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Roose A, Keita AM, Tapia MD, Sow SO, Mast TC, Kotloff KL. Incidence of Intussusception in Bamako, Mali, Before and After the Introduction of Rotavirus Vaccine. J Pediatric Infect Dis Soc 2022; 11:404-407. [PMID: 35713304 PMCID: PMC9520282 DOI: 10.1093/jpids/piac044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/01/2022] [Indexed: 12/04/2022]
Abstract
Pentavalent rotavirus vaccine has been associated with a small increase in intussusception, but pre- and post-introduction data are lacking in many low-resource settings. Using chart review and prospective surveillance data, intussusception incidence was estimated in Bamako, Mali. The mean annual intussusception incidence post-introduction was not significantly different from that of pre-introduction.
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Affiliation(s)
| | | | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Pediatrics and Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre for Vaccine Development, Bamako, Mali
| | | | - Karen L Kotloff
- Corresponding Author: Karen L. Kotloff, MD, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, USA. E-mail:
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2
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Oishi T, Matsunaga M, Nakano T, Sudo S, Kuwajima H, Tokuriki S, Study SR. Occurrence of severe rotavirus gastroenteritis in children younger than three years of age before and after the introduction of rotavirus vaccine: a prospective observational study in four pediatric clinics in Shibata City, Niigata Prefecture, Japan. Hum Vaccin Immunother 2020; 16:2495-2501. [PMID: 32609565 PMCID: PMC7644216 DOI: 10.1080/21645515.2020.1720435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In Japan, rotavirus (RV) vaccines have already been introduced but not used for universal vaccination as of 2018. Therefore, we identified cases of severe rotavirus gastroenteritis (RVGE) in children younger than three years of age and investigated the occurrence of infection before and after the introduction of RV vaccines. An ecological study through prospective surveillance was conducted in four pediatric clinics in Shibata City, Niigata Prefecture, Japan, during the 2011 to 2018 RVGE epidemic seasons. We divided the study period into three eras: pre-vaccine introduction era (2011), low-mid coverage transitional era (2012 to 2014, RV vaccine coverage rate: 32.9–56.5%), and high coverage plateau era (2015 to 2018, 67.7–81.7%). In this study, the incidence rate of severe RVGE was significantly lower in the plateau era than in the pre-vaccine introduction and transitional eras. Furthermore, the hospitalization rate due to RVGE in Shibata City was lower in the plateau era than in the pre-vaccination introduction and transitional eras. The number of hospitalizations due to RVGE in subjects who required or did not require intravenous rehydration at the pediatric clinics significantly decreased with the increase in vaccine coverage rates by more than 70% in the plateau era.
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Affiliation(s)
- Tomohiro Oishi
- Department of Pediatrics, Kawasaki Medical School , Kurashiki, Japan
| | - Masamichi Matsunaga
- Pediatric Department, Niigata Prefectural Shibata Hospital , Shibata City, Japan
| | - Tokushi Nakano
- Pediatric Department, Nakano Children's Clinic , Shibata City, Japan
| | - Shoji Sudo
- Pediatric Department, Sudo Pediatric Clinic , Shibata City, Japan
| | | | - Shuko Tokuriki
- Pediatric Department, Twin Smile Clinic , Shibata City, Japan
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3
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Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. BMC Pediatr 2020; 20:413. [PMID: 32873281 PMCID: PMC7461288 DOI: 10.1186/s12887-020-02293-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background India introduced rotavirus vaccines (RVV, monovalent, Rotavac™ and pentavalent, Rotasiil™) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 2–23 months in India. Methods The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Along with descriptive analysis, key parameters between four regions were compared using Chi-Square/Fisher’s exact/Mann–Whitney U/Kruskal-Wallis tests. The pre- and post-RVV periods were compared to estimate the risk ratios. Results Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Majority (n = 465, 74.8%) were infants (40.0% aged 4–7 months) with median age 8 months (IQR 5, 13 months), predominantly males (n = 408, 65.7%) and half (n = 311, 50.0%) occurred during March–June months. A shorter interval between weaning and intussusception was observed for ragi based food (median 1 month, IQR 0–4.2 months) compared to rice (median 4 months, IQR 1–9 months) and wheat (median 3 months, IQR 1–7 months) based food (p < 0.01). Abdominal pain or excessive crying (82.8%), vomiting (72.6%), and bloody stool (58.1%) were the leading symptoms. Classical triad (abdominal pain, vomiting and bloody stool) was observed in 34.8% cases (24.4 to 45.8% across regions). 95.3% of the cases were diagnosed by ultrasound. 49.3% (10.5 to 82.4% across regions) cases were managed by reduction, 39.5% (11.5 to 71.1% across regions) cases underwent surgery and 11.1% spontaneously resolved. Eleven (1.8%) cases died. 89.1% cases met Brighton criteria level 1 and 7.6% met Level 2. RVV was received by 12 cases within 1–21 days prior to intussusception. No increase in case load (RR = 0.44; 95% CI 0.22–1.18) or case ratio (RR = 0.5; 95% CI 0.3–1.2) was observed after RVV introduction in select sites. Conclusions Intussusception cases were observed across all sites, although there were variations in cases, presentation and mode of management. The high case load age coincided with age of the RVV third dose. The association with ragi based weaning food in intussusception needs further evaluation.
