Trends in intussusception-associated hospitalizations and deaths among US infants.
BACKGROUND
The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants.


OBJECTIVE
To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants.


METHODS
This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988-1997, Indian Health Service (IHS) for 1980-1997, California for 1990-1997, Indiana for 1994-1998, Georgia for 1997-1998, and MarketScan for 1993-1996, and mortality data from the national multiple cause-of-death data for 1979-1997 and linked birth/infant death data for 1995-1997.


METHODS
Infants (<1 year old) with an International Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively.


RESULTS
During 1994-1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9-35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33-79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980-1982 to 12 per 100 000 during 1995-1997 (relative risk =7.6, 95% CI = 3.2-18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979-1981 to 2.3 per 1 000 000 live births during 1995-1997 (relative risk = 2.8, 95% CI = 1.8-4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death.


CONCLUSIONS
Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants.
Parashar
U D
UD
Viral Gastroenteritis Section, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA. uap2@cdc.gov
Holman
R C
RC
Cummings
K C
KC
Staggs
N W
NW
Curns
A T
AT
Zimmerman
C M
CM
Kaufman
S F
SF
Lewis
J E
JE
Vugia
D J
DJ
Powell
K E
KE
Glass
R I
RI
D044383:Black People; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000401:mortality*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011159:Population Surveillance; D012189:Retrospective Studies; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American