Chee Fu Yung1, Chia Yin Chong2,3,4, Koh Cheng Thoon2,3,4. 1. Infectious Disease Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. cheefu.yung@gmail.com. 2. Infectious Disease Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. 3. Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. 4. Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, National University Health System Building (NUH), Singapore, 119228, Singapore.
Abstract
INTRODUCTION: The epidemiology of naturally occurring intussusception is known to increase significantly between the ages of 3 and 8 months. Post-licensure studies have reported a fivefold and twofold increase in intussusception in the first week after the first dose and second dose, respectively, of current rotavirus vaccines (RVs). PURPOSE: We carried out a public health risk analysis to model the impact of age at first vaccination in relation to rotavirus vaccination and risk of intussusception in infants. METHOD: We created a static model for a birth cohort followed until 1 year old to estimate the number of excess intussusception hospitalizations which could be caused by three different infant rotavirus vaccination schedules. A relative risk of 5.45 in the first 7 days after the first dose and 1.75 in the first 7 days after the second dose was used in the model. RESULT: We estimated that the risk of intussusception would be the lowest at about 1 in 49,000 if both first and second dose RVs were given at <3 months of age followed by 1 in 41,000 if first dose RVs were given at <3 months and second dose RVs were given at 3-5 months. It would be highest at about 1 in 11,000 if infants received both doses when >3 months old. CONCLUSION: Our epidemiological example illustrates the importance of ensuring that the first two doses of RVs are administered in infants <3 months old whenever possible to minimize the risk of intussusception as an adverse event following rotavirus vaccination.
INTRODUCTION: The epidemiology of naturally occurring intussusception is known to increase significantly between the ages of 3 and 8 months. Post-licensure studies have reported a fivefold and twofold increase in intussusception in the first week after the first dose and second dose, respectively, of current rotavirus vaccines (RVs). PURPOSE: We carried out a public health risk analysis to model the impact of age at first vaccination in relation to rotavirus vaccination and risk of intussusception in infants. METHOD: We created a static model for a birth cohort followed until 1 year old to estimate the number of excess intussusception hospitalizations which could be caused by three different infant rotavirus vaccination schedules. A relative risk of 5.45 in the first 7 days after the first dose and 1.75 in the first 7 days after the second dose was used in the model. RESULT: We estimated that the risk of intussusception would be the lowest at about 1 in 49,000 if both first and second dose RVs were given at <3 months of age followed by 1 in 41,000 if first dose RVs were given at <3 months and second dose RVs were given at 3-5 months. It would be highest at about 1 in 11,000 if infants received both doses when >3 months old. CONCLUSION: Our epidemiological example illustrates the importance of ensuring that the first two doses of RVs are administered in infants <3 months old whenever possible to minimize the risk of intussusception as an adverse event following rotavirus vaccination.
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Authors: Eric S Weintraub; James Baggs; Jonathan Duffy; Claudia Vellozzi; Edward A Belongia; Stephanie Irving; Nicola P Klein; Jason M Glanz; Steven J Jacobsen; Allison Naleway; Lisa A Jackson; Frank DeStefano Journal: N Engl J Med Date: 2014-01-14 Impact factor: 91.245
