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2017 ; 114
(15
): 255-262
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Risk of Intussusception After Rotavirus Vaccination
#MMPMID28468712
Koch J
; Harder T
; von Kries R
; Wichmann O
Dtsch Arztebl Int
2017[Apr]; 114
(15
): 255-262
PMID28468712
show ga
BACKGROUND: In 2013, the German Standing Committee on Vaccination (Ständige
Impfkommission, STIKO) recommended rotavirus (RV) vaccination for all infants
while stating that this mildly increased the risk of intussusception, a
potentially life-threatening event. Since this recommendation was issued,
multiple observational studies on this topic designed as self-controlled case
series (SCCS) have been published. The SCCS design is particularly suitable for
the study of rare adverse effects of medications. METHODS: We systematically
searched the literature for SCCS studies on the risk of intussusception after RV
vaccination. Relative risks (RR) corresponding to different doses of vaccine were
summarized in a meta-analysis, and attributable risks (AR) were calculated.
RESULTS: Of the 16 initially identified studies, 10 with a predominantly low risk
of bias were considered in the analysis. The RR for intussusception was 5.71 (95%
confidence interval [4.50; 7.25]) 1-7 days after the first dose, 1.69 [1.33;
2.14] after the second, and 1.14 [0.75; 1.74] after the third. The AR for
children of the age at which RV vaccination is recommended was 1.7 [1.1; 2.7]
additional intussusceptions per 100 000 vaccinated children after the first dose
and 0.25 [0.16; 0.40] after the second. If >3-month-old infants are vaccinated,
the AR is higher: 5.6 [4.3; 7.2] per 100 000 after the first dose and 0.81 [0.63;
1.06] per 100 000 after the second. CONCLUSION: RV vaccination is associated with
a markedly elevated RR and a mildly elevated AR for intussusception 1-7 days
after the first dose. Physicians should begin the series of vaccinations at age
6-12 weeks, as recommended by the STIKO, because the risk of intussusception is
higher afterward. Current health insurance company claim data indicate that 11.2%
of infants are still receiving the first dose of the vaccine at ages above 3
months. The parents of vaccinated children should be informed about the possible
signs of intussusception (colicky pain, bilious vomiting, and red "currant jelly"
stool).
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