Materiały źródłowe

• #1 Intussusception: Practice Essentials, Background, Etiology and Pathophysiology

  https://emedicine.medscape.com/article/930708-overview

  A wide geographic variation in incidence of intussusception among countries and cities within countries makes determining a true prevalence of the disease difficult. Studies on the absolute prevalence of intussusception in the United States are not available. Its estimated incidence is approximately 1 case per 2000 live births. In Great Britain, incidence varies from 1.6-4 cases per 1000 live births. […] Overall, the male-to-female ratio is approximately 3:1. With advancing age, gender difference becomes marked; in patients older than 4 years, the male-to-female ratio is 8:1. […] Two thirds of children with intussusception are younger than 1 year; most commonly, intussusception occurs in infants aged 5-10 months. Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years. […] Intussusception can account for as many as 25% of abdominal surgical emergencies in children younger than 5 years, exceeding the incidence of appendicitis. Although extremely rare, intussusception has been reported in the neonatal period.

• #1 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. — The Jenner Institute

  https://www.jenner.ac.uk/publications/986734

  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. […] 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 100000 aged 1 year ranged from 34 (13-56) in Africa to 90 (9-380) in the Western Pacific region. […] 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.

• #1 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  Intussusception occurs primarily in infants and toddlers. The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years. In a population-wide survey in Switzerland, the yearly mean incidence of intussusception was 38, 31, and 26 cases per 100,000 live births in the first, second, and third year of life, respectively. […] Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years. When intussusception occurs outside of the typical age range, it is likely to be associated with a pathologic lead point, which may include reactive lymphoid hyperplasia. […] Most episodes occur in otherwise healthy and well-nourished children. Intussusception appears to have a slight male predominance, with a male:female ratio of approximately 3:2.

• #1 Epidemiology of intussusception in infants less than one year of age in Ghana, 2012-2016

  https://www.panafrican-med-journal.com/content/series/39/1/8/full/

  Epidemiology of intussusception in infants less than one year of age in Ghana, 2012-2016 […] we examined the epidemiology, clinical and demographic characteristics of intussusception in Ghanaian infants. […] active sentinel surveillance for pediatric intussusception was conducted at Komfo Anokye Teaching Hospital in Kumasi and Korle Bu Teaching Hospital in Accra. […] The global incidence of intussusception in infants is 74 per 100,000 and varies considerably by region. In Africa, few incidence estimates are available; one study estimated a rate of 56 per 100,000 infants. The overall case fatality rate for intussusception cases is 9% in the African region but rates have ranged as high as 28-34% in some countries. […] Subsequently, the African Intussusception Surveillance Network was established in 2012 in 7 sub-Saharan African countries including Ghana to examine the risk of intussusception following monovalent rotavirus vaccination in this region.

• #1 Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India | Scientific Reports

  https://www.nature.com/articles/s41598-024-57187-8

  Both developed and developing countries carry a large burden of pediatric intussusception. […] The sentinel surveillance-based studies conducted thus far have highlighted the difference in the regional prevalence of intussusception in children, for example, in India, i.e., 17.7 (95% CI 5.9, 41.4) in northern India to 254 (95% CI 5.9, 41.4) cases per 100,000 child years in southern India. […] However, the true incidence, prevalence and epidemiology of intussusception are unclear. […] INCLEN established a nationwide multisite sentinel surveillance network (23 hospitals) in India for documenting the epidemiology of intussusception in children during the pre- and postrotavirus vaccine introduction periods. […] The average NNI was 0.171 (p value0.001) according to the pooled cases, suggesting a highly clustered pattern.

• #1 Epidemiology of Intussusception among Children Under-Two Years of Age from 2010-2017 in Odisha, India

  https://scholars.direct/Articles/gastroenterology/jgr-4-027.php?jid=gastroenterology

  371 children with intussusception (retrospective, n = 266; prospective, n = 105) were recruited. Among them, 78.7% were infants with median age 8 (IQR 6-12) months and 70.6% were males. Abdominal pain (60.9%), vomiting (55.5%), and bloody stools (53.4%) were the leading symptoms and triad was observed in 51.8% cases. 57.4% cases underwent surgery and 16.0% were managed by reduction. Nine (2.4%) children died. 71.4% cases met Brighton criteria Level-1. Intussusception cases increased 2014 onwards and the pooled incidence was estimated to be 5 (3.9-7.9) cases per 100000 infants per year. […] Intussusception in children was observed prior to rotavirus vaccination in Odisha, India. The risk factors for rising intussusception in children need further evaluation. […] The pooled incidence of intussusception in Odisha was estimated to be 5 cases (range 3.9-7.9) and 1.4 cases (range 1.1-2.8) per 100000 children per year during first and second year. The incidence for recent years (2015-2016) were 7.6-7.9 cases per 100000 infant years.

• #1

  https://link.springer.com/article/10.1007/s12098-021-03776-8

  To report background intussusception epidemiology in children under-two years in Coimbatore district of Tamil Nadu state, India, prior to rotavirus vaccine (RVV) introduction. […] Prospective sentinel surveillance was done at four hospitals in Coimbatore during April 2016 to September 2017. […] The incidence of intussusception requiring hospitalization was estimated to be 36.4 and 11.7 cases/100,000 children/y for the first and second years, respectively. […] Continued surveillance is needed to document the changes in intussusception epidemiology after RVV introduction.

