More on RotaShield and intussusception: the role of age at the time of vaccination.
نویسندگان
چکیده
BACKGROUND RotaShield, a vaccine intended to prevent severe rotavirus diarrhea, was withdrawn in July 1999, 9 months after it became available in the United States, because of a temporal association with intussusception events that occurred in vaccinated infants. We explore here the effect of age on the risk of intussusception. METHODS We reanalyzed a case-control database of the Centers for Disease Control and Prevention by use of a 21-day window, to define vaccine-associated events. We obtained data on vaccine use from the National Immunization Survey and estimated the age-stratified background incidence of intussusception by use of Healthcare Cost and Utilization Project data. We combined these data to estimate how absolute risk varies with age and to model the projected population-attributable risk associated with 3 different vaccination schedules. RESULTS We found that the incidence of intussusception associated with the first dose of vaccine increased with age. Infants > or = 90 days old accounted for 80% of cases of intussusception associated with a first dose but had received only 38% of first doses. Modeling of the recommended schedule of vaccination at ages 2, 4, and 6 months projected 1 intussusception event/11,000-16,000 vaccine recipients; modeling of a 2-dose schedule beginning in the neonatal period projected 1 intussusception event/38,000-59,000 vaccine recipients. CONCLUSIONS The practice of initiating immunization after age 90 days, which we call "catch-up" vaccination, contributed disproportionately to the occurrence of intussusception associated with the use of RotaShield. A fully implemented 2-dose vaccination schedule begun during the neonatal period would lead to, at most, a 7% increase in the incidence of intussusception above the annual background incidence.
منابع مشابه
The Withdrawl of the Rotashield Rotavirus Vaccination Due to an Association with Intussusception: Fact or Fiction?
Rotavirus exists throughout the world and is estimated to have infected every individual by their fifth birthday. For this reason, there has been a significant drive for the development of a vaccination for the virus. After much failure, Rotashield, a tetravalent rhesus-based live attenuated vaccine was developed and approved in 1998. Following over 1.5 million administrations, it was suspended...
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متن کاملTime to begin a new chapter and expand rotavirus immunization.
Rotavirus immunization has been limited to young infants owing to intussusception events noted with a prior rotavirus vaccine, RotaShield. Dramatic declines occurred in rotavirus-related disease beginning in 2008 after implementation of rotavirus vaccination in young infants. These declines occurred in vaccinated children and unvaccinated children and adults (through indirect protection). Despi...
متن کاملAge dependence of the relation between reassortant rotavirus vaccine (RotaShield) and intussusception.
متن کامل
The temporal relationship between RotaTeq immunization and intussusception adverse events in the Vaccine Adverse Event Reporting System (VAERS)
BACKGROUND In August of 2006, the Advisory Committee on Immunization Practices (ACIP) recommended RotaTeq for routine vaccination of US infants. The hypothesis tested in the present study is that rotavirus vaccines are associated with an increased risk of intussusception adverse events (AEs) characterized by an onset in a biologically plausible a priori identified temporal period post-vaccinati...
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عنوان ژورنال:
- The Journal of infectious diseases
دوره 192 Suppl 1 شماره
صفحات -
تاریخ انتشار 2005