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Hallowell BD, Tate J, Parashar U. An overview of rotavirus vaccination programs in developing countries. Expert Rev Vaccines 2020; 19:529-537. [PMID: 32543239 DOI: 10.1080/14760584.2020.1775079] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Rotavirus is the leading cause of acute diarrhea among children <5 years worldwide. As all children are equally susceptible to infection and disease development, rotavirus vaccination programs are the best upstream approach to preventing rotavirus disease, and the subsequent risk of hospitalization or death. AREAS COVERED We provide an overview of global rotavirus vaccine policy, summarize the burden of rotavirus disease in developing countries, review data on the effectiveness, impact, safety, and the cost-effectiveness of rotavirus vaccination programs, and identify areas for further research and improvement. EXPERT OPINION Rotavirus vaccines continue to be an effective, safe, and cost-effective solution to preventing rotavirus disease. As two new rotavirus vaccines enter the market (Rotasiil and Rotavac) and Asian countries continue to introduce rotavirus vaccines into their national immunization programs, documenting vaccine safety, effectiveness, and impact in these settings will be paramount.
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Affiliation(s)
- Benjamin D Hallowell
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA.,Epidemic Intelligence Service, CDC , Atlanta, GA, USA
| | - Jacqueline Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
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5
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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.
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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.
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Reddy S, Nair NP, Giri S, Mohan VR, Tate JE, Parashar UD, Gupte MD, Arora R, Kang G. Safety monitoring of ROTAVAC vaccine and etiological investigation of intussusception in India: study protocol. BMC Public Health 2018; 18:898. [PMID: 30029630 PMCID: PMC6053826 DOI: 10.1186/s12889-018-5809-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background ROTAVAC, an indigenous rotavirus vaccine, was introduced in the universal immunization program of India in four states in 2016 and expanded to five more states in 2017. The clinical trial on efficacy of ROTAVAC did not detect an increased risk of intussusception, but the trial was not large enough to detect a small risk. This protocol paper describes the establishment and implementation of a surveillance system to monitor the safety of rotavirus vaccine and investigate the potential infectious etiologies of intussusception. Methods This is a multi-centric hospital-based active surveillance being conducted at 28 hospitals in nine states of India. Data gathered from surveillance will be used to assess the risk of intussusception after ROTAVAC administration and to determine the infectious etiologies of intussusception. For safety assessment of ROTAVAC vaccine, children aged less than two years with intussusception admitted at the sentinel hospitals are enrolled into surveillance, a case report form completed, and a copy of the vaccination card obtained. The risk of intussusception following rotavirus vaccination will be assessed using a self-controlled case-series design. The investigation for potential infectious etiologies of intussusception is through a matched case-control design. Children enrolled for the safety assessment serve as cases and for each case, an age, gender and location matched control is enrolled within 30 days of case enrollment. Stool specimens are obtained from cases and controls. All forms and specimens are sent to the referral laboratory for data entry, analysis, multiplexed molecular testing, and storage. Discussion Anticipated public health benefits of this surveillance include the generation of information useful to national government on safety of vaccine and to make future decisions on vaccine use through risk-benefit analysis. Investigating infectious agents may help to determine the potential infectious etiologies of intussusception. Electronic supplementary material The online version of this article (10.1186/s12889-018-5809-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samarasimha Reddy
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nayana P Nair
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sidhartha Giri
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | - Mohan D Gupte
- Indian Council of Medical Research, New Delhi, India
| | - Rashmi Arora
- Translational Health Science and Technology Institute, Faridabad, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India. .,Translational Health Science and Technology Institute, Faridabad, India.
