6months. Two-thirds (106/158) of the cases were male. The most common presenting complaints were vomiting and bloody stool. At NICH, almost all (93%) were managed surgically, while at AKUH, ∼57% of the cases were managed with enemas. Three deaths occurred, all from NICH. Cases occurred without any seasonality. At NICH, 4% (128/3618) of surgical admissions among children aged <2years were attributed to intussusception, while that for AKUH was 2% (30/1702). CONCLUSION In this chart review, intussusception predominantly affected children 0-6months of age and occurred more commonly in males. This information on the baseline epidemiology of intussusception will inform post-vaccine introduction adverse event monitoring related to intussusception in Pakistan.
Collapse
Affiliation(s)
| | - Rozina Thobani
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Saqib Hamid Qazi
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | - Nasir Saddal
- Department of Surgery, National Institute of Child Health, Karachi, Pakistan
| | - Catherine Yen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Syed Asad Ali
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
16
|
Omore R, Osawa F, Musia J, Rha B, Ismail A, Kiulia NM, Moke F, Vulule J, Wainaina AM, Tole J, Machoki SM, Nuorti JP, Breiman RF, Parashar UD, Montgomery JM, Tate JE. Intussusception Cases Among Children Admitted to Referral Hospitals in Kenya, 2002-2013: Implications for Monitoring Postlicensure Safety of Rotavirus Vaccines in Africa. J Pediatric Infect Dis Soc 2016; 5:465-469. [PMID: 26407281 PMCID: PMC8721673 DOI: 10.1093/jpids/piv051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 07/18/2015] [Indexed: 11/14/2022]
Abstract
To describe the epidemiology of intussusception before introduction of the rotavirus vaccine, we reviewed the records of 280 patients younger than 5 years who were hospitalized in Kenya between 2002 and 2013. The patients who died (18 [6.4%]) had sought care later after symptom onset than the patients who survived (median, 5 vs 3 days, respectively; P = .04). Seeking prompt care may improve therapeutic outcomes.
Collapse
Affiliation(s)
- Richard Omore
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya,Department of Epidemiology, School of Health Sciences, University of Tampere, Finland
| | - Francis Osawa
- Department of Surgery, School of Medicine, University of Nairobi, Kenya
| | - Janet Musia
- Department of Pediatrics and Child Health, School of Medicine, University of Nairobi, Kenya
| | - Brian Rha
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amina Ismail
- Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | | | - Fenny Moke
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - John Vulule
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | | | - John Tole
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - J. Pekka Nuorti
- Department of Epidemiology, School of Health Sciences, University of Tampere, Finland
| | - Robert F. Breiman
- Global Health Institute, Emory University, Atlanta, Georgia,Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Umesh D. Parashar
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M. Montgomery
- Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jacqueline E. Tate
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
17
|
John J, Kawade A, Rongsen-Chandola T, Bavdekar A, Bhandari N, Taneja S, Antony K, Bhatnagar V, Gupta A, Kabra M, Kang G. Active surveillance for intussusception in a phase III efficacy trial of an oral monovalent rotavirus vaccine in India. Vaccine 2014; 32 Suppl 1:A104-9. [DOI: 10.1016/j.vaccine.2014.03.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|