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Di Martino G, Cedrone F, D’Addezio M, Odio C, Di Giovanni P, Trebbi E, Tognaccini L, Romano F, Staniscia T. Incidence of Rotavirus-Related Hospitalizations in an Italian Southern Region from 2015 to 2021. Diseases 2024; 12:26. [PMID: 38248377 PMCID: PMC10814902 DOI: 10.3390/diseases12010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Rotavirus is one of the leading causes of severe diarrhea and dehydration in infants and young children worldwide. The economic and social burden of rotavirus-related hospitalizations, particularly among children, remains a pressing concern for healthcare systems across the globe. Healthcare infrastructure and access to medical care can vary significantly within the region. Differences in the availability of healthcare facilities and the quality of care may influence the management and outcomes of rotavirus cases. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. The study considered all hospitalization due to rotavirus gastroenteritis that occurred in the Abruzzo region from the year 2015 to 2021. Data were extracted from the hospital discharge records. The trend in hospital admissions, hospitalization costs and length of stay were evaluated and analyzed. (3) Results: A total of 664 admissions were reported during the study period. The incident rate grew till year 2019 with an annual percentage change of +13.9% (95%CI 12.6-15.2, p < 0.001). During the pandemic years, the incident rate showed a significant decrease with an annual percentage change of 12.5% (95%CI 15.5-9.3, p = 0.004). The length of stay of admissions was significantly higher among patients aged less than 1 year. (4) Conclusions: Rotavirus admission represents a heavy burden even in a high-income country such as Italy. These findings have the potential to inform targeted public health interventions, including vaccination strategies, and improve the overall well-being of children.
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Affiliation(s)
- Giuseppe Di Martino
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (P.D.G.); (T.S.)
- Unit of Hygiene, Epidemiology and Public Health, Local Health Authority of Pescara, 65100 Pescara, Italy;
| | - Fabrizio Cedrone
- Hospital Management, Local Health Authority of Pescara, 65100 Pescara, Italy;
| | - Michela D’Addezio
- Unit of Hygiene, Epidemiology and Public Health, Local Health Authority of Pescara, 65100 Pescara, Italy;
| | - Camillo Odio
- Digital Health Unit, Department of Health, Abruzzo Region, 65100 Pescara, Italy;
| | - Pamela Di Giovanni
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (P.D.G.); (T.S.)
| | - Edoardo Trebbi
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, 00100 Rome, Italy; (E.T.); (L.T.); (F.R.)
| | - Livia Tognaccini
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, 00100 Rome, Italy; (E.T.); (L.T.); (F.R.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, “La Sapienza” University of Rome, 00100 Rome, Italy; (E.T.); (L.T.); (F.R.)
| | - Tommaso Staniscia
- Department of Medicine and Ageing Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (P.D.G.); (T.S.)
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2
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Amodio E, D'Anna A, Verso MG, Leonforte F, Genovese D, Vitale F. Rotavirus vaccination as a public health strategy to reduce the burden of hospitalization: The field experience of Italy (2008-2018). J Med Virol 2023; 95:e29000. [PMID: 37515481 DOI: 10.1002/jmv.29000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/29/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
Rotavirus (RV) infection is a leading cause of severe diarrhea among children younger than 5 years old and a considerable cause of RV gastroenteritis (RVGE) hospitalization. This study aimed to evaluate the impact of vaccination in Italy in the reduction of the burden of RV-related disease, estimating the relation between vaccination coverage and hospitalization rates. RVGE-related hospitalizations that occurred in Italy from 2008 to 2018 among children aged 0-35 months were assessed by consulting the Hospital Discharge Record database and including records whose ICD-9-CM diagnosis code was 008.61 in the first or in any diagnosis position. In the 2008-2018 period, a total of 17 535 791 at-risk person-years were considered and 74 211 (423.2 cases × 100 000 per year) RVGE hospitalizations were observed. Higher hospitalization rates occurred in males (456.6 vs. 387.9 × 100 000 per year) and in children aged 1 year (507.8 × 100 000 per year). Poisson regression analysis showed a decrease of -1.25% in hospitalization rates (-1.19% to -1.31%, p < 0.001) per unit increase in vaccination coverage. This is the first study that correlates hospitalization rate reduction with a percentage increase in vaccination coverage. Our findings strongly support RV vaccination as an effective public health strategy for reducing RVGE-related hospitalizations.
