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

ABSTRACT: BACKGROUND:India 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. METHODS:The 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. RESULTS:Six 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?

SUBMITTER: INCLEN Intussusception Surveillance Network Study Group

PROVIDER: S-EPMC7461288 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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

BMC pediatrics 20200901 1

<h4>Background</h4>India 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.<h4>Methods</h4>The prospective surveillance at 19 nationally representative sentinel hospitals from four regions recruited children with intussusception from April 2016 to September 2017. Data on sociodemography, immu ...[more]

PMID: 32873281

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Project description:ObjectivesThe study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations.DesignA bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017.SettingAt 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.Participants2161 children aged 2-24 months with first intussusception episode were included.InterventionsThe monthly mean meteorological parameters (temperature, sunshine, rainfall, humidity and wind speed) for the study sites were collected.MethodsThe association between monthly intussusception cases and meteorological parameters was examined at pooled, regional and site levels using Pearson (r) and Spearman's rank-order (ρ) correlation, factorial analysis of variance, and Poisson regression or negative binomial regression analyses.ResultsThe intussusception cases were highest in summer and lowest in autumn seasons. Pearson correlation analysis showed that temperature (r=0.056; p<0.05), wind speed (r=0.134; p<0.01) and humidity (r=0.075; p<0.01) were associated with monthly intussusception cases. Spearman's rank-order correlation analysis found that temperature (ρ=0.049; p<0.05), wind speed (ρ=0.096; p<0.01) and sunshine (ρ=0.051; p<0.05) were associated with monthly intussusception cases. Poisson regression analysis resulted that monthly intussusception case was associated with rising temperature (North region, p<0.01 and East region, p<0.05), sunshine (North region, p<0.01), humidity (East region, p<0.01) and wind speed (East region, p<0.01). Factorial analysis of variance revealed a significant seasonal difference in intussusception cases for pooled level (p<0.05), 2-6 months age group (p<0.05) and North region (p<0.01). Significant differences in intussusception cases between summer and autumn seasons were observed for pooled (p<0.01), children aged 2-6 months (p<0.05) and 7-12 months (p<0.05).ConclusionsSignificant 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.

Project description:BackgroundIn 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016.MethodsEight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS.ResultsComplete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019.ConclusionThrough effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets.

Dataset Information

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

Publications

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

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