• #1 Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in patients from India | Scientific Reports

  https://www.nature.com/articles/s41598-024-57187-8

  The clustering pattern was further confirmed by a Morans I index of 0.071 at a statistically significant (p value0.0010) z score of 16.14. […] The probability of cases being reported at hospitals for surgical purposes is a function of the distance between the patient location and healthcare providers. […] Our analysis clearly showed that the number of cases and hospital distance were inversely related, as two-thirds (67%) of the cases reported at the network hospitals were located less than 50 km apart, while one-third (33%) traveled more than 50 km. […] This study contributes new knowledge on the epidemiology of intussusception in children under two years of age and can reveal the regional pattern of intussusception, which cannot be determined by merely performing a quantitative analysis of cases from these sentinel sites. […] Therefore, to assess the true burden and regional pattern of this disease, community-based surveillance studies are required at the identified hotspots and cold spot areas.

• #1 Pediatric Intussusception Surgery: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/937730-overview

  The incidence of intussusception ranges from 26 to 38 cases per 100,000 live births in the first 3 years of life. […] Intussusception typically presents between the ages of 6 and 36 months. Approximately 60% of children with intussusception are younger than 1 year, and 80-90% are younger than 2 years. […] Although intussusception is most common in infants and toddlers, it is a diagnosis that should be considered in children outside this age range as well. Approximately 10% of cases occur in children older than 5 years, 3-4% in children older than 10 years, and 1% in infants younger than 3 months.

• #1 Epidemiology of intussusception among children less than 2 years of age; findings from baseline surveillance before rotavirus vaccine introduction in Myanmar

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8026906/

  Intussusception occurrence is most frequent between 5-7 months age group which is old enough to be vaccinated under the schedule that has now been introduced in Myanmar. […] Findings of this baseline surveillance provide important facts for public health officials in balancing risks and benefits of rotavirus vaccine introduction, defining targeted age and dosage scheduling and facilitate monitoring system in post-vaccination. […] This study provided important large-scale baseline epidemiological data on intussusception among children 2 years of age in Myanmar for the first time which is vital to public health officials in assessing the risk of intussusception, balancing risks and benefits of rotavirus vaccine and facilitate the monitoring system in post vaccination.

• #1 Child Intussusception – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431078/

  Intussusception is usually diagnosed in infancy and early childhood. […] Intussusception strikes about 2000 children in the United States in the first year of life. […] Intussusception is usually seen at five months of life, peaks at four to nine months, and then gradually declines at around 18 months. […] Intussusception occurs more frequently in boys than in girls, with a ratio of approximately 3:1. […] In adults, intussusception represents 1% of bowel obstructions and is associated with neoplasm.

• #1 Intussusception | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688804/6/Intussusception

  Incidence: 30 per 100,000 infants annually in the United States […] Predominant age: 5 to 10 months (~65% are 1 year of age) […] Only 10-25% of cases occur after 1 year of age. […] Predominant sex: male female (3:2). Male preponderance is more obvious in older infants.

• #1 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

  https://bmjopen.bmj.com/content/11/5/e043687

  The study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations. […] A bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017. […] 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. […] The intussusception cases were highest in summer and lowest in autumn seasons. […] 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.

• #1 Epidemiology – Primary Care Notebook

  https://primarycarenotebook.com/pages/gastroenterology/intussusception/epidemiology

  Most intussusception usually occurs in previously healthy children, commonly aged between 5 and 18 months, with boys affected twice as much as girls. The incidence is about 2 per 1000 live births, and it is the commonest cause of intestinal obstruction in children aged 3 months to 6 years. […] There is often a pronounced seasonal variation, suggesting an underlying viral aetiology (adenovirus and rotavirus have been suggested).

• #1

  https://discovery.ucl.ac.uk/1433621/

  Epidemiology of intussusception in children: National surveillance and use of record linkage to validate the incidence, and study of incidence trends. […] We aimed to determine the pre-vaccination incidence of IS among infants in the United Kingdom (UK) and Republic of Ireland (ROI) in 2008-2009. […] The established BPSU system was used to estimate the IS incidence (recorded per 100,000 live births) among infants in the UK and ROI using the standard Brighton Collaboration case definition. […] The annual (BPSU) IS incidence in infants was 24.8 (95% CI: 21.7-28.2) in the UK and 24.2 (95% CI: 15.0-37.0) in ROI. […] A decline in IS incidence was observed from 1995 to 2009, predominantly for infants, with significantly higher (p=0.001) rates in winter and spring for both BPSU and HES data. […] National (and ROI) pre-vaccination incidence rates of IS are now available to inform post-marketing rotavirus vaccine surveillance.

• #1 eCommons@AKU

  https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/14/

  Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. […] In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. […] Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.

• #1 Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03961-y

  Intussusception is a common cause of acute abdominal emergencies in infants and children. It is most common in infants and children aged 3 months to 3 years, with a peak incidence between 5 and 9 months of age. The average reported annual incidence is 340 cases per 10,000 live births in the United States, Europe, and Australia. More than 90% of the cases of intussusception in children are idiopathic, but about 5% have a pathological lead point, such as from lymphoid hyperplasia, Meckel diverticulum, duplication cyst, intestinal polyps, mesenteric nodes, lymphoma, surgery, or trauma, that initiates the problem. […] The disease onset was most frequent in December (15.2%), but it occurred throughout the year without an obvious central tendency. Most patients did not show an obvious etiology for the disease, while 30 patients (7.5%) had a history of cold food intake, diarrhea, and upper respiratory infection before the onset of the disease.

