Clinical and Epidemiological Characteristics and Rotavirus Vaccination Status in Children Aged Under 2 Years Hospitalized with Intussusception in Kerala, India, 2019-2022: A Multicenter Observational Study.

OBJECTIVES

Some rotavirus vaccines (RVV) have been associated with an increased risk of intussusception (IS). RVV was introduced in Kerala on September 6, 2019 through Universal Immunization Program (UIP). Aim of this study was to describe clinical and epidemiological characteristics and oral pentavalent rotavirus vaccination status in children hospitalized with IS in Kerala.

METHODS

This descriptive cross-sectional study was conducted at six tertiary-care hospitals in Kerala between September 2019 and December 2022. Children aged under 2 y admitted with intussusception were enrolled consecutively and data collected through caregiver interviews, ultrasonography records, procedure notes, and vaccination cards.

RESULTS

Among 727 children, males were 62.7%; median (IQR) age at presentation was 9 (6-16) mo. Seasonal peaks occurred from January to March in 2020-2021 and April to June in 2022. Vomiting (67.7%) was the predominant presenting symptom and ileocolic (91.6%) was the most frequent anatomical site. Hydrostatic reduction (676, 93%) was the primary successful treatment modality. Surgery was performed in 51 (7%) children of whom 14 (1.9%) underwent intestinal resection and anastomosis. First, second, and third doses of RVV were received by 554, 540, and 471 children respectively. A statistically significant difference (p = 0.001) was found between median (IQR) ages (in months) at onset of intussusception of vaccinated [8 (6-14), n = 554] and unvaccinated [14 (8-19), n = 173] groups. Sixty (10.8%) out of 554 vaccinated children had onset of IS between 1 and 21 d of preceding RVV.

CONCLUSIONS

Intussusception has a seasonal occurrence in Kerala. Surveillance of intussusception should continue in parallel with UIP specifically focusing on the risk window period between 1 and 21 d following RVV.