Tuesday, March 18, 2014

Risk of Intussusception after Rotavirus Vaccination

BACKGROUND

Although current rotavirus vaccines were not associated with an increased risk of intussusception in large trials before licensure, recent postlicensure data from international settings suggest the possibility of a small increase in risk of intussusception after monovalent rotavirus vaccination. We examined this risk in a population in the United States.

METHODS

Participants were infants between the ages of 4 and 34 weeks who were enrolled in six integrated health care organizations in the Vaccine Safety Datalink (VSD) project. We reviewed medical records and visits for intussusception within 7 days after monovalent rotavirus vaccination from April 2008 through March 2013. Using sequential analyses, we then compared the risk of intussusception among children receiving monovalent rotavirus vaccine with historical background rates. We further compared the risk after monovalent rotavirus vaccination with the risk in a concurrent cohort of infants who received the pentavalent rotavirus vaccine.

RESULTS

During the study period, 207,955 doses of monovalent rotavirus vaccine (including 115,908 first doses and 92,047 second doses) were administered in the VSD population. We identified 6 cases of intussusception within 7 days after the administration of either dose of vaccine. For the two doses combined, the expected number of intussusception cases was 0.72, resulting in a significant relative risk of 8.4. For the pentavalent rotavirus vaccine, 1,301,810 doses were administered during the study period, with 8 observed intussusception cases (7.11 expected), for a nonsignificant relative risk of 1.1. The relative risk of chart-confirmed intussusception within 7 days after monovalent rotavirus vaccination, as compared with the risk after pentavalent rotavirus vaccination, was 9.4 (95% confidence interval, 1.4 to 103.8). The attributable risk of intussusception after the administration of two doses of monovalent rotavirus vaccine was estimated to be 5.3 per 100,000 infants vaccinated.

CONCLUSIONS

In this prospective postlicensure study of more than 200,000 doses of monovalent rotavirus vaccine, we observed a significant increase in the rate of intussusception after vaccination, a risk that must be weighed against the benefits of preventing rotavirus-associated illness. (Funded by the Centers for Disease Control and Prevention.)
Supported by the CDC.
The views expressed in this article are those of the authors and do not necessarily represent the official position of the CDC.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on January 14, 2014, at NEJM.org.
We thank the participating integrated health care organizations and their staff for their dedication, helpful insights, and participation in this project.

SOURCE INFORMATION

From the Centers for Disease Control and Prevention, Immunization Safety Office, Atlanta (E.S.W., J.B., J.D., C.V., F.D.); Marshfield Clinic Research Foundation, Marshfield, WI (E.A.B.); Center for Health Research, Kaiser Permanente Northwest, Portland, OR (S.I., A.N.); Vaccine Study Center, Kaiser Permanente Northern California, Oakland (N.P.K.); Kaiser Permanente Colorado, Aurora (J.M.G.); Kaiser Permanente Southern California, Pasadena (S.J.J.); and Group Health Research Institute, Seattle (L.A.J.).
Address reprint requests to Mr. Weintraub at the Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS D26, Atlanta, GA 30333, or at .

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