Prospective study on two continents implicates respiratory adenovirus but not rotavirus in intussusception

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Investigators from Australia and Vietnam performed a concurrent, prospective case-control study of intussusception in children <2 years of age, and the results are published in this issue of The Journal. They used strict criteria for diagnosis and multiple tests on stool samples to identify bacteria, bacterial toxin, viruses, and protozoa. They documented incidence of intussusception in infants <1 year of age in Vietnam (302/100,000) that was 4-fold higher than in Australia (71/100,000). Odds ratio for identifying a respiratory tract adenovirus in stool was 8.2 in cases vs. controls in Hanoi and 44 in Melbourne. Thirty-four percent of children with intussusception in Hanoi and 40% in Melbourne had adenovirus isolated from stool sample. On the other hand, rotavirus infection was not common in cases or controls and was not associated with intussusception at either site.

This exquisite study answers one question soundly: natural rotavirus infection is not associated with intussusception in these developing and developed countries. What it doesn’t answer is why intussusception is more common in some countries (usually developing) than in others. Rate of adenovirus infection does not explain the difference. The incidence of adenovirus infection in Vietnamese infants was not greater than in Australian infants.