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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.
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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
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Attoun MA, Albalawi SMD, Ayoub A, Alnasser AK, Alkaram EH, Khubrani FA, Alzahrani KJ, Alatawi KA, Almutairi N, Alnami AG. The Management of Intussusception: A Systematic Review. Cureus 2023; 15:e49481. [PMID: 38152810 PMCID: PMC10752083 DOI: 10.7759/cureus.49481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Intussusception (ISN) is a dangerous condition where a portion of the intestine slides into an adjacent area of the intestine. This telescoping motion frequently prevents liquids or food from flowing through. Developing management guidelines for ileocolic (IC) intussusception was the aim of this systematic study. Data sources were PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, and Embase databases. Our review investigated English-language articles (from 2010 to 2023) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The search identified 561 studies; 15 were eligible for inclusion in the analysis. Further understanding of the management of intussusception may help improve evaluation and management in the future. The use of preventive antibiotics does not reduce problems following radiologic reduction. When clinically appropriate, repeated attempts at enema reduction may be made. After the enema reduction of ileocolic intussusception, patients can be safely watched in the emergency room (ER), thereby avoiding hospitalization. Success rates for laparoscopic reduction are high. When it comes to intussusception in children who are hemodynamically stable and do not have a serious illness, there is no need for pre-reduction antibiotics. Prioritizing nonoperative outpatient (OP) therapy is recommended as the primary approach, with the utilization of minimally invasive procedures to avoid the necessity for laparotomy. The management of colonic intussusception involves complete removal in one piece, while enteric intussusception can be addressed through reduction followed by resection. A targeted approach is recommended, recognizing the intermediate forms of intussusception that may exist between the colonic and enteric types. It is essential to note that the prevailing treatment for adult intussusception remains to be surgical intervention.
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Affiliation(s)
- Majed Ali Attoun
- Department of Surgery, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Afnan Ayoub
- Faculty of Medicine, Batterjee Medical College, Jeddah, SAU
| | - Ali K Alnasser
- Faculty of Medicine, Medical University of Lodz, Lodz, POL
| | - Esraa H Alkaram
- Department of Emergency Medicine, Almana Group of Hospitals (AGH), Dammam, SAU
| | | | - Khalid J Alzahrani
- Department of Radiology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Feng Y, Zhou H, Shu Q, Li H. Association of meteorological factors with paediatric intussusception in Hangzhou: an 8-year retrospective cohort study. BMJ Open 2022; 12:e064967. [PMID: 36307153 PMCID: PMC9621181 DOI: 10.1136/bmjopen-2022-064967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the seasonality of paediatric intussusception and the associations between meteorological factors and paediatric intussusception in Hangzhou, as well as aimed to compare the variance in sex and disease type. DESIGN An 8-year retrospective study was conducted from January 2014 to December 2021 in the Children's Hospital of Zhejiang University, Hangzhou, China. SETTING This was a single-centre retrospective study review of intussusception cases in a large Children's Hospital in Hangzhou. PARTICIPANTS There were 17 674 patients with intussusception in this study. METHODS A Spearman correlation analysis and Poisson regression analysis were used to determine the association between weekly intussusception cases and meteorological factors. The seasonality of paediatric intussusception was demonstrated via the t-test and visualised. RESULT In January, May and December, there were relatively more intussusception patients. In February, there was a trough in the number of intussusception patients. Both the Spearman correlation analysis and Poisson regression analysis proved that weekly intussusception cases had significant associations with temperature (λ=-0.205, p<0.01; β=-0.080, p<0.01), feels-like temperature (λ=-0.214, p<0.01; β=-0.012, p<0.01), dew (λ=-0.249, p<0.01; β=0.095, p<0.01), humidity (λ=-0.230, p<0.01; β=-0.037, p<0.01), precipitation (λ=-0.148, p<0.01; β=-0.001, p<0.01), windspeed (λ=-0.135, p<0.01; β=0.005, p<0.01), visibility (λ=-0.206, p<0.01; β=-0.066, p<0.01), sea level pressure (λ=0.171, p<0.01; β=-0.004, p<0.01) and a total of 20 of 25 dynamic meteorological factors (p<0.05). These associations reflected gender differences but showed stronger associations in groups that were prone to recurrence. CONCLUSIONS Paediatric intussusception in Hangzhou showed a seasonal tendency. Additionally, intussusception was significantly associated with certain meteorological factors in all of the cases. These findings suggest that parents and paediatricians should be more vigilant about the occurrence of intussusception in children regarding seasonal change times and climate change times.
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Affiliation(s)
- Yuqing Feng
- Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Haichun Zhou
- Radiology Department, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Qiang Shu
- Heart Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Haomin Li
- Clinical Data Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Review of Over 15 Years Postmarketing Safety Surveillance Spontaneous Data for the Human Rotavirus Vaccine (Rotarix) on Intussusception. Drug Saf 2022; 45:155-168. [PMID: 35015268 PMCID: PMC8894299 DOI: 10.1007/s40264-021-01141-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 01/16/2023]
Abstract
Introduction Rotavirus (RV) is the most common cause of acute gastroenteritis in children <5 years of age worldwide, and vaccination reduces the disease burden. Evidence from postmarketing surveillance studies suggested an increased risk of intussusception (IS) in infants post-RV vaccination. An overall positive benefit–risk balance for the human RV vaccine (HRV) Rotarix (GlaxoSmithKline [GSK], Belgium) has been established and recent findings indicate an indirect effect of reduced IS over the long term. Objective The aim of this study was to discuss spontaneous data from the GSK worldwide safety database on IS post-Rotarix administration. Methods The database was reviewed for all spontaneous IS cases from 2004 to 2020. Additionally, an observed versus expected (O/E) analysis was done for adverse events attributed to IS. Data were reviewed as overall worldwide and stratified by region (Europe/USA/Japan) and dose. Results A male predominance of IS patients was observed, consistent with earlier reports. The most frequently reported events in confirmed IS cases (Brighton Collaboration Working Group [BCWG] level 1) with time to onset ≤ 30 days post-vaccination were vomiting (55.8%), haematochezia (47.2%), and crying (21.1%). The observations from the IS spontaneous cases review and results of the O/E analysis are consistent with the known IS safety profile of RV vaccines: a transient increased incidence of IS post-vaccination (primarily in Europe/Japan/worldwide), mostly within 7 days postdose 1. Conclusion Since the outcomes of early IS management are favourable over delayed management, healthcare professionals should inform parents about the importance of seeking immediate medical advice in case of unusual behaviour of the vaccinated infant. GSK continues to monitor the IS risk post-Rotarix administration through routine pharmacovigilance activities. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01141-4. Rotavirus (RV) is the most common cause of acute gastroenteritis and a major cause of death in young children worldwide. Vaccination has been instrumental in reducing the impact of RV disease. Real-world evidence suggests an increased risk of intussusception (an infrequent type of bowel obstruction) in infants following RV vaccination. We reviewed IS cases reported spontaneously worldwide in children following a two-dose vaccination with the human RV vaccine (Rotarix, GlaxoSmithKline [GSK]) since its launch in 2004. We observed that (1) IS occurred more frequently 7 days after the first dose and, to a lesser extent, after the second dose; (2) boys were more frequently affected than girls (56.3%); (3) of 862 confirmed reported cases, 557 required hospitalisation; and (4) surgical intervention was required for 294 of 557 hospitalised cases. We used statistical analysis to assess whether the number of cases observed would be higher or lower than the natural occurrence of IS (irrespective of vaccination). These results were in line with the known RV vaccine safety profile. It is important to constantly monitor the real-world safety profile of RV vaccines in the postmarketing setting. Since the outcomes of early management of IS are favourable compared with delayed management, healthcare professionals should inform parents to seek immediate medical advice if they observe unusual behaviour in their vaccinated child. In conclusion, our analyses on data of a large patient pool for this rare event reinforce the favourable safety profile of human RV vaccine and the benefits of vaccination in young children.
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Tesfaye DD, Adem BM, Ketema I, Mehadi A, Eshetu B, Teshager T, Asfaw H, Desalew A. Clinical profile and treatment outcome of acute intussusception among children in eastern Ethiopia: A seven years retrospective study. Front Pediatr 2022; 10:968072. [PMID: 36518776 PMCID: PMC9742419 DOI: 10.3389/fped.2022.968072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute intussusception is the main cause of abdominal surgical emergencies worldwide in young children, with an incidence of approximately 1 to 4 per 2,000 children. An accurate estimate of the treatment outcomes of acute intussusception in children is unknown in low-and middle-income countries like Ethiopia. Hence, this study aimed to determine the clinical profile, treatment outcomes of acute intussusception and its associated factors among children admitted to Hiwot Fana Specialized University Hospital in eastern Ethiopia. METHODS An institutional-based retrospective cross-sectional study was conducted from November 01 to 30, 2021, among children admitted and managed for acute intussusception. All medical records of children admitted and managed for acute intussusception at Hiwot Fana Specialized University hospital between January 2014 and December 2020 were included. Data were collected using pretested structured checklists through a review of medical records, entered and analyzed using Statistical Package for Social Sciences version 25.0. Chi-square (χ 2) tests were applied to determine the associated factors with treatment outcome. The statistical significance was considered at a p-value < 0.05. RESULTS In this chart review of children, 13.3% (95% CL: 11.8-14.8) died. The median age of the study participant was 13 months. The majority, 72% were male and 76% were less than 24 months old. Regarding the clinical profile; abdominal pain (94.7%), vomiting (93.3%), bloody diarrhea (70.7%), and abdominal distention (76.0%) were the most common clinical presentations. Age less than 24 months [X 2 = 8.13 (df = 1); p = 0.004], preoperative vital signs [X 2 = 19.21 (df = 2); p = 0.000], intraoperative findings [X 2 = 18.89 (df = 1); p = 0.000], and postoperative complications [X 2 = 14.60 (df = 1); p = 0.000] were significantly associated with treatment outcome of acute intussusception. CONCLUSION In this chart review, the overall mortality rate in children was relatively high. One in seven children died from acute intussusception. Age less than 24 months, preoperative vital signs, intraoperative findings, and postoperative complications were significantly associated with acute intussusception treatment outcomes. Surgical management was the only treatment performed in all cases. Delayed presentation of patients and lack of other treatment modalities such as non-surgical interventions are serious concerns in this facility. The initiation of non-surgical reduction may reduce the need for surgical intervention-related complications, and child mortality.
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Affiliation(s)
- Dawit Desta Tesfaye
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Burka Mohammed Adem
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Indeshaw Ketema
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ame Mehadi
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bajrond Eshetu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Teshager
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Assefa Desalew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Suleiman JM, Msuya D, Tarmohamed M, Lodhia J. Prolapsed ileocolic intussusception in an infant: An uncommon presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Das MK. Association of meteorological parameters with intussusception in children aged under 2 years: results from a multisite bidirectional surveillance over 7 years in India. BMJ Open 2021; 11:e043687. [PMID: 34035093 PMCID: PMC8154980 DOI: 10.1136/bmjopen-2020-043687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations. DESIGN A bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017. SETTING At 20 hospitals in India, retrospective case record review during July 2010 and March 2016 and prospective surveillance during April 2016 and September 2017 were performed. PARTICIPANTS 2161 children aged 2-24 months with first intussusception episode were included. INTERVENTIONS The monthly mean meteorological parameters (temperature, sunshine, rainfall, humidity and wind speed) for the study sites were collected. METHODS The association between monthly intussusception cases and meteorological parameters was examined at pooled, regional and site levels using Pearson (r) and Spearman's rank-order (ρ) correlation, factorial analysis of variance, and Poisson regression or negative binomial regression analyses. RESULTS The intussusception cases were highest in summer and lowest in autumn seasons. Pearson correlation analysis showed that temperature (r=0.056; p<0.05), wind speed (r=0.134; p<0.01) and humidity (r=0.075; p<0.01) were associated with monthly intussusception cases. Spearman's rank-order correlation analysis found that temperature (ρ=0.049; p<0.05), wind speed (ρ=0.096; p<0.01) and sunshine (ρ=0.051; p<0.05) were associated with monthly intussusception cases. Poisson regression analysis resulted that monthly intussusception case was associated with rising temperature (North region, p<0.01 and East region, p<0.05), sunshine (North region, p<0.01), humidity (East region, p<0.01) and wind speed (East region, p<0.01). Factorial analysis of variance revealed a significant seasonal difference in intussusception cases for pooled level (p<0.05), 2-6 months age group (p<0.05) and North region (p<0.01). Significant differences in intussusception cases between summer and autumn seasons were observed for pooled (p<0.01), children aged 2-6 months (p<0.05) and 7-12 months (p<0.05). CONCLUSIONS Significant correlations between intussusception cases and temperature, humidity, and wind speed were observed at pooled and regional level in India. A peak in summer months was noted, which may be used for prediction, early detection and referral for appropriate management of intussusception.
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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).
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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.
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Evaluation of the safety profile of rotavirus vaccines: a pharmacovigilance analysis on American and European data. Sci Rep 2020; 10:13601. [PMID: 32788620 PMCID: PMC7423960 DOI: 10.1038/s41598-020-70653-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Rotaviruses (RVs) are the most common cause of severe diarrheal disease. To date two rotavirus oral vaccines are licensed: Rotarix and Rotateq. Our aim was to contribute to the post-marketing evaluation of these vaccines safety profile. We collected all RV vaccines-related reports of Adverse Events Following Immunization (AEFI) in US Vaccine Adverse Events Reporting System (VAERS) and VigiBase between January 2007 and December 2017. A disproportionality analysis using Reporting Odds Ratio (ROR) was performed. A total of 17,750 reports in VAERS and 6,358 in VigiBase were retrieved. In VAERS, 86.2% of the reports concerned RotaTeq, whereas in VigiBase 67.7% of them involved Rotarix. Across the databases, diarrhea (1,672 events in VAERS, 1,961 in VigiBase) and vomiting (1,746 in VAERS, 1,508 in VigiBase) were the most reported AEFIs. Noteworthy, the RV vaccines-intussusception pair showed a ROR greater than 20 in both databases. Some new potential safety signals emerged such as fontanelle bulging, hypotonic-hyporesponsive episode, livedo reticularis, and opisthotonus. Overall, our data show that most of the reported AEFIs are listed in the Summary of Product Characteristics (SPCs). However, there remains the need to investigate the potential safety signals arose from this analysis, in order to complete the description of the AEFIs.
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Thanh Xuan N, Huu Son N, Huu Thien H. Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study. Cureus 2020; 12:e7729. [PMID: 32432007 PMCID: PMC7234032 DOI: 10.7759/cureus.7729] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Intussusception is a common cause of small intestinal obstruction in children under two years of age. Late diagnosis can lead to a potentially worse condition. This prospective study aims to describe the clinical manifestation and develop a conservative management protocol for acute ileocaecal intussusception in children under two years of age. Methods This prospective study was carried out in 118 consecutive patients under two years of age. Patients presented with symptoms and signs of acute intestinal obstruction and a diagnosis of ileocaecal intussusception confirmed by ultrasound were included in this study. All the patients were managed with either pneumatic reduction or operation. Results There were 70 boys and 48 girls ranging in age from three months to two years with a median of 12.5 months. Clinical presentation included abdominal pain (100%), vomiting (82.2%), bloody stool (11.9%), and a palpable mass (43.2%). Patients hospitalized with the symptoms and signs for less than 24 hours accounted for 80.5% of the cases. The overall success rate of pneumatic reduction was 98.3%. Late hospital admission (≥ 24 hours from illness onset), bloody stool, and presenting with the classic triad of symptoms of intussusception were found as the factors that correlated to the surgical management outcome. All patients recovered well without any complications. The median of postoperative hospital stay of two days for the pneumatic reduction group and six days for the operation group. Conclusion The early diagnosis of intussusception contributes to the success of pneumatic reduction and reduces the requirement of surgical intervention.
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Affiliation(s)
- Nguyen Thanh Xuan
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
| | | | - Ho Huu Thien
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, VNM
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Bruun T, Watle SSV, Tveteraas IH, Flem E. Intussusception among Norwegian children: What to expect after introduction of rotavirus vaccination? Vaccine 2019; 37:5717-5723. [PMID: 31255303 DOI: 10.1016/j.vaccine.2019.06.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To reduce the risk of vaccine-associated intussusception, rotavirus vaccination in Norway was implemented under strict age limits (the first dose given by 12 weeks of age and the second dose by 16 weeks of age) in 2014. We estimated the incidence of intussusception in children <2 years old before vaccine introduction and the number of vaccine-associated cases under current and extended age limits for vaccine administration in Norway. METHODS To estimate the baseline incidence, we validated all diagnoses in children <2 years old registered in the national hospital registry during the pre-vaccine period of 2008-2013. Using national vaccine coverage data and international estimates of intussusception risk after rotavirus vaccination, we calculated the numbers of expected vaccine-associated intussusception cases to compare with the estimated numbers of averted rotavirus cases. Uncertainty was accounted for by several scenario analyses using current and extended age limits for vaccine administration. RESULTS The pre-vaccine incidence of intussusception was 26.7 (95% CI 23.1-30.6) cases/year per 100,000 children <2 years old and 37.1 (95% CI 31.2-43.8) cases/year per 100,000 children <1 year old. In the 2016 birth cohort (approx. 60,000) vaccinated under the current age limits, 1.3 (95% CI 0.7-2.0) vaccine-associated intussusception cases were expected to occur. If age limits were extended to 16 weeks for the first vaccine dose and 24 weeks for the second dose, leading to more children vaccinated at an older age, 2.2 (95% CI 1.2-3.5) excess cases would be expected in the same cohort. Simultaneously, an estimated 1768 rotavirus hospitalizations/year in children <5 years old would be averted under current age limits, with 98 additional rotavirus hospitalizations averted under extended age limits. CONCLUSIONS Administering rotavirus vaccines beyond current age limits in Norway would lead to a marginal increase in the number of intussusception cases, which would be offset by the benefits of vaccination.
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Affiliation(s)
- Tone Bruun
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.
| | | | | | - Elmira Flem
- Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway
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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]
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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.
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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
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14
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Shangareyeva RK, Soldatov PY. [Colonic intussusception in a child]. Khirurgiia (Mosk) 2017:104-105. [PMID: 28091466 DOI: 10.17116/hirurgia201612104-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- R Kh Shangareyeva
- Department of Pediatric Surgery, Bashkir State Medical University, Ufa, Russia
| | - P Yu Soldatov
- Department of Pediatric Surgery, Bashkir State Medical University, Ufa, Russia
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15
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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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16
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Mahaux O, Bauchau V, Van Holle L. Pharmacoepidemiological considerations in observed-to-expected analyses for vaccines. Pharmacoepidemiol Drug Saf 2015; 25:215-22. [PMID: 26602179 PMCID: PMC5063172 DOI: 10.1002/pds.3918] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Olivia Mahaux
- Vaccine Clinical Safety and Pharmacovigilance, GSK Vaccines, Wavre, Belgium
| | - Vincent Bauchau
- Vaccine Clinical Safety and Pharmacovigilance, GSK Vaccines, Wavre, Belgium
| | - Lionel Van Holle
- Vaccine Clinical Safety and Pharmacovigilance, GSK Vaccines, Wavre, Belgium
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17
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Rotavirus vaccines: a story of success. Clin Microbiol Infect 2015; 21:735-43. [DOI: 10.1016/j.cmi.2015.01.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 11/19/2022]
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18
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Huppertz HI, Borte M, Schuster V, Giaquinto C, Vesikari T. Report of the Third European Expert Meeting on Rotavirus Vaccination: Progress in rotavirus universal mass vaccination in Europe. Vaccine 2014; 32:4243-8. [DOI: 10.1016/j.vaccine.2014.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/09/2014] [Indexed: 11/26/2022]
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19
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Serayssol C, Abbo O, Mouttalib S, Claudet I, Labarre D, Galinier P, Bouali O. [Seasonal pattern of intussusceptions in infants and children: is fall/winter predominance still worth consideration? A 10-year retrospective epidemiological study]. Arch Pediatr 2014; 21:476-82. [PMID: 24698218 DOI: 10.1016/j.arcped.2014.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/29/2013] [Accepted: 02/06/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Intussusceptions in infants and children are a medical and surgical emergency. A seasonal pattern, with fall and winter predominance, is usually taught in medical schools, but in France the epidemiological characteristics of intussusceptions are not clearly described. METHODS We conducted a retrospective study concerning children with idiopathic ileocolic intussusceptions admitted and treated at our institution (Emergency Department and Pediatric Surgery Department, Toulouse University Hospital) between January 2002 and December 2011. The main purpose was to evaluate the seasonality of intussusceptions. We describe the sex ratio, age of occurrence, rate of recurrence, and rate of failed enema reduction. RESULTS A total of 306 idiopathic ileocolic intussusceptions (280 patients) were included over a 10-year period with an average of 31 cases per year [21-42]. No seasonal pattern of intussusceptions or fall/winter predominance was shown (P=0.6) in the cumulative number of monthly cases: 24% of the intussusceptions occurred during fall, 21% during winter, 29% during spring, and 27% during summer. There were two peaks: April (35 cases over 10 years) and June (34 cases). The mean age was 18.7 months [2.3-159.4]: 19.5 months [3-159.4] in boys and 14.8 months [2.3-77.5] for girls (P=0.02). Two peaks were shown: one between six and nine months, the other one between 18 and 21 months. Male children had a higher incidence than female children: the sex ratio was 2:1, with 65.4% boys and 34.6% girls (P=0.0003), with an increasing sex ratio for older children. The recurrence rate was 8.2% among all (26 recurrences): 10.1% in boys and 4.9% in girls (P=0.08). The rate of surgery after failed enema reduction was 7.5% (21/280 children). There was no case of recurrence after operation. CONCLUSION These results were consistent with previous reports. We did not show any seasonal pattern of idiopathic ileocolic intussusceptions in our patients. A new survey of childhood intussusceptions would be relevant to confirm these results and would make it possible to modify academic teachings about seasonality in intussusceptions.