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Gadroen K, Kemmeren JM, Bruijning-Verhagen PC, Straus SM, Weibel D, de Melker HE, Sturkenboom MC. Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012. ACTA ACUST UNITED AC 2017; 22:30556. [PMID: 28662763 PMCID: PMC5490455 DOI: 10.2807/1560-7917.es.2017.22.25.30556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 11/17/2016] [Indexed: 11/20/2022]
Abstract
Intussusception is a rare, potentially life-threatening condition in early childhood. It gained attention due to an unexpected association with the first rotavirus vaccine, RotaShield, which was subsequently withdrawn from the market. Across Europe, broad variations in intussusception incidence rates have been reported. This study provides a first estimate of intussusception incidence in young children in the Netherlands from 1 January 2008 to 31 December 2012, which could be used for future rotavirus safety monitoring. Our estimates are based on two different sources: electronic medical records from the primary healthcare database (IPCI), as well as administrative data from the Dutch hospital register (LBZ). The results from our study indicate a low rate of intussusception. Overall incidence rate in children < 36 months of age was 21.2 per 100,000 person-years (95% confidence interval (CI): 12.5–34.3) based on primary healthcare data and 22.6 per 100,000 person-years (95% CI: 20.9–24.4) based on hospital administrative data. The estimates suggest the upper and lower bound of the expected number of cases.
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Affiliation(s)
- Kartini Gadroen
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.,Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Jeanet M Kemmeren
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Patricia Cj Bruijning-Verhagen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sabine Mjm Straus
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.,Medicines Evaluation Board (CBG-MEB), Utrecht, the Netherlands
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Intussusception hospitalizations before rotavirus vaccine introduction: Retrospective data from two referral hospitals in Tamil Nadu, India. Vaccine 2017; 36:7820-7825. [PMID: 29199044 PMCID: PMC6290388 DOI: 10.1016/j.vaccine.2017.11.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 11/22/2022]
Abstract
Background The indigenous oral rotavirus vaccine Rotavac® was introduced into the public immunization system in India in 2016 and will be expanded in phases. This data will describe the epidemiology of intussusception in India in absence of rotavirus vaccination and will help in setting up or designing a safety monitoring system. Methods Medical records of intussusception cases between 2013 and 2016 in two major referral hospitals in Tamil Nadu, India were reviewed, and data on clinical presentation and management and outcome were collated. Results A total of 284 cases of intussusception were diagnosed and managed at the two centers of which 280/284 could be classified as level 1 by the Brighton criteria. Median age at presentation was 8 months (Inter Quartile Range, IQR 6–17.2) with a male to female ratio of 2.1:1. Over half (57.7%) required surgical intervention while the rest underwent non-surgical or conservative management. Conclusions Retrospective data from referral hospitals is sufficient to classify cases of intussusception by the Brighton criteria. These baseline data will be useful for monitoring when rotavirus vaccination is introduced.
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9
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Oral administration of Bifidobacterium bifidum G9-1 alleviates rotavirus gastroenteritis through regulation of intestinal homeostasis by inducing mucosal protective factors. PLoS One 2017; 12:e0173979. [PMID: 28346473 PMCID: PMC5367788 DOI: 10.1371/journal.pone.0173979] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/01/2017] [Indexed: 12/17/2022] Open
Abstract
Human rotavirus (RV) infection is a leading cause of dehydrating diarrhea in infants and young children worldwide. Since therapeutic approaches to RV gastroenteritis are limited to alleviation of dehydration with oral rehydration solutions, more direct approaches to palliate symptoms of RV gastroenteritis are required. Treatments with probiotics have been increasingly recognized as alternative safe and low cost treatments for moderate infectious diarrhea. In this study, Bifidobacterium bifidum G9-1 (BBG9-1), which has been used as an intestinal drug for several decades, was shown to have a remarkable protective effect against RV gastroenteritis in a suckling mice model. As well as prophylactic oral administration of BBG9-1 from 2 days before RV infection, therapeutic oral administration of BBG9-1 from 1 day after RV infection significantly alleviated RV-induced diarrhea. Therapeutic administration of BBG9-1 reduced various types of damage in the small intestine, such as epithelial vacuolization and villous shortening, and significantly diminished the infectious RV titer in mixtures of cecal contents and feces. It was also shown that therapeutic administration of BBG9-1 significantly increased the number of acidic mucin-positive goblet cells and the gene expression of mucosal protective factors including MUC2, MUC3, MUC4, TGFβ1 and TFF3 in the small intestine. This led to alleviation of low gut permeability shown as decreased gene expression levels of occludin, claudin-1 and villin-1 after RV infection. Furthermore, in the small intestine, therapeutic administration of BBG9-1 significantly palliated the decreased gene expression of SGLT-1, which plays an important role in water absorption. In the large intestine, administered BBG9-1 was shown to replicate to assimilate undigested nutrients, resulting in normalization of the abnormally high osmotic pressure. These results suggested that water malabsorption caused by RV infection was alleviated in mice administered BBG9-1. Thus, the present study showed that oral administration of BBG9-1 palliated diarrhea partly through protection against RV-induced lesions by inducing mucosal protective factors. Oral administration of BBG9-1 is thought to be an efficient method for management of an RV epidemic for both prophylactic and therapeutic purposes.
