title: Intussusception is associated with the detection of adenovirus C, enterovirus B and rotavirus in a rotavirus vaccinated population.
abstract: BACKGROUND
  Intussusception, a condition where one segment of intestine invaginates into another, occurs predominantly in infants and young children. A number of potential causes have been identified including infectious agents and rotavirus vaccination. Following the introduction of rotavirus vaccination of infants in Western Australia, a laboratory surveillance programme testing notified intussusception cases for infectious agents was commenced. This led to a PCR-based study of the association between gastrointestinal viruses and intussusception.
  
  
  OBJECTIVE
  Conduct viral testing on stool samples from intussusception patients to determine viruses that may have an association with intussusception.
  
  
  METHODS
  A retrospective case-control study was conducted using stool samples collected from children with intussusception (n=74) and matched controls (n=289) between 2008 and 2011. Samples were tested for rotavirus, norovirus, adenovirus, enterovirus, rhinovirus, astrovirus, parechovirus and bocavirus. Adenovirus, enterovirus and rhinovirus species were determined by DNA sequencing.
  
  
  RESULTS
  Human adenovirus C was detected in significantly more cases than controls with 31/74 (41.9%) cases testing positive compared to 39/289 (13.49%) controls (OR=4.38, p<0.001). A significant difference was seen in Enterovirus B detections with 11/74 (14.9%) cases testing positive compared to 21/289 (7.3%) controls (OR=2.24, p=0.04). Rotavirus was detected in 7/74 (9.46%) cases and 11/289 (3.81%) controls, which was also a significant difference (OR=2.88, p=0.045).
  
  
  CONCLUSIONS
  Our results show that intussusception is associated with non-enteric adenovirus infections, and Enterovirus B infections. While a statistical association was seen with rotavirus and intussusception, we were not able to determine if this was related to vaccine strain or wild type rotavirus.
authors.affiliation: PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia. Electronic address: cara.minney@health.wa.gov.au.
authors.forename: Cara A
authors.initials: CA
authors.lastname: Minney-Smith
authors.affiliation: PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Australia.
authors.forename: Avram
authors.initials: A
authors.lastname: Levy
authors.affiliation: PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Australia.
authors.forename: Meredith
authors.initials: M
authors.lastname: Hodge
authors.affiliation: Telethon Institute for Child Health Research, Subiaco, Western Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.affiliation: PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia.
authors.forename: Simon H
authors.initials: SH
authors.lastname: Williams
authors.affiliation: Communicable Disease Control Directorate, Perth, Western Australia, Australia.
authors.forename: Dale
authors.initials: D
authors.lastname: Carcione
authors.affiliation: Enteric Virus group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
authors.forename: Susie
authors.initials: S
authors.lastname: Roczo-Farkas
authors.affiliation: Enteric Virus group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Microbiology, La Trobe University, Bundoora, Victoria, Australia.
authors.forename: Carl D
authors.initials: CD
authors.lastname: Kirkwood
authors.affiliation: PathWest Laboratory Medicine WA, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Smith
mesh_terms: D000260:Adenoviruses, Human / Q000302:isolation & purification*; D016022:Case-Control Studies; D002675:Child, Preschool; D029822:Enterovirus B, Human / Q000302:isolation & purification*; D005243:Feces / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D012401:Rotavirus / Q000302:isolation & purification*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D017422:Sequence Analysis, DNA; D014904:Western Australia
chemical_list: D022243:Rotavirus Vaccines
keywords: Adenovirus; Enterovirus; Intussusception; Rotavirus