Risk factors for intussusception in infants in Vietnam and Australia: Adenovirus implicated, but not rotavirus
Received 12 December 2005; received in revised form 27 February 2006; accepted 5 April 2006.
Refers to article:
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Aruna Chandran, Rebekah R. Heinzen, Mathuram Santosham, George K. Siberry
The Journal of Pediatrics
October 2006 (Vol. 149, Issue 4, Pages 441-447) Full Text |
Full-Text PDF (128 KB)
New rotavirus vaccines: Renewed optimism
Miguel O’Ryan, David O. Matson
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Objective
This study aimed to investigate risk factors for the development of intussusception in infants in a developing country with a suspected high incidence and in a developed country with a low incidence.
Study design
A prospective case-control study of infants <2 years of age with idiopathic intussusception confirmed by air enema or surgery was conducted at the National Hospital of Paediatrics (NHP), Vietnam (n = 533) and the Royal Children’s Hospital (RCH), Australia (n = 51). Diagnosis was validated in a subset (84% NHP; 67% RCH) by an independent blinded radiologist. Risk factor assessment was performed using a standardized questionnaire. Stool specimens were assayed for bacterial, viral, and parasitic agents.
Results
The incidence of intussusception in Vietnam was 302/100,000 in infants <1 year of age (95% CI: 258-352), substantially higher than in Australia (71/100,000). A strong association with adenovirus infection was observed at both sites (cases positive at NHP: 34%, OR 8.2; cases positive at RCH: 40%, OR 44). No association was identified between intussusception and rotavirus, other enteric pathogens, oral polio vaccine, feeding practices, or living conditions.
Conclusions
The incidence of intussusception in infants was markedly higher in Vietnam than in Australia. A strong association between adenovirus infection and intussusception was identified at both sites suggesting that adenovirus may play a role in the etiology of intussusception.
Departments of Gastroenterology and Clinical Nutrition, Emergency Medicine, Microbiology, Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Parkville; the Department of Paediatrics, Department of Microbiology and Immunology, University of Melbourne; the Department of Diagnostic Imaging, Princess Margaret Hospital for Children, Perth; and the Murdoch Childrens Research Institute, Parkville, Australia; and the Department of Surgery, National Hospital of Paediatrics, Hanoi, Vietnam.
Reprint requests: Dr Julie Bines, Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Parkville, Victoria, Australia 3052.
Supported by a Research Grant from Vaccines and Biologicals, Initiative in Vaccine Research, World Health Organisation, Geneva. The funding source had no involvement in the study design, data collection, data analysis, data interpretation, or writing of the report.
Members of our group have received research grants for studies on rotavirus and intussusception surveillance in Australia from GlaxoSmithKline and CSL Pty. Ltd., but these have had no influence on the initiation, design, or data analysis of this study or preparation of this manuscript.
⁎ List of members of the Intussusception Study Group is available at www.jpeds.com.
ABSTRACT