Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals

Manoj Das ,Mahesh Kumar Aggarwal ,Jan Bonhoeffer,Suman Sarkar,Gowhar Nazir Mufti,Bhadresh Vyas ,Ashish Wakhlu,Rashmi Shad,Pradeep Haldar,Sushant Mane,Jimmy Shad,M K Ajayakumar,Harsh Trivedi,Vijayendra Kumar,Subrat Kumar Sahoo,Lalit Sankhe,Narendra K Arora ,Ajay Kumar ,Patrick Zuber ,John Mathai ,Sahadeb Ghosh ,Javeed I Bhat ,P Padmalatha ,Khwairakpam Sharmila ,K Kameswari ,Nihar Ranjan Sarkar ,Surender Kumar ,Anand Prakash Dubey ,Satya Mohapatra ,G Rajendra Prasad ,K Jothilakshmi ,Cenita J Sam ,Jayanta Kumar Goswami ,Bidyut Gupta ,Pavai Arunachalam,Pradeep Kumar Jena ,Neelam Mohan,Bashir Ahmad Charoo,Simmi K Ratan,Kaushik Lahiri,Rakesh Kumar,Rachita Sarangi,Apoorva Sharan,Meera Luthra,Sanjib Kumar Debbarma ,Bikasha Bihary Tripathy,J Shyamala,Saurabh Garge,Atul Gupta,Ruchirendu Sarkar,Yoga Nagender,Arindam Ray,Lalit Bharadia,Christine Maure

doi:10.1186/s12887-020-02293-5

Abstract

BackgroundIndia 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.MethodsThe 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.ResultsSix 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.ConclusionsIntussusception 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.

Highlights

India introduced rotavirus vaccines (RVV, monovalent, RotavacTM and pentavalent, RotasiilTM) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases
Documentation of the intussusception epidemiology prior to RVV introduction to establish a reliable baseline for monitoring the trend over time and identify potential risk factors was needed to support the vaccine safety surveillance efforts [19, 20]
Under the vaccine safety surveillance effort, we describe the epidemiology, clinical characteristics of intussusception among children aged under-2 years seeking hospital care in India and initial changes with RVV introduction documented through a nationally representative sentinel surveillance network

Summary

Introduction

India introduced rotavirus vaccines (RVV, monovalent, RotavacTM and pentavalent, RotasiilTM) in April 2016 with 6, 10 and 14 weeks schedule and expanded countrywide in phases. In view of the concern about intussusception, documentation of baseline and monitoring following RVV introduction have been recommended [12]. Documentation of the intussusception epidemiology prior to RVV introduction to establish a reliable baseline for monitoring the trend over time and identify potential risk factors was needed to support the vaccine safety surveillance efforts [19, 20]. Under the vaccine safety surveillance effort, we describe the epidemiology, clinical characteristics of intussusception among children aged under-2 years seeking hospital care in India and initial changes with RVV introduction documented through a nationally representative sentinel surveillance network

Methods

Results

Conclusion