Abstract
In 2012, Fiji introduced rotavirus vaccine (Rotarix, GSK) into the national immunisation schedule. We describe the intussusception epidemiology prior to rotavirus vaccine, temporal association of intussusception cases to administration of rotavirus vaccine, and estimate the additional number of intussusception cases that may be associated with rotavirus vaccine. A retrospective review of intussusception cases for children aged <24 months old was undertaken between January 2007 and October 2012 pre-vaccine. All admissions and deaths with a discharge diagnosis of intussusception, bowel obstruction, paralytic ileus, or intussusception ICD10-AM codes were extracted from national databases and hospital records. Nationwide active intussusception surveillance was established for three years post-vaccine (2013–2015). There were 24 definite intussusception cases in the pre-rotavirus vaccine period, 96% were confirmed by surgery. The median age was 6.5 months. The incidence rate was 22.2 (95% CI: 13.9–33.7) per 100,000 infants. There were no deaths. Active surveillance identified 25 definite intussusception cases, 96% of which were among children who were age-eligible for rotavirus vaccine. None were potentially vaccine related. We estimated one to five additional cases of intussusception every five years. The incidence of intussusception pre-rotavirus vaccine in Fiji is low. Intussusception associated with rotavirus vaccine is likely a rare event in Fiji.
Highlights
During the active surveillance period, January 2013 to December 2015, there were 12,242 hospital admissions among children under two years of age of which 47 were identified as cases of suspected IS
The incidence rate of definite IS among infants and all children under two years of age was 22.2 and 12.1 per 100,000 population respectively
IS incidence rate per 100,000 children
Summary
During the active surveillance period, January 2013 to December 2015, there were 12,242 hospital admissions among children under two years of age of which 47 were identified as cases of suspected IS. Twenty four (96%) definite IS cases were among children who were age-eligible for the RV vaccine. Of the 24 definite IS cases whom were vaccine eligible none were categorised as potentially or likely vaccine related: Thirteen cases (54%) received RV vaccine (2 doses) >21 days pre-event (range; 86–572 and 28–516 days post the first and second dose respectively); one (4%) received the second dose of rotavirus vaccine 13 days pre-event; eight (33%) cases had unknown vaccination status but all occurred >21 days post-vaccine had they received their vaccine according to schedule at 10 and 14 weeks (age range; 18–32 weeks old); and two (9%) were unvaccinated
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