Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines.
BACKGROUND
A licensed rotavirus vaccine was withdrawn from use because of an increased risk of intussusception. The association of rotavirus vaccination with intussusception raised concerns about a potential link between natural rotavirus disease and intussusception. The objectives of the present study were to determine whether an epidemiological association with natural rotavirus infection existed.


METHODS
From 1984 to 2003, all children younger than 5 years with intussusception were retrospectively identified by medical charts, and from 1995 to 2003, a prospective surveillance study of rotavirus infection in children younger than 5 years was independently conducted. Epidemiological characteristics of intussusception and rotavirus infection were then compared.


RESULTS
A total of 533 cases of intussusception and 146 cases of rotavirus infection were identified. The incidence of intussusception for infants younger than 1 year was 62/100,000 child-years. The age distributions of intussusception and rotavirus gastroenteritis overlapped, and a masculine predominance was noted in both cases. No significant association was observed between the monthly distribution of intussusception and rotavirus infection.


CONCLUSIONS
The present study has not convincingly shown that rotavirus diarrhea plays a major role in intussusception. However, data about age and sex distributions supported the biologic plausibility of such an association.
Chouikha
Anissa
A
Research Unit of Virology, UR06/SP20 Laboratory of Microbiology, University Hospital Sahloul, Sousse 4054, Tunisia.
Fodha
Imene
I
Maazoun
Kaies
K
Ben Brahim
Mohamed
M
Hidouri
Saida
S
Nouri
Abdellattif
A
Trabelsi
Abdelhalim
A
Steele
Andrew Duncan
AD
D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003968:Diarrhea, Infantile / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D007443:Intussusception / Q000453:epidemiology / Q000209:etiology*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000009:adverse effects* / Q000627:therapeutic use; D056737:Safety-Based Drug Withdrawals / Q000706:statistics & numerical data; D012621:Seasons; D017678:Sex Distribution; D014416:Tunisia / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014613:Vaccines, Attenuated / Q000009:adverse effects / Q000627:therapeutic use
D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated