Kim Kyu Yeun, Kim Dong Soo
Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
Yonsei Med J. 2017 May;58(3):631-636. doi: 10.3349/ymj.2017.58.3.631.
Despite withdrawal of RotaShield® and the development of second generation live attenuated rotavirus vaccines, concerns remain regarding the relationship between rotavirus vaccine and intussusception. Nevertheless, since there is no study in Korea, we reviewed data from cases at Severance Children's Hospital to determine the association between rotavirus vaccine and intussusception.
Patients coded as intussusception and following a prescription of RotaTeq® from 2007 to 2013 were reviewed. We calculated comparative incidence figures (CIFs) and 95% confidence intervals (CIs) to compare the risk of intussusception in Korea with the risk in the United States. Expected cases within the four-week post-vaccination window were calculated by applying rates of intussusception from data compiled by the Health Insurance Review and Assessment Service (for a five-year period) to numbers of vaccinations.
In total, 10530 doses of pentavalent rotavirus vaccine were administered. A total of 65 intussusception cases were diagnosed, although only two cases occurred within four weeks after vaccination. This was compared to six cases within 999123 doses in United States from April 2008 to March 2013 (CIF, 31.63; CI, 31.33-31.93). When we adjusted incidence rate differences for both countries, the CIF decreased to 7.05 (CI, 6.72-7.40). When we compared our identified cases with the expected cases from our hospital, there was no increased intussusception occurring within four weeks of vaccination.
We found no association between pentavalent rotavirus vaccine and intussusception. Therefore, rotavirus vaccination should be considered due to its benefits of preventing rotavirus-associated diseases.
尽管轮状病毒疫苗RotaShield®已退市且第二代减毒活轮状病毒疫苗已研发出来,但轮状病毒疫苗与肠套叠之间的关系仍受关注。然而,由于韩国尚无相关研究,我们回顾了Severance儿童医院的病例数据,以确定轮状病毒疫苗与肠套叠之间的关联。
对2007年至2013年编码为肠套叠且使用过Rotateq®的患者进行回顾。我们计算了比较发病率(CIF)和95%置信区间(CI),以比较韩国肠套叠风险与美国风险。通过将健康保险审查与评估服务机构(五年期间)汇编数据中的肠套叠发病率应用于疫苗接种数量,计算接种后四周内的预期病例数。
共接种10530剂五价轮状病毒疫苗。共诊断出65例肠套叠病例,不过仅2例发生在接种疫苗后四周内。相比之下,2008年4月至2013年3月美国999123剂疫苗中有6例(CIF,31.63;CI,31.33 - 31.93)。当我们对两国发病率差异进行调整后,CIF降至7.05(CI,6.72 - 7.40)。当我们将所确定的病例与本院预期病例进行比较时,接种疫苗后四周内未出现肠套叠增加的情况。
我们发现五价轮状病毒疫苗与肠套叠之间无关联。因此,鉴于其预防轮状病毒相关疾病的益处,应考虑接种轮状病毒疫苗。