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News

Intussusception risk after rotavirus vaccination in U.S. infants

This week's issue of the New England Journal of Medicine investigates intussusception risk after rotavirus vaccination among infants in the United States.

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International postlicensure studies have identified an increased risk of intussusception after vaccination with the second-generation rotavirus vaccines RotaTeq (RV5) and Rotarix (RV1).

Dr Katherine Yih and colleagues studied this association among infants in the United States.

The study included data from infants 5 to 37 weeks of age who were enrolled in 3U.S. health plans that participate in the Mini-Sentinel program sponsored by the Food and Drug Administration.

Potential cases of intussusception and vaccine exposures from 2004 through mid-2011 were identified through procedural and diagnostic codes.

Medical records were reviewed to confirm the occurrence of intussusception and the status with respect to rotavirus vaccination.

The primary analysis used a self-controlled risk-interval design that included only vaccinated children.

No significant increase was seen after dose 2 or 3
New England Journal of Medicine

The secondary analysis used a cohort design that included exposed and unexposed person-time.

The analyses included 507,874 first doses and 1,277,556 total doses of RV5 and 53,638 first doses and 103,098 total doses of RV1.

The statistical power for the analysis of RV1 was lower than that for the analysis of RV5.

The number of excess cases of intussusception per 100,000 recipients of the first dose of RV5 was significantly elevated, both in the primary analysis for the 7-day risk window, and in the secondary analysis.

The team observed no significant increase after dose 2 or 3.

The results with respect to the primary analysis of RV1 were not significant, but the secondary analysis showed a significant risk after dose 2.

Dr Yih's team concludes, "RV5 was associated with approximately 1.5 excess cases of intussusception per 100,000 recipients of the first dose."

"The secondary analysis of RV1 suggested a potential risk, although the study of RV1 was underpowered."

"These risks must be considered in light of the demonstrated benefits of rotavirus vaccination."

N Engl J Med 2014; 370:503-512
11 February 2014

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