• #1 Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02293-5

  The epidemiology, clinical presentation and management of intussusception in children across the regions may serve as baseline for future studies. […] To conclude, the intussusception cases were seen all across the country and the majority of the cases occurred during the first year of life. The high case load age (47months) for intussusception in children coincided with the age of RVV third dose. Some variations in case loads across the different regions and seasonality were observed. The potential role of diet exposure, weaning practices and food like ragi in intussusception needs further evaluation. No increased occurrence of intussusception cases was observed during the limited RVV post-introduction period. Early case detection, prompt referral and appropriate management are needed to avoid surgical intervention and complications. Immunization exposure must be documented to assess the vaccine associated risk. In absence of population-based incidence or case rate, the intussusception case rate per 1000 paediatric surgery admission may be used for inter-regional comparison and trend monitoring.

• #1 Childhood Intussusception: A Literature Review | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068482

  Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs. […] This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines. […] The past experience with RotaShield and the identification of a lower level risk of intussusception after RV1 and RV5 highlights the importance of ongoing intussusception monitoring as these new vaccines are broadly adopted in other regions of the world. […] Our review provides background rates of intussusception against which rates of intussusception after the introduction of vaccine could be compared for assessing potential vaccine-associated risk. However, the paucity of background rates from most settings supports the need for relying on other analytic methods of safety monitoring after the introduction of rotavirus vaccine. […] Our review provides important considerations when establishing surveillance for intussusception. First, in resource poor settings of Africa, specific attention should be placed on hospitals with surgery suites which are likely to manage most intussusception events.

• #1 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  GACVS last reviewed the safety profile of RotaTeq and Rotarix vaccines during its December 2011 meeting. At that time, the Committee concluded that both vaccines had a good safety profile, but that they may be associated with an increased (up to 6-fold) risk of intussusception after the first dose of vaccine in some populations. […] Findings were similar for both vaccines, suggesting that a significant risk of intussusception exists after the first and second dose of both vaccines. […] GACVS acknowledged that the findings from both countries tend to confirm a risk of intussusception following administration of both vaccines, in particular during the first 7 days following a first dose. […] The Committee concluded that available data suggest that both Rotarix and RotaTeq continue to exhibit a good safety profile, but may be associated with an increased (up to 6-fold) risk of intussusception after the first dose of vaccine in some populations.

• #1 Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021

  https://www.mdpi.com/2076-393X/12/2/170

  The incidence of intussusception peaks between 4 and 10 months of age and varies substantially by region. A study from Ho Chi Minh City from 2009 to 2011 showed a relatively high baseline intussusception rate of 287/100,000 among children aged <1 year, which is higher than the intussusception rates in most other countries globally (global average, 74/100,000). Since 1999 when the first commercially available rotavirus vaccine, RotaShield® (Wyeth-Ayerst, Philadelphia, Pennsylvania, USA), was linked with cluster of intussusception cases among vaccinees, subsequent rotavirus vaccines have undergone post-marketing surveillance for intussusception. Post-marketing surveillance for both Rotarix™ (GSK, Rixensart, Belgium) and RotaTeq® (Merck & Co., Whitehouse Station, NJ, USA) vaccines showed an increased risk of intussusception in high- and middle-income countries. The risk of intussusception after the administration of Rotarix™ was estimated to be 1.1–7.0 excess cases of intussusception per 100,000 infants vaccinated; RotaTeq® was associated with approximately 1.5–7.3 excess cases per 100,000 recipients. No increased risk of intussusception has been seen with Rotarix™, RotaTeq®, or Rotavac® (Bharat Biotech, India) in low-income countries.

• #1 Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India

  https://www.mdpi.com/2409-9279/1/2/11

  India has recently introduced a rotavirus vaccine under a universal immunization program. There is limited information on intussusception, an adverse event, following immunization in children from India. We are conducting sentinel surveillance for intussusception in children aged under two years at 19 hospitals. […] The combination of prospective and retrospective surveillance shall be informative about the trend of intussusception over the last seven years in India. […] The objectives were: (1) to establish a hospital-based surveillance system for intussusception in India, considering the sociocultural and geographic diversity; (2) to document the burden, trend, and epidemiology of intussusception over the past five years and nine months at the surveillance sites; (3) to document the trend and epidemiology of intussusception and potential linkage with rotavirus vaccines over 18 months at the surveillance sites.

• #1 Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021

  https://www.mdpi.com/2076-393X/12/2/170

  Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021 […] Rotavin-M1 (POLYVAC) was licensed in Vietnam in 2012. The association of Rotavin-M1 with intussusception, a rare adverse event associated with rotavirus vaccines, and with adverse events following immunization (AEFI) have not been evaluated and monitored under conditions of routine use. From February 2017 to May 2021, we conducted a pilot introduction of Rotavin-M1 into the routine vaccination program in two provinces. Surveillance for intussusception was conducted at six sentinel hospitals. AEFI reports at 30 min and 7 days after vaccination were recorded. Among 443 children <12 months of age admitted for intussusception, most (92.3%) were children ≥ 6 months. Of the 388 children who were age-eligible to receive Rotavin-M1, 116 (29.9%) had received ≥1 dose. No intussusception cases occurred in the 1–21 days after dose 1 and one case occurred on day 21 after dose 2. Among the 45,367 children who received ≥1 dose of Rotavin-M1, 9.5% of children reported at least one AEFI after dose 1 and 7.3% after dose 2. Significantly higher AEFI rates occurred among children given Rotavin-M1 with pentavalent vaccines (Quinvaxem®, ComBE Five®) compared to Rotavin-M1 without pentavalent vaccines. There was no association between intussusception and Rotavin-M1. The vaccine was generally safe when administered alone and when co-administered with other vaccines.

