Intussusception-Rotavirus Vaccine Risk

Last time we spoke about intussusception and its treatment.  This week, we try to discover whether there is a real link between rotavirus vaccines and this rare cause of abdominal pain in infants.

Discussing vaccine efficacy and risks often engenders strong feelings from both sides of the river… the traditional believers AND the ‘anti-vaxxers’.  As with many controversies, it depends how you interpret the numbers – where your innate beliefs lie will influence how you see the data.  Join us as we try to walk the middle ground of objectivity…

Intussusception: Is Rotavirus Vaccination a real risk?

[cp] intro, disclaimer, overview

[cp] History: the RotaShield experience

Evidence – selected papers:
[rr] Belongia 2010 (USA surveillance)
[sf] TGA-Study 2011 (Australia)
[cp] Buttery 2011 (post-marketing surveillance Australia)
[sf] Patel 2011 NEJM (Mexico & Brazil)
[rr] Greenberg 2011 NEJM (editorial of Patel paper)
[cp] (similar studies/reports from numerous countries)

WHO position:
[cp] 2007 position paper
[rr] 2009 update of position paper (& NUVI implementation statement)
[sf] 2011 safety statement

Australian Health authorities’ position:
[cp] CMO letter 2011
[sf] Health Department Provider Info

Current practicalities:
[cp] Immunisation Handbook (Ch 3.18 Rotavirus)
[rr] Choice of vaccine
[sf] Timing of vaccination (catch-ups ?not allowed)
[cp] Both rotavirus infection and intussusception are Notifiable Diseases in (Western) Australia

[all] Summary, goodbye

ZDogg MD says: Immunize!

ZDoggMD \”Immunize!\” on YouTube

References

Belongia EA, Irving SA, Shui IM, Kulldorff M, Lewis E, Yin R, Lieu TA, Weintraub E, Yih WK, Li R, Baggs J; Vaccine Safety Datalink Investigation Group.
Real-time surveillance to assess risk of intussusception and other adverse events after pentavalent, bovine-derived rotavirus vaccine.
Pediatr Infect Dis J. 2010 Jan;29(1):1-5. PubMed PMID: 19907356.

Rotavirus vaccination and risk of intussusception
Therapeutic Goods Administration
25 February 2011
http://www.tga.gov.au/safety/alerts-medicine-rotavirus-110225.htm

Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, Elliott EJ, Booy R, Bines JE; PAEDS/APSU Study Group.
Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia.
Vaccine. 2011 Apr 5;29(16):3061-6. PubMed PMID: 21316503.

Patel MM, López-Collada VR, Bulhões MM, De Oliveira LH, Bautista Márquez A, Flannery B, Esparza-Aguilar M, Montenegro Renoiner EI, Luna-Cruz ME, Sato HK, Hernández-Hernández Ldel C, Toledo-Cortina G, Cerón-Rodríguez M, Osnaya-Romero N, Martínez-Alcazar M, Aguinaga-Villasenor RG, Plascencia-Hernández A, Fojaco-González F, Hernández-Peredo Rezk G, Gutierrez-Ramírez SF, Dorame-Castillo R, Tinajero-Pizano R, Mercado-Villegas B, Barbosa MR, Maluf EM, Ferreira LB, de Carvalho FM, dos Santos AR, Cesar ED, de Oliveira ME, Silva CL, de Los Angeles Cortes M, Ruiz Matus C, Tate J, Gargiullo P, Parashar UD.
Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil.
N Engl J Med. 2011 Jun 16;364(24):2283-92. PubMed PMID: 21675888.

Greenberg HB.
Rotavirus vaccination and intussusception–act two.
N Engl J Med. 2011 Jun 16;364(24):2354-5. PubMed PMID: 21675894.

Rotavirus Vaccines
World Health Organization
Weekly Epidemiological Record (WER) 10 August 2007, vol. 82, 32 (pp 285–296)
http://www.who.int/wer/2007/wer8232/en/index.html

Rotavirus Vaccines: an update
World Health Organization
Weekly Epidemiological Record (WER) 18 December 2009, vol. 84, 50 (pp 533–540)
http://www.who.int/wer/2009/wer8451_52/en/index.html

New and Under-utilized Vaccines Implementation (NUVI): Rotavirus
World Health Organization
Updated November 2009
http://www.who.int/nuvi/rotavirus/en/

Rotavirus vaccine and intussusception
Global Advisory Committee on Vaccine Safety
World Health Organization 2011
http://www.who.int/vaccine_safety/topics/rotavirus/rotarix_and_rotateq/Dec_2010/en/index.html
Extract from report of GACVS meeting of 8-9 December 2010, published in the WHO Weekly Epidemiological Report on 28 January 2011:http://www.who.int/wer/2011/wer8605/en/index.html

CMO Letter on Intussusception and rotavirus vaccine
Immunise Australia Program
Department of Health and Ageing (Australian Government)
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-cmo-intussusception

Rotavirus vaccine and intussusception: Information for Immunisation Providers
Immunise Australia Program
Department of Health and Ageing (Australian Government)
http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/ITO135-cnt

The Australian Immunisation Handbook 9th Edition 2008
http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home
Rotavirus Chapter:
http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-rotavirus

Australian national notifiable diseases and case definitions
Department of Health and Ageing (Australian Government)
http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-casedefinitions.htm