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Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries.

ABSTRACT: BACKGROUND:The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children <2 years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction. METHODS:From 2015 to 2017, we enrolled 1-to-1 matched intussusception cases and hospital controls; 249 pairs were included. Stool specimens were tested for 37 infectious agents using TaqMan Array technology. We used conditional logistic regression to estimate odds ratio (OR) and 95% confidence interval (CI) of each pathogen associated with intussusception in a pooled analysis and quantitative subanalyses. RESULTS:Adenovirus (OR, 2.67; 95% CI, 1.75-4.36) and human herpes virus 6 (OR, 3.50; 95% CI, 1.15-10.63) were detected more frequently in cases than controls. Adenovirus C detection <20 quantification cycles was associated with intussusception (OR, 18.59; 95% CI, 2.45-140.89). Wild-type rotavirus was not associated with intussusception (OR, 1.07; 95% CI, 0.52-2.22). CONCLUSIONS:In this comprehensive evaluation, adenovirus and HHV-6 were associated with intussusception. Future research is needed to better understand mechanisms leading to intussusception, particularly after rotavirus vaccination.

SUBMITTER: Burnett E

PROVIDER: S-EPMC7371463 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries.

Burnett Eleanor E Kabir Furqan F Van Trang Nguyen N Rayamajhi Ajit A Satter Syed M SM Liu Jie J Yousafzai Mohammad Tahir MT Anh Dang Duc DD Basnet Anupama Thapa AT Flora Meerjady S MS Houpt Eric E Qazi Saqib Hamid SH Canh Tran Minh TM Rayamajhi Anjana Karki AK Saha Bablu K BK Saddal Nasir Saleem NS Muneer Sehrish S Hung Pham Hoang PH Islam Towhidul T Ali Syed Asad SA Tate Jacqueline E JE Yen Catherine C Parashar Umesh D UD

The Journal of infectious diseases 20200401 9

<h4>Background</h4>The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children <2 years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction.<h4>Methods</h4>From 2015 to 201 ...[more]

PMID: 31754717

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Project description: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.

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Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries.

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Infectious Etiologies of Intussusception Among Children <2 Years Old in 4 Asian Countries.

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