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ABSTRACT
Background: Intussusception has been identified as a rare adverse event following rotavirus immunization. We sought to determine the incidence of intussusception among infants in Canada both before and after introduction of rotavirus immunization programs. Methods: We used Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) to identify infants under 1 y of age who were admitted to a Canadian hospital, which the exception of Quebec, which does not submit data to CIHI, with a diagnosis of intussusception (ICD-10 code K56.1, and ICD-9 code 560) between January 1st, 2003 and December 31, 2013. We compared rates of intussusception hospitalization before and after rotavirus vaccine program introduction. Rates were adjusted for calendar year, age (in months), sex and region using Poisson regression models. Denominator data for infants under 1 year, stratified by age in months, were obtained from Statistics Canada. Results: Annual intussusception hospitalization rates ranged from 20-30 per 100,000 infants over the study period, with no evidence of a trend over time. Intussusception hospitalization rates were highest in infants 4 to <8 months and lowest in those under 2 months or between 10 and <12 months. Males had higher rates than females both overall and within each age group. The rate of intussusception hospitalization after rotavirus vaccine program introduction was 22.4 (95% CI: 18.3, 27.4) compared to 23.4 (95% CI: 21.5, 25.4) per 100,000 before program introduction. Conclusions: We have described baseline intussusception hospitalization rates for infants in Canada and have found no evidence of a change in rate after implementation of routine rotavirus immunization programs.
Abbreviations
| CIHI | = | Canadian Institute for Health Information |
| DAD | = | Discharge Abstract Database |
| ICD | = | International Classification of Disease |
| US | = | United States |
| NPV | = | Negative Predictive Value |
| PPV | = | Positive Predictive Value |
| NL | = | Newfoundland and Labrador |
| NB | = | New Brunswick |
| NS | = | Nova Scotia |
| AB | = | Alberta |
| MB | = | Manitoba |
| NT | = | Northwest Territories |
| NU | = | Nunavut |
| YK | = | Yukon |
| ON | = | Ontario |
| PEI | = | Prince Edward Island |
| CI | = | Confidence Interval |
| NACI | = | National Advisory Committee on Immunization |
| CAEFISS | = | Canadian Adverse Events Following Immunization Surveillance System |
| IMPACT | = | Immunization Monitoring Program-Active |
Disclosure of potential conflicts of interest
The authors have no conflicts of interest relevant to this article to disclose.
Acknowledgments
Parts of this material are based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed herein are those of the authors and not those of the Canadian Institute for Health Information.
Eric Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, the Canadian Association of Gastroenterology, and Crohn's and Colitis Canada. Laura Rosella is supported by Tier 2 Canada Research Chair in Population Health Analytics. Joanne Langley is supported by the CIHR-GSK Chair in Pediatric Vaccinology at Dalhousie University.
Funding
This study was funded by the Canadian Immunization Research Network, through a grant from the Canadian Institutes of Health Research.
Author contributions
Dr. Deeks conceptualized, designed and executed the study, interpreted the results, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.
Dr. Hawken conceptualized, designed and executed the study, carried out all data preparation and statistical analysis, interpreted the results, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.
Ms. Ducharme, Dr. Rosella, Dr. Benchimol Dr Langley, Dr. Wilson, Dr. Crowcroft, Dr. Halperin, Dr. Desai, Dr. Naus, Dr. Sanford and Dr. Mahmood provided important scientific input into the conduct of the study and interpretation of results, reviewed and revised the manuscript, and approved the final manuscript as submitted.