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Preparing for rotavirus vaccine introduction – A retrospective assessment of the epidemiology of intussusception in children below 2 years of age in Nepal

Author:
Rayamajhi, Ajit, Thapa, Anupama, Kumar, Manoj, Yen, Catherine, Tate, Jacqueline E., Parashar, Umesh D., Rayamajhi, Anjana Karki
Source:
Vaccine 2018 v.36 no.51 pp. 7836-7840
ISSN:
0264-410X
Subject:
Rotavirus, childhood, children, demographic statistics, diarrhea, disease course, epidemiology, hospitals, males, medical records, monitoring, morbidity, mortality, pain, public health, risk, surgery, vaccination, vaccines, vomiting, Nepal
Abstract:
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.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.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.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.
Agid:
5870000