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Authors: John B Carlin; Kristine K Macartney; Katherine J Lee; Helen E Quinn; Jim Buttery; Ruth Lopert; Julie Bines; Peter B McIntyre Journal: Clin Infect Dis Date: 2013-08-26 Impact factor: 9.079
Authors: Rafael Lozano; Mohsen Naghavi; Kyle Foreman; Stephen Lim; Kenji Shibuya; Victor Aboyans; Jerry Abraham; Timothy Adair; Rakesh Aggarwal; Stephanie Y Ahn; Miriam Alvarado; H Ross Anderson; Laurie M Anderson; Kathryn G Andrews; Charles Atkinson; Larry M Baddour; Suzanne Barker-Collo; David H Bartels; Michelle L Bell; Emelia J Benjamin; Derrick Bennett; Kavi Bhalla; Boris Bikbov; Aref Bin Abdulhak; Gretchen Birbeck; Fiona Blyth; Ian Bolliger; Soufiane Boufous; Chiara Bucello; Michael Burch; Peter Burney; Jonathan Carapetis; Honglei Chen; David Chou; Sumeet S Chugh; Luc E Coffeng; Steven D Colan; Samantha Colquhoun; K Ellicott Colson; John Condon; Myles D Connor; Leslie T Cooper; Matthew Corriere; Monica Cortinovis; Karen Courville de Vaccaro; William Couser; Benjamin C Cowie; Michael H Criqui; Marita Cross; Kaustubh C Dabhadkar; Nabila Dahodwala; Diego De Leo; Louisa Degenhardt; Allyne Delossantos; Julie Denenberg; Don C Des Jarlais; Samath D Dharmaratne; E Ray Dorsey; Tim Driscoll; Herbert Duber; Beth Ebel; Patricia J Erwin; Patricia Espindola; Majid Ezzati; Valery Feigin; Abraham D Flaxman; Mohammad H Forouzanfar; Francis Gerry R Fowkes; Richard Franklin; Marlene Fransen; Michael K Freeman; Sherine E Gabriel; Emmanuela Gakidou; Flavio Gaspari; Richard F Gillum; Diego Gonzalez-Medina; Yara A Halasa; Diana Haring; James E Harrison; Rasmus Havmoeller; Roderick J Hay; Bruno Hoen; Peter J Hotez; Damian Hoy; Kathryn H Jacobsen; Spencer L James; Rashmi Jasrasaria; Sudha Jayaraman; Nicole Johns; Ganesan Karthikeyan; Nicholas Kassebaum; Andre Keren; Jon-Paul Khoo; Lisa Marie Knowlton; Olive Kobusingye; Adofo Koranteng; Rita Krishnamurthi; Michael Lipnick; Steven E Lipshultz; Summer Lockett Ohno; Jacqueline Mabweijano; Michael F MacIntyre; Leslie Mallinger; Lyn March; Guy B Marks; Robin Marks; Akira Matsumori; Richard Matzopoulos; Bongani M Mayosi; John H McAnulty; Mary M McDermott; John McGrath; George A Mensah; Tony R Merriman; Catherine Michaud; Matthew Miller; Ted R Miller; Charles Mock; Ana Olga Mocumbi; Ali A Mokdad; Andrew Moran; Kim Mulholland; M Nathan Nair; Luigi Naldi; K M Venkat Narayan; Kiumarss Nasseri; Paul Norman; Martin O'Donnell; Saad B Omer; Katrina Ortblad; Richard Osborne; Doruk Ozgediz; Bishnu Pahari; Jeyaraj Durai Pandian; Andrea Panozo Rivero; Rogelio Perez Padilla; Fernando Perez-Ruiz; Norberto Perico; David Phillips; Kelsey Pierce; C Arden Pope; Esteban Porrini; Farshad Pourmalek; Murugesan Raju; Dharani Ranganathan; Jürgen T Rehm; David B Rein; Guiseppe Remuzzi; Frederick P Rivara; Thomas Roberts; Felipe Rodriguez De León; Lisa C Rosenfeld; Lesley Rushton; Ralph L Sacco; Joshua A Salomon; Uchechukwu Sampson; Ella Sanman; David C Schwebel; Maria Segui-Gomez; Donald S Shepard; David Singh; Jessica Singleton; Karen Sliwa; Emma Smith; Andrew Steer; Jennifer A Taylor; Bernadette Thomas; Imad M Tleyjeh; Jeffrey A Towbin; Thomas Truelsen; Eduardo A Undurraga; N Venketasubramanian; Lakshmi Vijayakumar; Theo Vos; Gregory R Wagner; Mengru Wang; Wenzhi Wang; Kerrianne Watt; Martin A Weinstock; Robert Weintraub; James D Wilkinson; Anthony D Woolf; Sarah Wulf; Pon-Hsiu Yeh; Paul Yip; Azadeh Zabetian; Zhi-Jie Zheng; Alan D Lopez; Christopher J L Murray; Mohammad A AlMazroa; Ziad A Memish Journal: Lancet Date: 2012-12-15 Impact factor: 79.321