• #1 Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India

  https://www.mdpi.com/2409-9279/1/2/11

  The data collected through this sentinel surveillance shall inform the following on intussusception in India: (1) description of the epidemiology, trend over the years, and geographic and seasonal variation of intussusception among children aged under two years; (2) clinical features, management, and outcome of intussusception at the sites; (3) agreement between clinical diagnosis and level of certainty according to Brighton Collaboration criteria; and (4) the relationship between intussusception and rotavirus and other UIP vaccines; (5) For some surveillance sites, the trend of intussusception before and after rotavirus vaccine introduction under the national immunization program shall be available.

• #1 SciELO Brazil – Hospital-based surveillance of intussusception among infants Hospital-based surveillance of intussusception among infants

  https://www.scielo.br/j/jped/a/cDYGTxHhXFLnPqM6DLyXCjm/

  It is reassuring that there was no large increase in intussusception cases at a population level following vaccine introduction in the state of So Paulo, Brazil. […] The present experience, establishing intussusception surveillance for monitoring post-licensure rotavirus vaccine safety in So Paulo, should provide valuable information for other similar countries that are introducing rotavirus vaccine and do not have existing safety monitoring systems.

• #1 SciELO Brazil – Hospital-based surveillance of intussusception among infants Hospital-based surveillance of intussusception among infants

  https://www.scielo.br/j/jped/a/cDYGTxHhXFLnPqM6DLyXCjm/

  Intussusception surveillance was initiated after the nationwide introduction of live attenuated monovalent rotavirus vaccine (RV1). The objective is to assess the epidemiology of intussusception and compare the number of cases before and after the introduction of rotavirus vaccine. […] From 2001 to 2008, 331 intussusception cases were identified, 59.5% were male, with peak incidence among those 18-24 weeks of age. […] Among the 21 hospitals that reported cases throughout the entire surveillance period (2001-2008), the number of intussusception events during 2007 (n = 26) and 2008 (n = 19) was not greater than the average annual number (n= 31, range 24-42) during baseline years 2001-2005. […] Although this analysis did not identify an increase in intussusception cases during the two years after RV1 introduction, these results support the need for special epidemiologic methods to assess the potential link between rotavirus vaccine and this very rare adverse event.

• #1 Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. | EBSCOhost

  https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=14712431&AN=145432936&h=uoCD45Jmjw9iAO8ReOdH%2FLIdkYzGyR9n2KVpfDUGyY0P0OSEWjxFLwXfT4cKeySLHVXrEGYexbJdWAt3pcxlAA%3D%3D&crl=c

  Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. We describe the epidemiology of intussusception among children aged 2-23 months in India. The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Intussusception cases were observed across all sites, although there were variations in cases, presentation and mode of management. The association with ragi based weaning food in intussusception needs further evaluation. […] 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.

• #1 Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021

  https://www.mdpi.com/2076-393X/12/2/170

  In this study, we found that no cases of intussusception occurred in the 1 to 21 days after dose 1 of Rotavin-M1 and only one case occurred in the 1 to 21 days after dose 2 of this vaccine. Thus, no intussusception cases were seen in the 1–7 day risk window, with nearly 45,000 first doses administered. While the lack of cases precluded a formal risk assessment using the self-controlled case-series design, it suggests that the risk, if any, is likely to be quite low. Although Vietnam is among the countries with the highest rates of intussusception globally, no cases of intussusception occurred in children <3 months of age and only 8% of cases occurred in children 3 to 5 months of age. Thus, intussusception cases rarely occurred in young infants in Vietnam when the doses of Rotavin-M1 were administered.

• #1 Intussusception in Children: Causes, Symptoms, and Treatment

  https://patient.info/doctor/intussusception-in-children

  Intussusception is much more common in children than in adults. […] The male-to-female ratio is approximately 3:1. […] Two thirds of patients are under 1 year old. […] Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years and accounts for up to 25% of abdominal emergencies in children up to age 5. […] The mean incidence of intussusception is 74 per 100,000 in children under 1 year of age, with a peak between 5-7 months of age. […] It has been associated with the rotavirus vaccine but the incidence is small and it is outweighed by the benefits of the vaccine.

• #1

  https://www.indianpediatrics.net/july2016/july-635-638.htm

  Monitoring of the rate of intussusception following vaccine introduction requires preparation of hospitals to accurately record vaccination information for all cases of intussusception, which needs appropriate investment in training and data capture. […] Overall, information on intussusception is needed, particularly when rotavirus vaccination is introduced, and the use of sentinel facilities will support safety monitoring post-vaccine introduction.

• #1 Epidemiology of Intussusception among Children Under-Two Years of Age from 2010-2017 in Odisha, India

  https://scholars.direct/Articles/gastroenterology/jgr-4-027.php?jid=gastroenterology

  Documentation of changes in intussusception rate with RVV introduction is recommended as part of the vaccine safety surveillance effort. Considering the geographic, dietary practices and other possible risk factors for intussusception, there is need for documentation of the intussusception epidemiology from different parts of India.

• #1 Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03961-y

  This study suggested that acute intussusception is common in infants and young children but is also not uncommon in older children. There is no obvious predisposing factor before the onset of the disease, and the clinical manifestations are mostly atypical, with paroxysmal abdominal pain/crying being the most common. Air enema reduction is an effective treatment. […] The etiology and pathogenesis of intussusception are still not fully understood. In the present study, 7.5% of the children had clearly identified predisposing factors. […] This study showed that about 16.8% of the children suffered relapses, and the age distribution of the children with relapse was approximately the same as the overall age distribution of the children with the disease. Some studies reported that about 10% of children would relapse after successful non-surgical reduction of intussusception, and the risk of relapse is higher in children 1 year old but is not related to the duration of the disease and the reduction technique used.

