Intussusception after Rotavirus Vaccine Introduction in India
Samarasimha Reddy N, Nayana P. Nair, Jacqueline E. Tate, Varunkumar Thiyagarajan, Sidhartha Giri, Ira Praharaj, Venkata Raghava Mohan, Sudhir Babji, M D Gupte, Rashmi Arora, Sunita Bidari, Sowmiya Senthamizh, Suhasini Mekala, Krishna Babu Goru, Bhaskar Reddy, Padmalatha Pamu, Rajendra P. Gorthi, Manohar Badur, Vittal Mohan, Saroj Sathpathy, Hiranya Kishor Mohanty, Mrutunjay Dash, Nirmal Kumar Mohakud, Rajib Kumar Ray, Prasantajyoti Mohanty, Geeta Gathwala, Suraj Chawla, Madhu Gupta, Rajkumar Gupta, Suresh Goyal, Pramod Sharma, Mannancheril Abraham Mathew, Tarun John K Jacob, Sundaram Balasubramanian, Girish K.C. Purushothaman, Priyadarishini Dorairaj, Muthukumaran Jagannatham, Kulandaivel Murugiah, Hemanthkumar Boopathy, Raghul Maniam, Rajamani Gurusamy, Sambandan Kumaravel, Ashwitha Shenoy, Hemant Jain, Jayanta Kumar Goswami, Ashish Wakhlu, Vineeta Gupta, Gopinath Vinayagamurthy, Umesh D. Parashar, Gagandeep Kang
Abstract
BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).