Population Health Sciences, University of Bristol, Bristol, UK.
Population Health Sciences, University of Bristol, Bristol, UK; School of Cellular and Molecular Medicine , University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
Vaccine. 2020 Jul 31;38(35):5618-5626. doi: 10.1016/j.vaccine.2020.06.078. Epub 2020 Jul 10.
An increased risk of intussusception has been reported following rotavirus vaccination. We sought to determine whether introduction of rotavirus vaccination in England in July 2013 was associated with a change in the burden of total and age group-specific childhood hospital admissions for intussusception.
We identified all children aged 0-36 months admitted to hospitals in England with intussusception using the Hospital Episode Statistics dataset. We performed a retrospective ecological analysis comparing hospital admission rates for intussusception during the periods before (2008/2009-2012/2013) and after (2014/2015-2017/2018) introduction of rotavirus vaccination using modified Poisson regression and interrupted time series analysis. Length of hospital stay and clinical outcomes were also examined.
The mean annual admission rate for intussusception in infants over the ten-year study period was 31.5 per 100,000 person-years. An increase in the admission rate in the 8-16 weeks age group (RR 1.46, 95% CI 1.12-1.91), those receiving vaccination, was compensated for by decreases in the 17-24 weeks (RR 0.77, 0.63-0.94), 25-32 weeks (RR 0.71, 0.59-0.86) and 41-52 weeks (RR 0.80, 0.66-0.98) age groups. Using interrupted time series analysis, we observed a significant decrease in incidence in the 0-12 months age group (RR 0.80, 0.67-0.96), but not in the overall 0-36 months age group (RR 1.09, 0.98-1.20). There was no significant change in the proportion of children requiring surgical intervention or with major complications of intussusception. Length of hospital stay decreased among infants receiving surgery for intussusception.
Our results suggest that introduction of rotavirus vaccination in England has resulted in a downward shift in the age at which intussusception occurs in infants, with no overall increase in hospital admission rate or disease severity. These findings support the view that the benefits of rotavirus vaccination outweigh the small increased risk of intussusception in the early post-vaccination period.
轮状病毒疫苗接种后，肠套叠的风险增加。我们试图确定 2013 年 7 月在英国引入轮状病毒疫苗接种是否与儿童因肠套叠住院的总人数和年龄组特定的负担变化有关。
我们使用医院入院统计数据集，确定所有在英格兰因肠套叠住院的 0-36 个月龄儿童。我们使用修正泊松回归和中断时间序列分析比较了疫苗接种前（2008/2009-2012/2013）和后（2014/2015-2017/2018）时期肠套叠住院率，采用回顾性生态分析。还检查了住院时间和临床结果。
在十年的研究期间，婴儿肠套叠的平均年入院率为每 100,000 人年 31.5 例。接种疫苗的 8-16 周龄组（RR 1.46，95%CI 1.12-1.91）的入院率增加，而 17-24 周（RR 0.77，0.63-0.94）、25-32 周（RR 0.71，0.59-0.86）和 41-52 周（RR 0.80，0.66-0.98）龄组的入院率下降。通过中断时间序列分析，我们观察到 0-12 个月龄组的发病率显著下降（RR 0.80，0.67-0.96），但 0-36 个月龄组的总体发病率没有变化（RR 1.09，0.98-1.20）。需要手术干预或肠套叠严重并发症的儿童比例没有明显变化。接受肠套叠手术的婴儿的住院时间缩短。
我们的研究结果表明，英国引入轮状病毒疫苗接种导致婴儿肠套叠的发病年龄下降，而住院率或疾病严重程度没有总体增加。这些发现支持这样的观点，即在疫苗接种后的早期，轮状病毒疫苗接种的小的肠套叠风险增加超过了其益处。