• #2 Intussusception in children – UpToDate

  https://www.uptodate.com/contents/intussusception-in-children

  Intussusception occurs primarily in infants and toddlers. The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years. In a population-wide survey in Switzerland, the yearly mean incidence of intussusception was 38, 31, and 26 cases per 100,000 live births in the first, second, and third year of life, respectively. […] Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years. When intussusception occurs outside of the typical age range, it is likely to be associated with a pathologic lead point, which may include reactive lymphoid hyperplasia. […] Most episodes occur in otherwise healthy and well-nourished children. Intussusception appears to have a slight male predominance, with a male:female ratio of approximately 3:2.

• #2 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

  https://bmjopen.bmj.com/content/11/5/e043687

  The incidence of intussusception varies widely with a mean of 74 per 100000 (range: 9328) among infants with the peak during 57 months of age. […] The available reports from India suggest that intussusception incidence varies from 17.7 to 254 per 100000 child-years. […] A recent publication by our group reported regional variation in intussusception cases among Indian children under 2 years of age. […] There is variation in the seasonality of intussusception occurrence globally. […] Reports from China found the intussusception caseload to be associated with meteorological parameters like temperature, sunshine and humidity. […] Multisite surveillance in India documented the epidemiology and trend of intussusception in children as part of the vaccine safety surveillance linked to the RVV introduction.

• #2 Intussusception | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/1688804/6/Intussusception

  Incidence: 30 per 100,000 infants annually in the United States […] Predominant age: 5 to 10 months (~65% are 1 year of age) […] Only 10-25% of cases occur after 1 year of age. […] Predominant sex: male female (3:2). Male preponderance is more obvious in older infants.

• #2 Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02293-5

  India introduced rotavirus vaccines (RVV, monovalent, Rotavac and pentavalent, Rotasiil) in April 2016 with 6, 10 and 14weeks schedule and expanded countrywide in phases. We describe the epidemiology of intussusception among children aged 223months in India. […] The nationally representative background epidemiology of intussusception in India is not clear. The reports from India primarily included retrospective data and considerably varied in the epidemiology, presentation and management. […] The incidence of intussusception vary widely globally, across the different high and low-middle income countries. […] Thus, 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.

• #2 Intussusception in Children: Causes, Symptoms, and Treatment

  https://patient.info/doctor/intussusception-in-children

  Intussusception is much more common in children than in adults. […] The male-to-female ratio is approximately 3:1. […] Two thirds of patients are under 1 year old. […] Intussusception is the most common cause of intestinal obstruction in patients aged 5 months to 3 years and accounts for up to 25% of abdominal emergencies in children up to age 5. […] The mean incidence of intussusception is 74 per 100,000 in children under 1 year of age, with a peak between 5-7 months of age. […] It has been associated with the rotavirus vaccine but the incidence is small and it is outweighed by the benefits of the vaccine.

• #2 Intussusception – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intussusception/symptoms-causes/syc-20351452

  Intussusception is the most common cause of intestinal obstruction in children younger than 3 years old. […] In most cases of intussusception in children, the cause is unknown. Intussusception seems to occur more often in the fall and winter. […] Risk factors for intussusception include: Age. Children especially young children are much more likely to develop intussusception than adults are. It’s the most common cause of bowel obstruction in children between the ages of 6 months and 3 years.

• #2 Pediatric Intussusception Surgery: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/937730-overview

  The incidence of intussusception ranges from 26 to 38 cases per 100,000 live births in the first 3 years of life. […] Intussusception typically presents between the ages of 6 and 36 months. Approximately 60% of children with intussusception are younger than 1 year, and 80-90% are younger than 2 years. […] Although intussusception is most common in infants and toddlers, it is a diagnosis that should be considered in children outside this age range as well. Approximately 10% of cases occur in children older than 5 years, 3-4% in children older than 10 years, and 1% in infants younger than 3 months.

• #2 Revista de Pediatría de Atención Primaria – Can intussusception be managed at the outpatient level?

  https://pap.es/articulo.php?lang=en&id=12550&term1=

  Intussusception is the most frequent cause of bowel obstruction in paediatric patients aged less than 3 years, although it can occur at any age. Its incidence is approximately 1 to 4 per 1000 children, and it is higher in children aged 3 to 12 months of age (0.6 to 1 per 1000). It is more frequent in males, and the male:female ratio ranges between 1.2:1 and 2.4:1, depending on the published series. […] In 60%-90% of cases the aetiology is unknown, although infection/inflammation leading to intestinal lymphoid hyperplasia has been suggested as the lead point in its pathogenesis. […] The current trend in most facilities is to keep patients hospitalised during this period, reintroducing previously established oral nutrition after discharge. However, with the purpose of decreasing the discomfort of patients and their families and of optimising health care resources, an increasing number of specialists and publications suggest that observation in the emergency department following reduction for a period of no more than 12 hours is a safe and cost-effective approach, as it has not been associated with less favourable outcomes in patients that experience recurrence after hospital discharge. […] Observation in the Emergency Department for a period of approximately 12 hours after the reduction of intussusception by air enema has not been associated with a greater incidence of complications compared to hospitalization.

• #2 Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong | HKMJ

  https://www.hkmj.org/abstracts/v21n6/518.htm

  A total of 173 children (108 male, 65 female) presented to our hospital with intussusception during the study period. […] Intussusception is the most common cause of intestinal obstruction in infants and young children between the age of 3 months and 3 years, and the peak age of presentation is 4 to 8 months. […] The reported incidence of a pathological lead point in paediatric intussusception is approximately 6%, the most common of which is Meckels diverticulum. […] The first-line investigation for diagnosis of intussusception in children is abdominal ultrasound, given its high sensitivity (98%-100%) and specificity (88%-100%). […] Pneumatic reduction is currently the preferred standard treatment, given the greater ease of performing the examination, the lesser morbidity with complications, and the slightly higher success rate of 84% to 100%.