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Affiliation(s)
- Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Antonio D'Anna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Maria G Verso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Leonforte
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Dario Genovese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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3
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Marchetti F, Verazza S, Brambilla M, Restivo V. Rotavirus and the web: analysis of online conversations in Italy during 2020. Hum Vaccin Immunother 2021; 18:2002087. [PMID: 34856884 PMCID: PMC8966986 DOI: 10.1080/21645515.2021.2002087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rotavirus is the most common cause of severe diarrhea among children worldwide. In 2017, Italy included rotavirus vaccination in its National Immunization Program. The use of social media monitoring, an efficient tool to understand vaccine hesitancy, has increased in recent years; however, only a few examples of such monitoring are available for Italy. Present study analyzed content on online sources, including social media, to identify factors contributing to Italian parents’ decisions to vaccinate or not their children against rotavirus. Blogmeter Suite was used to search and analyze conversations related to rotavirus in Italian on online sources during 2020. These data were compared with data from 2019. There were 2250 mentions of “rotavirus” recorded; 1080 were related to the rotavirus vaccine. Terms and hashtags used were similar in both years. Facebook was the main source of influence, Instagram dominated the engagement (the sum of interactions related to a post), and Google Trends showed a 5-year upward trend in searches for rotavirus vaccine. Of 1270 sentiment opinions, 60.7% were negative. More parents were familiar with the disease and the vaccine in 2020 compared with 2019. Pediatricians were the most influential healthcare professionals (59.2% of mentions), followed by vaccination staff (33.4%). The most relevant factors for vaccine hesitancy were fear of adverse events, concerns about the vaccination schedule, and COVID-19. Present study represents the first web listening analysis of online discussions about rotavirus. The results can be used to inform targeted communication to counteract misinformation and raise awareness about rotavirus vaccination among parents.
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Affiliation(s)
| | | | | | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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4
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Bonanni P, Conforti G, Franco E, Gabutti G, Marchetti F, Mattei A, Prato R, Vitali Rosati G, Vitale F. Fourteen years' clinical experience and the first million babies protected with human live-attenuated vaccine against rotavirus disease in Italy. Hum Vaccin Immunother 2021; 17:4636-4645. [PMID: 34370615 PMCID: PMC8828124 DOI: 10.1080/21645515.2021.1955611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Rotavirus (RV) causes up to half of hospital and community acute gastroenteritis (AGE) cases in young children in Italy. Two RV vaccines, available since 2006, are human RV (HRV) and human bovine RV (HBRV). This report looks back at the implementation of RV vaccination with HRV in Italy, and at HRV current and future perspectives. Initial regional policies led to national implementation by 2018, after scientific societies' disease awareness efforts. Following vaccination, RV hospitalizations declined significantly, and cost savings were observed. The two-dose HRV vaccine is easily administered during compulsory vaccine visits, helping increase coverage. Intussusception, a serious event in children <1 year, was reported in Italy with a rate of 33-40 per 100,000 infants. RV vaccination presents a low increased risk of intussusception after the first dose, estimated at 0.6 cases per 100,000 doses in Italy in 2019. Parents should be aware of the intussusception risk and symptoms to ensure prompt treatment. It is widely recognized that the vaccination benefits (large numbers of RV hospitalizations prevented) outweigh the risk. HRV introduction in Italy was supported by epidemiologic burden studies, healthcare provider opinions, and congress debates, which significantly contributed to implementation of RV universal routine infant vaccination in Italy.
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Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Italy
| | - Giorgio Conforti
- Italian Federation of Primary Care Pediatricians (FIMP), Genoa, Italy
| | - Elisabetta Franco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia; Department of Hygiene, Policlinico Riuniti University Hospital of Foggia, Foggia, Italy
| | - Giovanni Vitali Rosati
- Family Pediatrician (FIMP Federazione Italiana Medici Pediatri), Greve in Chianti, FI, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal-Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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5
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Clark AD, Hasso-Agopsowicz M, Kraus MW, Stockdale LK, Sanderson CFB, Parashar UD, Tate JE. Update on the global epidemiology of intussusception: a systematic review of incidence rates, age distributions and case-fatality ratios among children aged <5 years, before the introduction of rotavirus vaccination. Int J Epidemiol 2020; 48:1316-1326. [PMID: 30879038 PMCID: PMC6693807 DOI: 10.1093/ije/dyz028] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 01/20/2023] Open
Abstract
Background In some countries that have introduced oral rotavirus vaccines, a small but elevated risk of intussusception—a rare bowel disorder—has been reported. Updated estimates on the global epidemiology of intussusception are needed to help predict the potential number of intussusception cases that could be caused by the vaccine in different settings. Methods We estimated incidence rates, age distributions and case-fatality ratios (CFRs) for intussusception hospital admissions among children aged <5 years, before the introduction of rotavirus vaccines. We included all articles identified in a systematic review between January 2002 and January 2018, and contacted authors for more granular unpublished data on age distributions. Results We identified 128 articles containing 227 country datasets (61 age distributions, 71 incidence rates and 95 CFRs). The median age of intussusception ranged from 29 weeks in Africa (83% of cases in the first year of life) to 70 weeks in the Western Pacific region (35% of cases in the first year of life). The median (range) annual incidence of intussusception hospital admissions per 100 000 aged <1 year ranged from 34 (13–56) in Africa to 90 (9–380) in the Western Pacific region. We found extreme differences between the CFRs in Africa (1 death in every 10 hospital admissions) and the rest of the world (fewer than 1 death in every 100–2000 hospital admissions). Conclusion Intussusception epidemiology varies by country and region. Understanding and recognizing these differences will be important when assessing the potential number of intussusception cases associated with rotavirus vaccines.
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Affiliation(s)
- Andrew D Clark
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mateusz Hasso-Agopsowicz
- London School of Hygiene and Tropical Medicine, London, UK.,World Health Organization, Geneva, Switzerland
| | | | - Lisa K Stockdale
- London School of Hygiene and Tropical Medicine, London, UK.,University of Oxford, Oxford, UK
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Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital. Pediatr Emerg Care 2020; 36:e189-e191. [PMID: 29337838 DOI: 10.1097/pec.0000000000001393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception. METHODS A retrospective cohort study of children with an abdominal ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception. RESULTS A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly in ileocolic intussusception. None of the ileoileal intussusception patients required surgical intervention, and all were discharged without complication. CONCLUSIONS With recent advances in abdominal ultrasound, the diagnosis of ileoileal intussusception has become easier than before. Patients presenting with small bowel intussusception may not need any immediate intervention. The presence of fever supports the diagnosis of ileoileal intussusception.
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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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Fever as a Presenting Symptom in Children Evaluated for Ileocolic Intussusception: The Experience of a Large Tertiary Care Pediatric Hospital. Pediatr Emerg Care 2019; 35:121-124. [PMID: 29337836 DOI: 10.1097/pec.0000000000001391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to bowel perforation. The objective of this study was to determine the prevalence of fever in patients with ileocolic intussusception and to determine its utility as a predictive symptom. METHODS This was a 3-year retrospective study, at a tertiary care center, of children aged 1 month to 6 years, presenting with possible intussusception. Charts were reviewed for clinical signs and symptoms at presentation, and all diagnostic studies were retrieved. A pediatric radiologist reviewed all ultrasounds. RESULTS A total of 488 ultrasounds were performed on suspicion of intussusception. In 30 patients with confirmed ileocolic intussusception, mean age was 27 months and all were successfully reduced by air enema. Of 118 patients with fever, 2 had confirmed intussusception, 1 with pneumonia and 1 with acute otitis media, compared with 116 febrile patients with negative ultrasounds (P < 0.05). CONCLUSIONS Traditional teaching is that intussusception presents as intermittent colicky abdominal pain, red currant jelly stool, vomiting, and a palpable abdominal mass, but it is important to remember that this classic triad is a very late finding and this condition should be recognized before the development of these findings. The concurrence of fever can help to rule out the possibility of intussusception and prompt the health care professional to search diligently for alternative infectious etiologies but cannot eliminate the possibility, especially when other findings suggestive of intussusception are present.