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10
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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.
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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
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Pan XX, Zhao BX, Teng YM, Xia WY, Wang J, Li XF, Liao GY, Yang C, Chen YD. Immunoreactivity of chimeric proteins carrying poliovirus epitopes on the VP6 of rotavirus as a vector. Mol Biol 2016. [DOI: 10.1134/s0026893316030092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Yen C, Healy K, Tate JE, Parashar UD, Bines J, Neuzil K, Santosham M, Steele AD. Rotavirus vaccination and intussusception - Science, surveillance, and safety: A review of evidence and recommendations for future research priorities in low and middle income countries. Hum Vaccin Immunother 2016; 12:2580-2589. [PMID: 27322835 PMCID: PMC5084992 DOI: 10.1080/21645515.2016.1197452] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/10/2016] [Accepted: 05/25/2016] [Indexed: 02/04/2023] Open
Abstract
As of January 2016, 80 countries have introduced rotavirus vaccines into their national immunization programs. Many have documented significant declines in rotavirus-specific and all-cause diarrheal illnesses following vaccine introduction. Two globally licensed rotavirus vaccines have been associated with a low risk of intussusception in several studies. In July 2014, the Rotavirus Organization of Technical Allies Council convened a meeting of research and advocacy organizations, public health experts, funders, and vaccine manufacturers to discuss post-marketing intussusception surveillance and rotavirus vaccine impact data. Meeting objectives were to evaluate updated data, identify and prioritize research gaps, discuss best practices for intussusception monitoring in lower-income settings and risk communication, and provide insight to country-level stakeholders on best practices for intussusception monitoring and communication. Meeting participants agreed with statements from expert bodies that the benefits of vaccination with currently available rotavirus vaccines outweigh the low risk of vaccination-associated intussusception. However, further research is needed to better understand the relationship of intussusception to wild-type rotavirus and rotavirus vaccines and delineate potential etiologies and mechanisms of intussusception. Additionally, evidence from research and post-licensure evaluations should be presented with evidence of the benefits of vaccination to best inform policymakers deciding on vaccine introduction or vaccination program sustainability.
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Affiliation(s)
- Catherine Yen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly Healy
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacqueline E. Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Bines
- Murdoch Childrens Research Institute, The University of Melbourne, Victoria, Australia
| | - Kathleen Neuzil
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mathuram Santosham
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Duncan Steele
- Enteric and Diarrhoeal Diseases, Global Health, Bill and Melinda Gates Foundation, Seattle, WA, USA
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Leino T, Ollgren J, Strömberg N, Elonsalo U. Evaluation of the Intussusception Risk after Pentavalent Rotavirus Vaccination in Finnish Infants. PLoS One 2016; 11:e0144812. [PMID: 26950702 PMCID: PMC4780707 DOI: 10.1371/journal.pone.0144812] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An association between rotavirus immunisation and intussusception (IS) has been suggested with present rotavirus vaccines in post-licensure studies. In Finland, rotavirus vaccination programme was implemented in September 2009 using a 2, 3, and 5 months schedule with the pentavalent rotavirus vaccine. By the end of 2013, it is estimated that 719 000 rotavirus vaccine doses have been given in the national programme of which 240 000 were first doses. Nationwide register allows us to evaluate the association between rotavirus vaccination and IS. METHODS AND MATERIALS Cases of IS diagnosed during 1999-2013 were identified from National Hospital Discharge Register. All cases under 250 days of age diagnosed during 2009-2013 were confirmed by reviewing medical charts. Self-controlled case-series method was used to assess the risk of IS during 1-21 days compared to 22-42 days post vaccination. FINDINGS In register data the relative incidence of IS at 2 months of age between the post and pre vaccination era was 9.1 (95%CI 2.0-84.3). We identified 22 verified cases with date of admission less than 43 days after any of the three rotavirus vaccine doses. The incidence of IS in the risk period after the 1st dose relative to the control period was 2.0 (95% CI 0.5-8.4; p = 0.34.) Number of excess IS cases per 100 000 first vaccine doses was therefore estimated to be 1.04 (95% CI 0.0-2.5), i.e. one additional IS case per 96 000 first doses of rotavirus vaccine (95% CI 54 600 to ∞). There was no risk detected after 2nd and 3rd doses. CONCLUSION The finding is in line with the recent published estimates. The benefits of rotavirus immunisation programme outweigh possible small risks of intussusception.