• #2 Epidemiology, clinical characteristics, and treatment of children with acute intussusception: a case series | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-03961-y

  This study suggested that acute intussusception is common in infants and young children but is also not uncommon in older children. There is no obvious predisposing factor before the onset of the disease, and the clinical manifestations are mostly atypical, with paroxysmal abdominal pain/crying being the most common. Air enema reduction is an effective treatment. […] The etiology and pathogenesis of intussusception are still not fully understood. In the present study, 7.5% of the children had clearly identified predisposing factors. […] This study showed that about 16.8% of the children suffered relapses, and the age distribution of the children with relapse was approximately the same as the overall age distribution of the children with the disease. Some studies reported that about 10% of children would relapse after successful non-surgical reduction of intussusception, and the risk of relapse is higher in children 1 year old but is not related to the duration of the disease and the reduction technique used.

• #2 Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. | EBSCOhost

  https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=14712431&AN=145432936&h=uoCD45Jmjw9iAO8ReOdH%2FLIdkYzGyR9n2KVpfDUGyY0P0OSEWjxFLwXfT4cKeySLHVXrEGYexbJdWAt3pcxlAA%3D%3D&crl=c

  Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals. We describe the epidemiology of intussusception among children aged 2-23 months in India. The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Six hundred twenty-one children with intussusception from South (n = 262), East (n = 190), North (n = 136) and West (n = 33) regions were recruited. Intussusception cases were observed across all sites, although there were variations in cases, presentation and mode of management. The association with ragi based weaning food in intussusception needs further evaluation. […] 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.

• #2 Intussusception | PAEDS

  https://paeds.org.au/surveillance-and-research/intussusception

  Intussusception is the most common cause of bowel obstruction in infants and young children and was associated with a previous rotavirus vaccine in the USA which was withdrawn in 1999. Timely, active and systematic surveillance of intussusception cases is important and has identified a temporal but low incidence association with the rotavirus vaccines currently available under the National Immunisation Program (since July 2007). Surveillance also aims to describe the epidemiology, aetiology and severity of intussusception. Surveillance of intussusception is currently paused.

• #2 Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021

  https://www.mdpi.com/2076-393X/12/2/170

  The incidence of intussusception peaks between 4 and 10 months of age and varies substantially by region. A study from Ho Chi Minh City from 2009 to 2011 showed a relatively high baseline intussusception rate of 287/100,000 among children aged <1 year, which is higher than the intussusception rates in most other countries globally (global average, 74/100,000). Since 1999 when the first commercially available rotavirus vaccine, RotaShield® (Wyeth-Ayerst, Philadelphia, Pennsylvania, USA), was linked with cluster of intussusception cases among vaccinees, subsequent rotavirus vaccines have undergone post-marketing surveillance for intussusception. Post-marketing surveillance for both Rotarix™ (GSK, Rixensart, Belgium) and RotaTeq® (Merck & Co., Whitehouse Station, NJ, USA) vaccines showed an increased risk of intussusception in high- and middle-income countries. The risk of intussusception after the administration of Rotarix™ was estimated to be 1.1–7.0 excess cases of intussusception per 100,000 infants vaccinated; RotaTeq® was associated with approximately 1.5–7.3 excess cases per 100,000 recipients. No increased risk of intussusception has been seen with Rotarix™, RotaTeq®, or Rotavac® (Bharat Biotech, India) in low-income countries.

• #2 Rotavirus vaccines and intussusception

  https://www.who.int/groups/global-advisory-committee-on-vaccine-safety/topics/rotavirus-vaccines/intussusception

  Active surveillance of intussusception in African and Asian countries that plan to introduce rotavirus vaccines should be seriously considered, because the data accrued would eventually provide additional benefit-risk information related to these important vaccines. […] In summary, postmarketing surveillance indicates the possibility of an increased risk of intussusception shortly after the first dose of rotavirus vaccine in some populations.

• #2 Post-licensure passive safety surveillance of rotavirus vaccines: Reporting sensitivity for intussusception | Anales de Pediatría

  https://www.analesdepediatria.org/en-post-licensure-passive-safety-surveillance-rotavirus-articulo-S2341287914000349

  The results of this study suggest that rotavirus vaccines have a good safety profile overall, and that compared to other passive surveillance systems, the CFCV has a high-enough reporting sensitivity to detect signs of a potential association with intussusception. This risk needs to be investigated by means of well-designed epidemiological studies, and weighted against the evident benefits provided by these vaccines.

• #2

  https://www.ajol.info/index.php/pamj/article/view/238643

  Surveillance for intussusception (IS) post-rotavirus vaccine introduction in World Health Organization Africa Region (WHO/AFRO) has been restricted mainly to the large referral teaching hospitals. […] The surveillance has been well coordinated by the African Intussusception Surveillance Network established in 2012. […] Although, this network has provided much needed data, there is an inherent bias in monitoring and reporting of IS cases in only large tertiary hospitals. […] For these reasons suitable linkages between IS monitoring and routine Adverse Event Following Immunization (AEFI) should be established for continuity of monitoring of this condition.

