Health benefits of rotavirus vaccine outweigh intussusception risk

January 01, 0001

Health benefits of rotavirus vaccine outweigh intussusception risk

Because postlicensure surveillance determined that a previous rotavirus vaccine, RotaShield, caused intussusception in 1 of every 10,000 recipients, these authors from multiple countries assessed the association of the new monovalent rotavirus vaccine (RV1) with intussusception after routine immunization of infants in Mexico and Brazil using case-series and case-control methodology.

They found: "We enrolled 615 case patients (285 in Mexico and 330 in Brazil) and 2050 controls. An increased risk of intussusception 1 to 7 days after the first dose of RV1 was identified among infants in Mexico with the use of both the case-series method (incidence ratio, 5.3) and the case-control method (odds ratio, 5.8). No significant risk was found after the first dose among infants in Brazil, but an increased risk, albeit smaller than that seen after the first dose in Mexico — an increase by a factor of 1.9 to 2.6 — was seen 1 to 7 days after the second dose. A combined annual excess of 96 cases of intussusception in Mexico (approximately 1 per 51,000 infants) and in Brazil (approximately 1 per 68,000 infants) and of 5 deaths due to intussusception was attributable to RV1. However, RV1 prevented approximately 80,000 hospitalizations and 1300 deaths from diarrhea each year in these two countries."

The authors concluded: "RV1 was associated with a short-term risk of intussusception in approximately 1 of every 51,000 to 68,000 vaccinated infants. The absolute number of deaths and hospitalizations averted because of vaccination far exceeded the number of intussusception cases that may have been associated with vaccination."

The benefits clearly outweigh the risks in these populations. Parents should get an explanation of the risk vs benefit prior to immunizing for informed consent.

For the full abstract, click here.

N Engl J Med 364:2283-2292, 16 June 2011 © 2011 to the American Medical Association
Intussusception Risk and Health Benefits of Rotavirus Vaccination in Mexico and Brazil. Manish M. Patel, Vesta Richardson López-Collada, Marília Mattos Bulhões,et al. Correspondence to Dr. Patel: [email protected]

Category: D. Digestive, B. Blood/Immune Mechanisms. Keywords: vaccine, rotavirus, monovalent, intussusceptions, death, case-series and case-control study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 1 July 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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