Tate Jacqueline E, Simonsen Lone, Viboud Cecile, Steiner Claudia, Patel Manish M, Curns Aaron T, Parashar Umesh D
Division of Viral Diseases, Epidemiology Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pediatrics. 2008 May;121(5):e1125-32. doi: 10.1542/peds.2007-1590.
In 2006, a new rotavirus vaccine was recommended for routine immunization of US infants. Because a previous rotavirus vaccine was withdrawn in 1999 after it was associated with intussusception, monitoring for this adverse event with the new vaccine is important. The objectives of this study were to assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management.
By using the Healthcare Cost and Utilization Project's State Inpatient Database that captures US hospital discharges from 16 states representing 49% of the birth cohort during 1993-2004 and from 35 states representing 85% of the birth cohort in 2002-2004, we examined hospitalizations among infants (<12 months of age) with an International Classification of Disease, Ninth Revision, Clinical Modification code for intussusception (560.0). Incidence rates were calculated by using census data, and rate ratios with 95% confidence intervals were calculated by using Poisson regression data.
Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at approximately 35 cases per 100,000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100,000) then increased rapidly, peaking at approximately 62 per 100,000 at 26 to 29 weeks, before declining gradually to 26 per 100,000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100,000), rates were greater among non-Hispanic black infants (37 per 100,000) and Hispanic infants (45 per 100,000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks.
This assessment of US hospitalizations provides up-to-date and nationally representative prevaccine rates of intussusception. Because rates varied almost 12-fold by week of age and to a lesser extent by race/ethnicity during the age of vaccination, adjusting baseline rates to reflect the demographics of the vaccinated population will be crucial for assessing risk for intussusception after rotavirus vaccination.
2006年，一种新型轮状病毒疫苗被推荐用于美国婴儿的常规免疫接种。由于之前的一种轮状病毒疫苗在1999年因与肠套叠有关而被撤回，因此监测这种新型疫苗的这一不良事件很重要。本研究的目的是评估1993年至2004年美国婴儿肠套叠住院趋势；提供2002 - 2004年肠套叠住院率的估计值；并评估按年龄、种族/族裔和手术治疗情况划分的背景率差异。
利用医疗保健成本与利用项目的州住院数据库，该数据库收录了1993 - 2004年来自16个州（代表出生队列的49%）以及2002 - 2004年来自35个州（代表出生队列的85%）的美国医院出院数据，我们检查了年龄小于12个月、具有国际疾病分类第九版临床修订本中肠套叠编码（560.0）的婴儿的住院情况。发病率通过人口普查数据计算得出，率比及其95%置信区间通过泊松回归数据计算得出。
1993年至2004年，年度肠套叠住院率下降了25%，但自2000年以来一直稳定在每10万名婴儿约35例。9周龄以下婴儿的发病率非常低（每10万名中少于5例），然后迅速上升，在26至29周时达到每10万名约62例的峰值，之后逐渐下降至52周时的每10万名26例。与非西班牙裔白人婴儿的发病率（每10万名27例）相比，非西班牙裔黑人婴儿（每10万名37例）和西班牙裔婴儿（每10万名45例）的发病率更高；然而，16周龄以下婴儿的发病率在种族/族裔方面没有差异。
这项对美国住院情况的评估提供了最新的、具有全国代表性的疫苗接种前肠套叠发病率。由于在疫苗接种年龄段发病率按周龄变化近12倍，按种族/族裔变化程度较小，因此调整基线发病率以反映接种疫苗人群的人口统计学特征对于评估轮状病毒疫苗接种后肠套叠风险至关重要。