• #2 Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India

  https://www.mdpi.com/2409-9279/1/2/11

  The surveillance network involved 19 tertiary care hospitals, including medical college hospitals (both public and private institutions) and private hospitals. […] The necessary administrative and ethical approvals from all participating and coordinating institutions were obtained. […] The surveillance was conducted in two components. The retrospective surveillance was conducted for 69 months (July 2010–March 2016) and the prospective surveillance was conducted for 18 months (April 2016–September 2017) at all the sites. […] The study is being conducted in accordance with the Declaration of Helsinki, and the protocol has been approved by the Ethics Committee of INCLEN (protocol reference IIEC 023). […] The findings shall be shared with the Indian national government and state program managers in immunization, vaccine safety, and public health surveillance. The findings shall be shared with the academic and research community through peer-reviewed journals and meetings.

• #2 SciELO Brazil – Hospital-based surveillance of intussusception among infants Hospital-based surveillance of intussusception among infants

  https://www.scielo.br/j/jped/a/cDYGTxHhXFLnPqM6DLyXCjm/

  Intussusception surveillance was initiated after the nationwide introduction of live attenuated monovalent rotavirus vaccine (RV1). The objective is to assess the epidemiology of intussusception and compare the number of cases before and after the introduction of rotavirus vaccine. […] From 2001 to 2008, 331 intussusception cases were identified, 59.5% were male, with peak incidence among those 18-24 weeks of age. […] Among the 21 hospitals that reported cases throughout the entire surveillance period (2001-2008), the number of intussusception events during 2007 (n = 26) and 2008 (n = 19) was not greater than the average annual number (n= 31, range 24-42) during baseline years 2001-2005. […] Although this analysis did not identify an increase in intussusception cases during the two years after RV1 introduction, these results support the need for special epidemiologic methods to assess the potential link between rotavirus vaccine and this very rare adverse event.

• #2 Prospective surveillance for intussusception in Indian children aged under two years at nineteen tertiary care hospitals | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02293-5

  The epidemiology, clinical presentation and management of intussusception in children across the regions may serve as baseline for future studies. […] To conclude, the intussusception cases were seen all across the country and the majority of the cases occurred during the first year of life. The high case load age (47months) for intussusception in children coincided with the age of RVV third dose. Some variations in case loads across the different regions and seasonality were observed. The potential role of diet exposure, weaning practices and food like ragi in intussusception needs further evaluation. No increased occurrence of intussusception cases was observed during the limited RVV post-introduction period. Early case detection, prompt referral and appropriate management are needed to avoid surgical intervention and complications. Immunization exposure must be documented to assess the vaccine associated risk. In absence of population-based incidence or case rate, the intussusception case rate per 1000 paediatric surgery admission may be used for inter-regional comparison and trend monitoring.

• #2 SciELO Brazil – Hospital-based surveillance of intussusception among infants Hospital-based surveillance of intussusception among infants

  https://www.scielo.br/j/jped/a/cDYGTxHhXFLnPqM6DLyXCjm/?lang=en

  In Brazil, no increased risk was identified after the first dose, but a potential small risk was identified after the second dose of RV1 (excess of 1.5 cases per 100,000 vaccinated infants). […] This study’s objective was to monitor and characterize the intussusception events in a subset of participating hospitals and compares the number of intussusceptions cases before and after the introduction of rotavirus vaccine. […] When restricting the analysis to cases at the 21 hospitals with stable reporting during the entire 2001-2008 surveillance period, no increase was observed in the number of reported intussusception events during the surveillance period after vaccine introduction. […] While clinical trials for rotavirus vaccines have not identified a vaccine-associated increased risk of intussusception, large post-licensure evaluations in Mexico and Australia have found a low risk after the first dose of both rotavirus vaccines, amounting to roughly one to four excess cases of intussusception for every 100,000 vaccinated children. […] The present experience, establishing intussusception surveillance for monitoring post licensure rotavirus vaccine safety in So Paulo, should provide valuable information for other similar countries that are introducing rotavirus vaccine and do not have existing safety monitoring systems.

• #2 Intussusception and Other Adverse Event Surveillance after Pilot Introduction of Rotavirus Vaccine in Nam Dinh and Thua Thien Hue Provinces—Vietnam, 2017–2021

  https://www.mdpi.com/2076-393X/12/2/170

  Our first-ever-in-Vietnam finding that there is no evidence of an association between intussusception and Rotavin-M1 vaccination is in line with other studies in low and low-middle–income countries and in sub-Saharan African countries that use Rotarix™ and RotaTeq®. Of note, Rotavin-M1 and Rotarix™ are both based on G1P [8] rotavirus vaccine strains that were derived from human infants. These findings are in contrast with those from high and upper-middle income countries where there is an association between rotavirus vaccination and intussusception during the first week after the first rotavirus vaccine dose. […] In this study, after 3.5 years of intussusception surveillance, there was no evidence to suggest an association between intussusception and Rotavin-M1 vaccination. The prevalence of AEFI was significantly higher in children vaccinated with Rotavin-M1 and pentavalent vaccine than in children who received Rotavin-M1 vaccine alone.

• #2 Post-licensure passive safety surveillance of rotavirus vaccines: Reporting sensitivity for intussusception | Anales de Pediatría

  https://www.analesdepediatria.org/en-post-licensure-passive-safety-surveillance-rotavirus-articulo-S2341287914000349

  The aims of this study were to describe the reports of suspected adverse events due to rotavirus vaccines, and assess the reporting sensitivity for intussusception. […] The reporting sensitivity for intussusception at the Pharmacovigilance Centre in the 17 day interval following rotavirus vaccination was 50%. […] Our results suggest that rotavirus vaccines have, in general, a good safety profile. Intussusception reporting to the Pharmacovigilance Centre shows sensitivity similar to other passive surveillance systems. The intussusception risk should be further investigated using well-designed epidemiological studies, and evaluated in comparison with the well-known benefits provided by these vaccines. […] The CFCV received reports of 2 cases of intussusception diagnosed up to 7 days following the administration of a rotavirus vaccine dose. The observational study found that 4 confirmed cases with Level 1 or 2 of diagnostic certainty for the standardised BC case definition of intussusception were detected in the same time period for the same risk window (17 days post-vaccination). Consequently, the reporting sensitivity for reports to the CFCV for this risk window was of 50%.

