From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales.
The University of Sydney, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales.
Pediatr Infect Dis J. 2022 Jun 1;41(6):507-513. doi: 10.1097/INF.0000000000003521. Epub 2022 May 6.
Multiple studies have shown an association between intussusception (IS) and receipt of monovalent or pentavalent rotavirus vaccine (RV) in the previous 21 days. Disease severity is an important consideration for risk-benefit evaluations of RV, but no studies have compared the severity of IS within 21 days of vaccination (vaccine-associated, VA) and later (not temporally-associated, VNA).
We used active hospital-based surveillance in the Australian Paediatric Active Enhanced Disease Surveillance (PAEDS) network (July 2007 to February 2018) to identify infants ≤9 months of age meeting Brighton level 1 criteria for IS. We used five severity levels: (1) no surgery and length of stay (LOS) ≤1 day, (2) no surgery and LOS ≥2 days, (3) surgery, no bowel resection, (4) bowel resection, and (5) ICU admission.
Of 323 eligible cases, 87 (26.9%) were VA and 236 (73.1%) VNA. VA-IS cases (median 21 weeks; 24.1% ≤14 weeks) were significantly younger than VNA-IS cases (median 28 weeks, 7.2% ≤14 weeks). Cases 0-≤14 weeks of age were significantly more likely than cases ≥25 weeks to require bowel resection (relative risk ratio 4.6, 95% CI, 1.48-14.3). This effect was not associated with RV. After adjustment for age and sex, VA-IS was not significantly overrepresented in severity levels 2-5; adjusted RRR of 1.37 (95% CI: 0.61-3.11) for bowel resection in cases 0-≤14 weeks of age.
IS was uncommon but significantly more severe under 14 weeks of age. After adjustment for age and sex, IS severity was not related to RV.
多项研究表明，在 21 天内接受单价或五价轮状病毒疫苗（RV）与肠套叠（IS）之间存在关联。疾病的严重程度是评估 RV 风险效益的一个重要考虑因素，但尚无研究比较接种后 21 天内（疫苗相关，VA）和之后（无时间关联，VNA）IS 的严重程度。
我们利用澳大利亚儿科主动强化疾病监测（PAEDS）网络中的基于医院的主动监测（2007 年 7 月至 2018 年 2 月），鉴定符合肠套叠 1 级Brighton 标准且年龄≤9 个月的婴儿。我们使用了五个严重程度级别：（1）无手术且住院时间（LOS）≤1 天，（2）无手术且 LOS≥2 天，（3）手术，无肠切除，（4）肠切除，（5）ICU 住院。
在 323 例符合条件的病例中，87 例（26.9%）为 VA 病例，236 例（73.1%）为 VNA 病例。VA-IS 病例（中位数 21 周；24.1%≤14 周）显著比 VNA-IS 病例（中位数 28 周，7.2%≤14 周）年轻。0-≤14 周龄的病例比≥25 周龄的病例更有可能需要肠切除（相对风险比 4.6，95%CI，1.48-14.3）。这种效果与 RV 无关。在调整年龄和性别后，VA-IS 在严重程度 2-5 中的比例没有显著增加；在 0-≤14 周龄的病例中，调整后的相对危险比（RRR）为 1.37（95%CI：0.61-3.11）。
IS 并不常见，但在 14 周龄以下时明显更严重。在调整年龄和性别后，IS 的严重程度与 RV 无关。