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Affiliation(s)
- C Serayssol
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - O Abbo
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - S Mouttalib
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - I Claudet
- Urgences médico-chirurgicales, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - D Labarre
- Service de radiologie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - P Galinier
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - O Bouali
- Service de chirurgie pédiatrique, hôpital des enfants de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
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20
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Guo WL, Zhang SF, Li JE, Wang J. Association of meteorological factors with pediatric intussusception in subtropical china: a 5-year analysis. PLoS One 2014; 9:e90521. [PMID: 24587386 PMCID: PMC3938762 DOI: 10.1371/journal.pone.0090521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 02/01/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to determine whether climate factors correlate with variations in the rate of pediatric intussusception cases presenting to the Children’s Hospital in Suzhou, China. Material and Methods The hospital records of 5,994 pediatric cases of intussusception who had presented between Aug 2006 and Dec 2011 were retrospectively analyzed. Demographic data and air enema reduction data were collected for each case. Results The monthly rate of new intussusception cases fluctuated throughout the year generally rising from April to September with a peak from May to July. This annual cycling of intussusception incidence was highly significant over the 5 year observation period. Poisson regression analysis showed that the monthly number of intussusception cases was associated with an increase in mean temperature per month (P = 0.0001), sum of sunshine per month (P<0.0001), precipitation per month (P<0.0001), and was marginally associated with increased mean wind speed per month (P = 0.0709). Conclusion The incidence of intussusception in Suzhou was seasonally variable with a peak in cases presenting during hotter, sunnier, and wetter months demonstrating a positive association with certain climatic factors.
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Affiliation(s)
- Wan-liang Guo
- Radiology Department, The Children’s Hospital Affiliated to Soochow University, Suzhou, China
| | - Shu-feng Zhang
- Orthopaedics Department, Traditional Chinese Medicine Hospital of Yulin, Yulin, China
| | - Jin-en Li
- Radiology Department, The Children’s Hospital Affiliated to Soochow University, Suzhou, China
| | - Jian Wang
- General Surgery Department, The Children’s Hospital Affiliated to Soochow University, Suzhou, China
- * E-mail:
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Linhares AC, Justino MCA. Rotavirus vaccination in Brazil: effectiveness and health impact seven years post-introduction. Expert Rev Vaccines 2013; 13:43-57. [PMID: 24308577 DOI: 10.1586/14760584.2014.861746] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Before vaccine introduction in Brazil, rotavirus caused approximately 650,000 outpatient visits, 92,000 hospitalizations and 850 deaths annually among children aged <5 years. Brazil was one of the first countries to introduce rotavirus vaccination into the National Immunisation Program (NIP), in 2006, but estimated coverage (87.1%) for 2011 remained lower if compared with other routine immunizations (95%). Case-control studies reached effectiveness rates as high as 85%. Observational studies showed a significant reduction in gastroenteritis-related hospitalizations and deaths among children aged <1 year, at rates as high as 48 and 54%, respectively. There was a significant increase in the relative prevalence of G2P[4] genotype after vaccine introduction, reaching 100% of strains in some settings. A small increase in intussusception incidence was seen within 1 week following the second vaccine dose, but benefits far outweigh any potential risk. This article provides an in-depth review of postlicensure studies conducted in Brazil 7-year postintroduction.
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Affiliation(s)
- Alexandre C Linhares
- Instituto Evandro Chagas, Health Surveillance Secretariat, Brazilian Ministry of Health, Ananindeua, Pará, Brazil
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