• #2 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

  https://bmjopen.bmj.com/content/11/5/e043687

  This study is the first to explore the association between intussusception and monthly mean meteorological parameters (temperature, rainfall, wind speed, humidity and sunshine) in India. […] The association was more pronounced for North and East regions, where the meteorological parameter fluctuation across months, were widest. […] Further studies are needed to confirm the seasonality, association with meteorological parameters and variations in seasonality across the regions in India, along with the influences of the preventive healthcare services coverage, care-seeking practices, access to sanitation and hygiene, and changes in dietary practices.

• #2 Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India

  https://www.mdpi.com/2409-9279/1/2/11

  The data collected through this sentinel surveillance shall inform the following on intussusception in India: (1) description of the epidemiology, trend over the years, and geographic and seasonal variation of intussusception among children aged under two years; (2) clinical features, management, and outcome of intussusception at the sites; (3) agreement between clinical diagnosis and level of certainty according to Brighton Collaboration criteria; and (4) the relationship between intussusception and rotavirus and other UIP vaccines; (5) For some surveillance sites, the trend of intussusception before and after rotavirus vaccine introduction under the national immunization program shall be available.

• #2

  https://www.hksmp.com/journals/git/article/view/756

  Intussusception (IS) is a common cause of bowel obstruction in children and has attracted increased attention since it was linked with the first rotavirus vaccine, Rotashield, although many cases of intussusception self-resolve and could be fatal if not treated promptly. This study aims to provide information on clinical and epidemiology characteristics of IS among children aged 24 months before rotavirus vaccine introduction. […] National monitoring of intussusception prior to the introduction of Rotavirus vaccines has a crucial role in providing important background data to monitor the safety of these vaccines. […] Efforts should be made to complete a large-scale baseline surveillance of intussusception around the country before the introduction of rotavirus vaccine. […] Baseline intussusception surveillance is needed in sites where trials of rotavirus vaccines are planned, and post-licensure intussusception surveillance may also be required by some licensing agencies. […] The data collected could facilitate the monitoring on any potential risk of IS as an adverse event associated with the vaccine post-approval. Efforts should be made to complete a large-scale baseline surveillance of IS around the country to promote the rotavirus vaccine introduction.

• #2 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. — The Jenner Institute

  https://www.jenner.ac.uk/publications/986734

  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. […] 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 100000 aged 1 year ranged from 34 (13-56) in Africa to 90 (9-380) in the Western Pacific region. […] 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.

• #2 Intussusception in Young Children: Protocol for Multisite Hospital Sentinel Surveillance in India

  https://www.mdpi.com/2409-9279/1/2/11

  India has recently introduced a rotavirus vaccine under a universal immunization program. There is limited information on intussusception, an adverse event, following immunization in children from India. We are conducting sentinel surveillance for intussusception in children aged under two years at 19 hospitals. […] The combination of prospective and retrospective surveillance shall be informative about the trend of intussusception over the last seven years in India. […] The objectives were: (1) to establish a hospital-based surveillance system for intussusception in India, considering the sociocultural and geographic diversity; (2) to document the burden, trend, and epidemiology of intussusception over the past five years and nine months at the surveillance sites; (3) to document the trend and epidemiology of intussusception and potential linkage with rotavirus vaccines over 18 months at the surveillance sites.

• #3 Revista de Pediatría de Atención Primaria – Can intussusception be managed at the outpatient level?

  https://pap.es/articulo.php?lang=en&id=12550&term1=

  Intussusception is the most frequent cause of bowel obstruction in paediatric patients aged less than 3 years, although it can occur at any age. Its incidence is approximately 1 to 4 per 1000 children, and it is higher in children aged 3 to 12 months of age (0.6 to 1 per 1000). It is more frequent in males, and the male:female ratio ranges between 1.2:1 and 2.4:1, depending on the published series. […] In 60%-90% of cases the aetiology is unknown, although infection/inflammation leading to intestinal lymphoid hyperplasia has been suggested as the lead point in its pathogenesis. […] The current trend in most facilities is to keep patients hospitalised during this period, reintroducing previously established oral nutrition after discharge. However, with the purpose of decreasing the discomfort of patients and their families and of optimising health care resources, an increasing number of specialists and publications suggest that observation in the emergency department following reduction for a period of no more than 12 hours is a safe and cost-effective approach, as it has not been associated with less favourable outcomes in patients that experience recurrence after hospital discharge. […] Observation in the Emergency Department for a period of approximately 12 hours after the reduction of intussusception by air enema has not been associated with a greater incidence of complications compared to hospitalization.

• #3 Hospital Based Rotavirus & Intussusception Surveillance (HBRIS)

  http://www.iedcr.org/index.php?option=com_content&view=article&id=43&Itemid=104

  IEDCR in collaboration with icddr,b has started hospital based Rotavirus Intussusception surveillance in three selected hospitals across the country from July 2012. […] to estimate the frequency of hospitalization associated with intussusception among children less than 2 years of age in surveillance hospitals.

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