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Intussusception among Infants Given an Oral Rotavirus Vaccinehttp://content.nejm.org/cgi/content/short/344/8/564
Intussusception among
Infants Given an Oral Rotavirus Vaccine Trudy V. Murphy, M.D., Paul M. Gargiullo, Ph.D., Mehran S. Massoudi, Ph.D., M.P.H., David B. Nelson, B.S., Aisha O. Jumaan, Ph.D., M.P.H., Catherine A. Okoro, M.S., Lynn R. Zanardi, M.D., M.P.H., Sabeena Setia, M.P.H., Elizabeth Fair, M.P.H., Charles W. LeBaron, M.D., Melinda Wharton, M.D., M.P.H., John R. Livingood, M.D., for The Rotavirus Intussusception Investigation Team
ABSTRACT Background Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Our investigation began on May 27, 1999, after nine cases of infants who had intussusception after receiving the tetravalent rhesus–human reassortant rotavirus vaccine (RRV-TV) were reported to the Vaccine Adverse Event Reporting System. Methods In 19 states, we assessed the potential association between RRV-TV and intussusception among infants at least 1 but less than 12 months old. Infants hospitalized between November 1, 1998, and June 30, 1999, were identified by systematic reviews of medical and radiologic records. Each infant with intussusception was matched according to age with four healthy control infants who had been born at the same hospital as the infant with intussusception. Information on vaccinations was verified by the provider. Results Data were analyzed for 429 infants with intussusception and 1763 matched controls in a case–control analysis as well as for 432 infants with intussusception in a case-series analysis. Seventy-four of the 429 infants with intussusception (17.2 percent) and 226 of the 1763 controls (12.8 percent) had received RRV-TV (P=0.02). An increased risk of intussusception 3 to 14 days after the first dose of RRV-TV was found in the case–control analysis (adjusted odds ratio, 21.7; 95 percent confidence interval, 9.6 to 48.9). In the case-series analysis, the incidence-rate ratio was 29.4 (95 percent confidence interval, 16.1 to 53.6) for days 3 through 14 after a first dose. There was also an increase in the risk of intussusception after the second dose of the vaccine, but it was smaller than the increase in risk after the first dose. Assuming full implementation of a national program of vaccination with RRV-TV, we estimated that 1 case of intussusception attributable to the vaccine would occur for every 4670 to 9474 infants vaccinated. Conclusions The strong association between vaccination with RRV-TV and intussusception among otherwise healthy infants supports the existence of a causal relation. Rotavirus vaccines with an improved safety profile are urgently needed.
From the Epidemiology and Surveillance Division (T.V.M., P.M.G., D.B.N., A.O.J., L.R.Z., E.F., C.W.L., M.W., J.R.L.), the Immunization Services Division (M.S.M., S.S.), and the Data Management Division (C.A.O., P.M.G.), National Immunization Program, Centers for Disease Control and Prevention, Atlanta. Benjamin Schwartz, M.D., Epidemiology and Surveillance Division, National Immunization Program, Centers for Disease Control and Prevention, was also an author. Address reprint requests to Dr. Murphy at the Epidemiology and Surveillance Division, National Immunization Program, 1600 Clifton Rd. NE, Mail Stop E-61, Atlanta, GA 30333, or at tvmurphy@cdc.gov.
This article has been cited by other articles:
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MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
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YOUR HEALTH CARE PROVIDER.
DISCLAIMER: All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice. The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.
Copyright 2012 by Vaccination News, A Non-Profit Corporation. All Rights Reserved. This content may not be copied unless permission in writing from Sandy Gottstein has been obtained. 
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 "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?" -- Sandy Gottstein |
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