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Affiliation(s)
- Tuija Leino
- Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland
- * E-mail:
| | - Jukka Ollgren
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nina Strömberg
- Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ulpu Elonsalo
- Department of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland
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Veldwijk J, van der Heide I, Rademakers J, Schuit AJ, de Wit GA, Uiters E, Lambooij MS. Preferences for Vaccination. Med Decis Making 2015; 35:948-58. [DOI: 10.1177/0272989x15597225] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/05/2015] [Indexed: 11/17/2022]
Abstract
Purpose. The purpose of this study is to examine to what extent health literacy is associated with parental preferences concerning childhood vaccination. Methods. A cross-sectional study was conducted among 467 Dutch parents of newborns aged 6 weeks (response rate of 37%). A self-reported questionnaire was used to measure health literacy by means of Chew’s Set of Brief Screening Questions, as well as parental preferences for rotavirus vaccination by means of a discrete choice experiment. Five rotavirus-related characteristics were included (i.e., vaccine effectiveness, frequency of severe side effects, location of vaccination, protection duration, and out-of-pocket costs). Panel latent class models were conducted, and health literacy and educational level were added to the class probability model to determine the association between health literacy and study outcomes. Results. Lower educated and lower health literate respondents considered protection duration to be more important and vaccine effectiveness and frequency of severe side effects to be less important compared with higher educated and higher health literate respondents. While all respondents were willing to vaccinate against rotavirus when the vaccine was offered as part of the National Immunization Program, only lower educated and lower health literate parents were willing to vaccinate when the vaccine was offered on the free market. Conclusion: Health literacy is associated with parents’ preferences for rotavirus vaccination. Whether differences in vaccination decisions are actually due to varying preferences or might be better explained by varying levels of understanding should be further investigated. To contribute to more accurate interpretation of study results, it may be advisable that researchers measure and report health literacy when they study vaccination decision behavior.
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Affiliation(s)
- Jorien Veldwijk
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - Iris van der Heide
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - Jany Rademakers
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - A. Jantine Schuit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - G. Ardine de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - Ellen Uiters
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
| | - Mattijs S. Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands (JV, IH, AJS, GAW, EU, MSL)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (JV, GAW)
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands (IH, JR)
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands (AJS)
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Affiliation(s)
- Sunil Taneja
- Department of Pediatrics, Madhuraj Hospital, Kanpur, UP
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Veldwijk J, Lambooij MS, Bruijning-Verhagen PCJ, Smit HA, de Wit GA. Parental preferences for rotavirus vaccination in young children: a discrete choice experiment. Vaccine 2014; 32:6277-83. [PMID: 25236585 DOI: 10.1016/j.vaccine.2014.09.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/22/2014] [Accepted: 09/02/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to identify characteristics that affect parental decisions about rotavirus vaccination, to determine the relative importance of those characteristics and subsequently to estimate vaccination coverage for different implementation strategies. METHODS A Discrete choice experiment (DCE) questionnaire was sent to the parents of 1250 newborns aged 6 weeks (response rate 37.3%). Mixed-logit models were used to estimate the relative importance of the five included rotavirus vaccine and implementation characteristics; vaccine effectiveness, frequency of severe side effects, protection duration, the healthcare facility that administrates vaccination and out-of-pocket costs. Based on the utility functions of the mixed-logit model, the potential vaccination coverage was estimated for different vaccine scenarios and implementation strategies. RESULTS All characteristics, except for healthcare facility that administrates vaccination, influenced parental willingness to vaccinate their newborn against rotavirus. Parents were willing to trade 20.2 percentage points vaccine effectiveness for the lowest frequency of severe side effects (i.e., 1 in 1,000,000) or 20.8 percentage points for a higher protection duration. Potential vaccination coverage ranged between 22.7 and 86.2%, depending on vaccine scenario (i.e., vaccine effectiveness and protection duration) and implementation strategy (i.e., out-of-pocket costs and healthcare facility that administrates vaccination). CONCLUSIONS When deciding about vaccination against rotavirus, parents are mostly driven by the out-of-pocket costs, vaccine effectiveness, protection duration, and frequency of severe side effects. The highest vaccination coverage is expected for a vaccine with high effectiveness and protection duration that is implemented within the current National Immunization Program context. Implementation of the same rotavirus vaccine in the free market will result in lowest coverage.