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Restivo V, Costantino C, Giorgianni G, Cuccia M, Tramuto F, Corsello G, Casuccio A, Vitale F. Case–control study on intestinal intussusception: implications for anti-rotavirus vaccination. Expert Rev Vaccines 2018; 17:1135-1141. [DOI: 10.1080/14760584.2018.1546122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Vincenzo Restivo
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Claudio Costantino
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Gabriele Giorgianni
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Mario Cuccia
- Infection Diseases Epidemiology and Prevention Section, Catania Local Health Unit, Catania, Italy
| | - Fabio Tramuto
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Science for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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Cost-effectiveness estimates of vaccination against rotavirus in Piedmont, Italy. J Infect Public Health 2018; 11:867-872. [DOI: 10.1016/j.jiph.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/29/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022] Open
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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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Costantino C, Restivo V, Tramuto F, Casuccio A, Vitale F. Universal rotavirus vaccination program in Sicily: Reduction in health burden and cost despite low vaccination coverage. Hum Vaccin Immunother 2018; 14:2297-2302. [PMID: 29757707 PMCID: PMC6183134 DOI: 10.1080/21645515.2018.1471306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rotavirus is considered the main cause of severe gastroenteritis and nosocomial infections in Pediatric units, especially during late winter and early spring season in temperate region. In 2013 Sicilian Region, for the first time in Italy, introduced universal Rotavirus vaccination. This study aims to estimate health and economic impact on rotavirus Gastroenteritis (RVGE) among children aged 0–59 months in Sicily, after rotavirus vaccine introduction. We analyzed hospital discharge records including a diagnosis of RVGE occurred from 1st January 2009 to 31st December 2016 among hospitalized children aged 0 to 59 months, residents in Sicily. RVGEs were defined as all hospitalizations with an ICD-9-CM diagnosis code of 008.61 on first or any diagnosis position. Also an economic impact analysis on Health Regional System was conducted. We observed a consistent decline of hospitalization after rotavirus vaccination introduction from 394 per 100,000 in 2009–2012 to 220 per 100,000 in 2013–2016. We found a change in the peak of reported cases by at least one month from March-April in the pre-vaccination period to May-June in the post-vaccination period. Since 2013, we estimated that the annual average cost saved is 1,134,056 € when considering direct and indirect costs to health care as well as vaccination costs. Our study is the first analysis conducted as far as we are aware in a high-income setting with poor coverage (lower than 50%), demonstrating a significant reduction of RVGE hospitalizations in Sicily after vaccine introduction. Moreover, was observed a consistent impact of vaccination on health care cost saving.
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Affiliation(s)
- Claudio Costantino
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Vincenzo Restivo
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Alessandra Casuccio
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
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Rayamajhi A, Thapa A, Kumar M, Yen C, Tate JE, Parashar UD, Rayamajhi AK. Preparing for rotavirus vaccine introduction - A retrospective assessment of the epidemiology of intussusception in children below 2 years of age in Nepal. Vaccine 2017; 36:7836-7840. [PMID: 29169894 DOI: 10.1016/j.vaccine.2017.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/01/2017] [Accepted: 11/09/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rotavirus is the most common cause of severe diarrhea in Nepali children, accounting for 25-33% of childhood diarrhea hospitalizations. Two rotavirus vaccines recommended for inclusion in national immunization programs have been associated with a low risk of intussusception in post-marketing studies conducted in several countries. Data on the epidemiology of intussusception hospitalizations are lacking in Nepal. Thus, we aimed to describe the epidemiology of intussusception-associated hospitalizations among Nepali children in preparation for rotavirus vaccine introduction. METHODS A retrospective review of intussusception hospitalizations for a three year period was conducted at two major pediatric hospitals in Kathmandu, Nepal. Possible intussusception cases were identified through admission, discharge, and operation theater logs and ultrasound registers. Cases with a diagnosis of possible intussusception were selected for medical record review and classified as confirmed if they met the Brighton Collaboration level 1 criteria of diagnostic certainty and the child was aged < 24 months. Data on demographics, clinical course, and outcome were abstracted and analyzed. RESULTS Eight-five confirmed intussusception cases were identified; most (96%) were confirmed at surgery. The number of intussusception cases peaked between ages 4-7 months; no cases occurred in children 0-2 months. Fifty-nine (64%) case-patients were male. The median duration of symptoms before admission was 2 days (range: 0-14). Abdominal pain, bloody stool, and vomiting were the most common clinical features. All cases underwent surgical treatment; there was only one death. CONCLUSIONS This is the first study to evaluate the epidemiology of intussusception hospitalizations among children aged < 24 months in Nepal. Because the public health impact of rotavirus vaccination could be substantial in Nepal, where childhood diarrhea-related morbidity and mortality are high, this baseline knowledge of intussusception prior to introduction of rotavirus vaccine in the national immunization schedule will provide useful information for post-vaccine introduction safety monitoring.
