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Review
. 2013 Jul 22;8(7):e68482.
doi: 10.1371/journal.pone.0068482. Print 2013.

Childhood intussusception: a literature review

James Jiang  1 , Baoming Jiang, Umesh Parashar, Trang Nguyen, Julie Bines, Manish M Patel
Affiliations
Review

Childhood intussusception: a literature review

James Jiang et al. PLoS One. .

Abstract

Background: Postlicensure data has identified a causal link between rotavirus vaccines and intussusception in some settings. As rotavirus vaccines are introduced globally, monitoring intussusception will be crucial for ensuring safety of the vaccine programs.

Methods: To obtain updated information on background rates and clinical management of intussusception, we reviewed studies of intussusception in children <18 years of age published since 2002. We assessed the incidence of intussusception by month of life among children <1 year of age, seasonality, method of diagnosis, treatment, and case-fatality.

Findings: We identified 82 studies from North America, Asia, Europe, Oceania, Africa, Eastern Mediterranean, and Central & South America that reported a total of 44,454 intussusception events. The mean incidence of intussusception was 74 per 100,000 (range: 9-328) among children <1 year of age, with peak incidence among infants 5-7 months of age. No seasonal patterns were observed. A radiographic modality was used to diagnose intussusception in over 95% of the cases in all regions except Africa where clinical findings or surgery were used in 65% of the cases. Surgical rates were substantially higher in Africa (77%) and Central and South America (86%) compared to other regions (13-29%). Case-fatality also was higher in Africa (9%) compared to other regions (<1%). The primary limitation of this review relates to the heterogeneity in intussusception surveillance across different regions.

Conclusion: This review of the intussusception literature from the past decade provides pertinent information that should facilitate implementation of intussusception surveillance for monitoring the postlicensure safety of rotavirus vaccines.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram for the intussusception literature review.
Figure 2
Figure 2. Global map of intussusception incidence.
In countries where local, regional, and national studies were conducted, we preferentially mapped the national rates. For countries with more than one national study, average rates of the studies were used for the map. If no national rates were available, regional and/or local rates were used for the map.
Figure 3
Figure 3. Incidence of intussusception by month of life during first year of life.
Intussusception incidence or number of cases by month of life from 22 studies extrapolated to remaining 13 studies that only presented data on rates for infants <1 year (as displayed in Table 2).
Figure 4
Figure 4. Seasonality of intussusception globally.
Figure 5
Figure 5. Seasonality of intussusception, by WHO region.
Figure 6
Figure 6. Diagnosis of intussusception by WHO region.
Studies where diagnosis was unspecified were not included. Data from Central and South America were from one prospective research study that might not reflect clinical practice under routine conditions.
Figure 7
Figure 7. Treatment of intussusception by WHO region.
Studies where treatment was unspecified were not included.
See this image and copyright information in PMC

References

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    1. Bines JE, Patel M, Parashar U (2009) Assessment of postlicensure safety of rotavirus vaccines, with emphasis on intussusception. J Infect Dis 200 Suppl 1S282–290. - PubMed
    1. WHO (2002) Acute intussusception in infants and children. Incidence, clinical presentation and management: a global perspective. Geneva: World Health Organization. Document WHO/V & B/02 (19) 1–98.
    1. Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, et al. (2001) Intussusception among infants given an oral rotavirus vaccine. N Engl J Med 344: 564–572. - PubMed
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