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Affiliation(s)
- Jorien Veldwijk
- National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, Bilthoven, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
| | - Mattijs S Lambooij
- National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, Bilthoven, The Netherlands
| | - Patricia C J Bruijning-Verhagen
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; National Institute for Public Health and the Environment, Center for infectious disease control, Bilthoven, The Netherlands
| | - Henriette A Smit
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Center for Prevention and Health Services Research, Bilthoven, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Muhsen K, Kassem E, Efraim S, Goren S, Cohen D, Ephros M. Incidence and risk factors for intussusception among children in northern Israel from 1992 to 2009: a retrospective study. BMC Pediatr 2014; 14:218. [PMID: 25174640 PMCID: PMC4236660 DOI: 10.1186/1471-2431-14-218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/29/2014] [Indexed: 01/19/2023] Open
Abstract
Background Determining the background incidence of intussusception is important in countries implementing rotavirus immunization. Rotavirus immunization was introduced into the routine infant immunization program in Israel during late 2010. Incidence and risk factors for intussusception were examined in children aged less than five years between 1992 and 2009. Methods Data were collected from medical records of children hospitalized due to intussusception (N = 190), and from control children (N = 295), at Carmel and Hillel Yaffe hospitals in northern Israel. Results The average annual incidence of intussusception in Jewish and Arab children aged less than five years was estimated at 36.1 (95% CI 17.0-76.5) vs. 23.2 per 100,000 (95% CI 9.3-57.9); for infants less than 12 months of age- 128.1 (95% CI 53.0-309.6) vs. 80.1 (95% CI 29.1-242.6) per 100,000. The risk of intussusception was higher in infants aged 3–5 months: OR 5.30 (95% CI 2.11-13.31) and 6–11 months: OR 2.53 (95% CI 1.13-5.62) when compared to infants aged less than 3 months; in those living in low vs high socioeconomic communities: OR 2.81 (95% CI 1.45-5.43), and in children with recent gastroenteritis: OR 19.90 (95% CI 2.35-168.32) vs children without recent gastroenteritis. Surgical reduction was required in 23.2%. The likelihood of surgery was significantly increased in patients presenting with bloody stool, in Arabs and those who were admitted to Hillel Yaffe Hospital. Conclusions The incidence of intussusception prior to universal rotavirus immunization was documented in northern Israel. Despite the lower incidence, Arab patients underwent surgery more often, suggesting delayed hospital admission of Arab as opposed to Jewish patients.
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Affiliation(s)
- Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel.
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Teng Y, Zhao B, Pan X, Wen Y, Chen Y. A new rotavirus VP6-based foreign epitope presenting vector and immunoreactivity of VP4 epitope chimeric proteins. Viral Immunol 2014; 27:96-104. [PMID: 24702286 PMCID: PMC3994975 DOI: 10.1089/vim.2013.0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The VP6, the group antigenic rotavirus (RV), is highly conserved and the most abundant, constituting about 39% of the viral structure proteins by weight. The high degree of identity (>87%-99%) in the primary amino acid sequences suggests VP6-based vaccines could potentially provide heterotypic protection. Although some efforts have been made toward producing recombinant rotavirus VP6 vaccines, the native VP6 is still unsatisfactory as an optimal vaccine. The major neutralizing antigenic epitopes that exist on VP4 or VP7 are not on the native VP6, and as a vector the native VP6 lacks insertion sites that can be used for insertion of foreign epitopes. In this study, a new foreign epitope presenting system using VP6 as a vector (VP6F) was constructed on the outer surface of the vector six sites that could be used for insertion of the foreign epitopes created. Using this system, three VP6-based VP4 epitope chimeric proteins were constructed. Results showed that these chimeric proteins reacted with anti-VP6 and -VP4 antibodies, and elicited antibodies against VP6 and VP4 in guinea pigs. Antibodies against VP6F or antibodies against the chimeric proteins neutralized RV Wa and SA11 infection in vitro. It is optimistic that the limitation for using the native VP6 as a vaccine candidate or vector will be solved with our proposed approach. It is expected that this VP6-based epitope presenting system and the VP6-based VP4 epitope chimeric proteins will be valuable for and contribute to the development of novel RV vaccines and vaccine vectors.
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Affiliation(s)
- Yumei Teng
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Bingxin Zhao
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Xiaoxia Pan
- Key Laboratory of Chemistry in Ethnic Medicinal Resources, State Ethnic Affairs Commission and Ministry of Education, Yunnan University of Nationalities, Kunming, China
| | - Yuling Wen
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yuanding Chen
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
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Azevedo MP, Vlasova AN, Saif LJ. Human rotavirus virus-like particle vaccines evaluated in a neonatal gnotobiotic pig model of human rotavirus disease. Expert Rev Vaccines 2014; 12:169-81. [DOI: 10.1586/erv.13.3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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High index of suspicion of intussusception in an 8-month South African child: a case report. Pediatr Infect Dis J 2014; 33 Suppl 1:S104-6. [PMID: 24343606 DOI: 10.1097/inf.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This case report describes diagnosis and management of intussusception in an 8-month-old baby girl seen at the Ventersdorp District Hospital, South Africa. According to the vaccination card, the child had been immunized with rotavirus vaccine with the last dose given 6 months and 2 weeks before presentation to Ventersdorp Hospital. This case of intussusception was unlikely associated with rotavirus vaccination.