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Affiliation(s)
- Ajit Rayamajhi
- Janak Medical and Research Center, Balaju, Kathmandu, Nepal; Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal; National Academy of Medical Sciences, Kathmandu, Nepal.
| | - Anupama Thapa
- Janak Medical and Research Center, Balaju, Kathmandu, Nepal; Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Catherine Yen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Anjana Karki Rayamajhi
- Janak Medical and Research Center, Balaju, Kathmandu, Nepal; B & B Hospital, Gwarko, Lalitpur, Nepal
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14
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Restivo V, Costantino C, Tramuto F, Vitale F. Hospitalization rates for intussusception in children aged 0-59 months from 2009 to 2014 in Italy. Hum Vaccin Immunother 2017; 13:445-449. [PMID: 28075671 DOI: 10.1080/21645515.2017.1264784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The real cause of intussusception is not fully understood and a variety of conditions have been associated with it (Meckel diverticulum, polyps, duplication cysts, parasites, Henoch-Schönlein purpura, cystic fibrosis, hemolytic-uremic syndrome and infectious gastroenteritis). Furthermore few European countries, following WHO recommendation to monitor baseline incidence of intussusception before implementation of immunization program for rotavirus, used intussusception rate as a baseline value to compare the same figures in the period before and after introduction of vaccination. In this study, data of intussusception hospitalizations occurred among Italian children aged 0 through 59 months from 2009 to 2014 were analyzed. A total amount of 3,088 children were included, accounting for a hospitalization rate of 20.2 per 100,000. Overall, the hospitalization rate for intussusception had a slight increase in trend from 2009 to 2014 (18%). In particular children 0-11 months had a hospitalization rate higher than 12-59 months with an aggregate value of 36 Vs. 16 per 100,000 respectively. Among all children hospitalized for intussusception a total of 239 (7.7%) had also a previous or concomitant hospitalization for gastroenteritis. This study demonstrates that Italian hospitalizations for intussusception are increasing by time and the role played by different risk factors, including acute gastroenteritis, have to be investigated in the future. These data could be useful to monitor intussusception hospitalization in the perspective of anti-rotavirus vaccination introduction in Italy.
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Affiliation(s)
- Vincenzo Restivo
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Fabio Tramuto
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
| | - Francesco Vitale
- a Department of Science for Health Promotion and Mother-Child Care "G. D'Alessandro," University of Palermo , Palermo , Italy
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Vitale F, Costantino C, Restivo V, Casuccio N, Corsello G, Palermo M, Tozzo I. Precise reply and clarifications on behalf of Sicilian Public Health Authorities to the case report published by La Rosa and collegues. Hum Vaccin Immunother 2016; 12:2969-2971. [PMID: 27560654 PMCID: PMC5137532 DOI: 10.1080/21645515.2016.1200777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
As a results of the case report “Post-rotavirus vaccine intussusception in identical twins: a case report” recently published on Human Vaccines & Immunotherapy by La Rosa et al., the principal Sicilian Public Health Authorities decided to specify several points and underline some important details omitted by the authors. In particular, aims to underline the remarkable benefit for Sicilian Regional Health service after the introduction of the rotavirus vaccination. Universal mass vaccination against rotavirus is properly managed by the Regional Health Authorities and is contributing to a consistent increase of public health in the Sicilian pediatric population; any modification of such a program should be based on robust scientific evidences. Finally, a single case report should not be considered as a basis to recommend a change in the clinical practice but instead a possible point of start for discussion and research.
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Affiliation(s)
- Francesco Vitale
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy.,b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,c Past President of the Sicilian Section of the Italian Society of Hygiene, Preventive Medicine and Public Health (S.It.I.) , Palermo , Italy
| | - Claudio Costantino
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Vincenzo Restivo
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy
| | - Nicolò Casuccio
- b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,d President of the Sicilian Section of the Italian Society of Hygiene, Preventive Medicine and Public Health (S.It.I.) , Palermo , Italy
| | - Giovanni Corsello
- a Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro" - University of Palermo , Palermo , Italy.,b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,e President of the Italian Society for Pediatrics (S.I.P.) , Palermo , Italy
| | - Mario Palermo
- b Member of the Vaccination Board of the Sicilian Health Department , Palermo , Italy.,f Director of the Public Hygiene service of the Sicilian Health Department , Palermo , Italy
| | - Ignazio Tozzo
- g Director of the Department of Sanitary Activities and Epidemiological Observatory of the Sicilian Health Department , Palermo , Italy
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