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Chattha KS, Kandasamy S, Vlasova AN, Saif LJ. Vitamin A deficiency impairs adaptive B and T cell responses to a prototype monovalent attenuated human rotavirus vaccine and virulent human rotavirus challenge in a gnotobiotic piglet model. PLoS One 2013; 8:e82966. [PMID: 24312675 PMCID: PMC3846786 DOI: 10.1371/journal.pone.0082966] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/30/2013] [Indexed: 12/23/2022] Open
Abstract
Rotaviruses (RV) are a major cause of gastroenteritis in children. Widespread vitamin A deficiency is associated with reduced efficacy of vaccines and higher incidence of diarrheal infections in children in developing countries. We established a vitamin A deficient (VAD) gnotobiotic piglet model that mimics subclinical vitamin A deficiency in children to study its effects on an oral human rotavirus (HRV) vaccine and virulent HRV challenge. Piglets derived from VAD and vitamin A sufficient (VAS) sows were orally vaccinated with attenuated HRV or mock, with/without supplemental vitamin A and challenged with virulent HRV. Unvaccinated VAD control piglets had significantly lower hepatic vitamin A, higher severity and duration of diarrhea and HRV fecal shedding post-challenge as compared to VAS control pigs. Reduced protection coincided with significantly higher innate (IFNα) cytokine and CD8 T cell frequencies in the blood and intestinal tissues, higher pro-inflammatory (IL12) and 2-3 fold lower anti-inflammatory (IL10) cytokines, in VAD compared to VAS control pigs. Vaccinated VAD pigs had higher diarrhea severity scores compared to vaccinated VAS pigs, which coincided with lower serum IgA HRV antibody titers and significantly lower intestinal IgA antibody secreting cells post-challenge in the former groups suggesting lower anamnestic responses. A trend for higher serum HRV IgG antibodies was observed in VAD vs VAS vaccinated groups post-challenge. The vaccinated VAD (non-vitamin A supplemented) pigs had significantly higher serum IL12 (PID2) and IFNγ (PID6) compared to vaccinated VAS groups suggesting higher Th1 responses in VAD conditions. Furthermore, regulatory T-cell responses were compromised in VAD pigs. Supplemental vitamin A in VAD pigs did not fully restore the dysregulated immune responses to AttHRV vaccine or moderate virulent HRV diarrhea. Our findings suggest that that VAD in children in developing countries may partially contribute to more severe rotavirus infection and lower HRV vaccine efficacy.
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Affiliation(s)
- Kuldeep S. Chattha
- The Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio, United States of America
- * E-mail: (LJS); (KSC)
| | - Sukumar Kandasamy
- The Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio, United States of America
| | - Anastasia N. Vlasova
- The Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio, United States of America
| | - Linda J. Saif
- The Food Animal Health Research Program, Department of Veterinary Preventive Medicine, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio, United States of America
- * E-mail: (LJS); (KSC)
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Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One 2013; 8:e68482. [PMID: 23894308 PMCID: PMC3718796 DOI: 10.1371/journal.pone.0068482] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023] Open
Abstract
Background Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. Methods To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality. Findings We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9–328) among children <1 year of age, with peak incidence among infants 5–7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13–29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions. Conclusion This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.
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Affiliation(s)
- James Jiang
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Bruijning-Verhagen P, Mangen MJJ, Felderhof M, Hartwig NG, van Houten M, Winkel L, de Waal WJ, Bonten MJM. Targeted rotavirus vaccination of high-risk infants; a low cost and highly cost-effective alternative to universal vaccination. BMC Med 2013; 11:112. [PMID: 23622110 PMCID: PMC3665442 DOI: 10.1186/1741-7015-11-112] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/09/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The cost-effectiveness of universal rotavirus (RV) vaccination is controversial in developed countries. As a result, RV vaccination programs do not currently exist in most European countries. Hospitalization is the main driver of RV disease costs, and prematurity, low birth weight (LBW) and underlying medical conditions have been associated with RV hospitalization and complications. We investigated the cost-effectiveness of targeted RV vaccination of high-risk infants and universal RV vaccination versus no vaccination. METHODS Disease burden, mortality and healthcare costs of RV hospitalization for children with and without prematurity, LBW and congenital pathology were quantified in two hospital-based observational studies in the Netherlands. Cost-effectiveness analysis was based on an age-structured stochastic multi-cohort model of the Dutch population comparing universal RV vaccination and targeted vaccination of high-risk infants to no vaccination. The primary endpoint was the incremental cost-effectiveness ratio (ICER), with a threshold of €35,000/quality-adjusted life year (QALY) from the healthcare provider perspective. Sensitivity analyses included vaccine price and coverage, herd-immunity and QALY losses. RESULTS A total of 936 children with RV infection were included. Prematurity, LBW and congenital pathology were associated with increased risks of RV hospitalization (relative risks (RR) ranging from 1.6 to 4.4), ICU admission (RR ranging from 4.2 to 7.9), prolonged hospital stay (1.5 to 3.0 excess days) and higher healthcare costs (€648 to €1,533 excess costs). Seven children succumbed due to RV complications, all belonging to the high-risk population. Targeted RV vaccination was highly cost-effective and potentially cost-saving from the healthcare provider perspective with ICERs below €20,000/QALY in all scenarios with total (undiscounted) annual healthcare costs between -€0.1 and €0.5 million/year. Results were most sensitive to mortality rates, but targeted vaccination remained highly cost-effective up to reductions of 90% compared to observed mortality. Universal RV vaccination was not considered cost-effective (mean ICER: €60,200/QALY) unless herd-immunity and caretaker QALY losses were included and vaccine prices were €60 at most (mean ICER: €21,309/QALY). CONCLUSION We recommend targeted RV vaccination for high-risk infants in developed countries.
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Affiliation(s)
- Patricia Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - Marie-Josée J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
| | - Mariet Felderhof
- Department of Pediatrics, Spaarne Hospital, Postbus 770, Hoofddorp 2130 AT, The Netherlands
| | - Nico G Hartwig
- Department of Pediatrics, Sint-Franciscus Hospital, Postbus 10900, Rotterdam 3004 BA, The Netherlands
| | - Marlies van Houten
- Department of Pediatrics, Spaarne Hospital, Postbus 770, Hoofddorp 2130 AT, The Netherlands
| | - Léon Winkel
- Department of Pediatrics, Kennemer Hospital, Postbus 417, Haarlem 2000 AK, The Netherlands
| | - Wouter J de Waal
- Department of Pediatrics, Diakonessen Hospital, Postbus 80250, Utrecht 3508 TG, The Netherlands
| | - Marc JM Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispostnummer STR.6.131, Postbus 85500, Utrecht 3508 GA, The Netherlands
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Retrospective hospital based surveillance of intussusception in children in a sentinel paediatric hospital: benefits and pitfalls for use in post-marketing surveillance of rotavirus vaccines. Vaccine 2012; 30 Suppl 1:A190-5. [PMID: 22520131 DOI: 10.1016/j.vaccine.2011.11.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/23/2011] [Accepted: 11/03/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED Evaluation of the safety of rotavirus vaccines, particularly with respect to the risk of intussusception, is recommended for countries planning to introduce rotavirus vaccines into the National Immunisation Program. However, as prospective studies are costly, require time to conduct and may be difficult to perform in some settings, retrospective hospital based surveillance at sentinel sites has been suggested as an option for surveillance for intussusception following introduction of rotavirus vaccines. OBJECTIVE To assess the value of retrospective hospital based surveillance to describe clinical and epidemiological features of intussusception in children aged <24 months and to investigate any temporal association between receipt of a rotavirus vaccine and intussusception. METHODS A retrospective chart review of all patients diagnosed with intussusception at Royal Children's Hospital, Melbourne, Australia over an 8-year period including before and after rotavirus vaccine introduction into the National Immunisation Program, was conducted using patients identified by a medical record database (ICD-10-CM 56.1). Patient profile, clinical presentation, treatment and outcome were analysed along with records of immunisation status obtained using the Australian Childhood Immunisation Register. RESULTS A 9% misclassification rate of discharge diagnosis of intussusception was identified on critical chart review. The incidence rate of intussusception at the Royal Children's Hospital over the study period was 1.91 per 10,000 infants <24 months (95% CI 1.65-2.20). Intestinal resection was required in 6.5% of infants (95% CI 3.6%, 11.0%). Intussusception occurred within 30 days after vaccination in 2 of 27 patients who had received at least 1 dose of a rotavirus vaccine. CONCLUSIONS Valuable data on the incidence, clinical presentation and treatment outcomes of intussusception can be obtained from data retrieved from hospital medical records in a sentinel paediatric hospital using standardised methodology. However, there are methodological limitations and the quality of the data is highly dependent on the accuracy and completeness of the patient information recorded, the system of coding and record retrieval.
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Rotavirus vaccines for children in developing countries: Understanding the science, maximizing the impact, and sustaining the effort. Vaccine 2012; 30 Suppl 1:A1-2. [DOI: 10.1016/j.vaccine.2011.10.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/14/2011] [Indexed: 12/26/2022]
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