Incidence of Intussusception in Early Infancy: A Capture-Recapture Estimate for Germany

Abstract

Background: Rotavirus (RV) vaccination with the first generation vaccine (Rotashield) has been associated with intussusception (IS). Reliable age specific baseline incidence data for children ≤6 months of age in particular is fundamental for further post marketing monitoring of potential effects of recently introduced new RV vaccines.

Methods: IS incidence was estimated by a 2-source capture-recapture calculation (CRC) based on ESPED (German Paediatric Surveillance Unit) reports and on hospital discharge records for 2006 and 2007. ESPED as well as hospital records were validated according to the Brighton Collaboration's Group definition for definite IS.

Patients: Children that have been treated for IS in a hospital in one of two states of Germany (North-Rhine Westphalia and Bavaria).

Results: The annual IS incidence for infants <1 year in Germany calculated with the CRC estimate in Germany was 61.7/100 000 (95% CI: 54.5–70.1). However, the incidence appeared to vary by month of age over a range of 19.2/100 000 cases (95% CI: 12.5–30.4) in the first 3 months of life to 98.5/100 000 cases (95% CI: 80.9–120.6) during the 6^th to 8^th month. The male to female ratio for infants was 1.7:1 (95%CI: 1.6–1.8).

Conclusion: The average incidence estimate for IS in infants (< 1 year) confirms previous estimates in Germany and Switzerland. However, age specific baseline incidence estimates for IS substantially vary during the first year of life. This has to be taken into account when analysing episodes of IS potentially associated with RV vaccination.

Zusammenfassung

Hintergrund: Der erste Rotavirus-Impfstoff „Rotashield“ stand im Zusammenhang mit einer erhöhten Anzahl von Invaginationen (IV). Besonders wichtig für das Monitoring der neu eingeführten zweiten Generation von Rotavirus-Impfstoffen bzgl. dieses potenziellen Zusammenhangs, sind verlässliche altersspezifische Daten zur Hintergrundinzidenz der Invagination bei Kindern ≤6 Monate.

Patienten: Kinder, die 2006 oder 2007 in einem Krankenhaus in Nordrhein-Westfalen oder Bayern aufgrund einer IV behandelt wurden.

Methoden: Die Inzidenz der IV wurde durch eine Capture-Recapture Berechnung (CRC) anhand von 2 Quellen – ESPED (Erhebungseinheit für seltene pädiatrische Erkrankungen) und Meldungen aus den Krankenhausdatenbanken – für die Jahre 2006 und 2007 geschätzt. Alle Fallmeldungen aus beiden Quellen wurden auf Basis der Definition der Brighton Collaboration Group für „definitive IV“ validiert.

Ergebnisse: Die mit der CRC-Methode berechnete Inzidenz für Kinder <1 Jahr beläuft sich auf 61,7/100 000 pro Jahr (95% Konfidenzintervall (KI): 54,5–70,1). Die Inzidenz pro Lebensmonat variiert jedoch zwischen 19,2/100 000 (95% KI: 12,5–30,4) in den ersten 3 Lebensmonaten und 98,5/100 000 (95% KI: 80,9–120,6) in den dritten 3 Lebensmonaten. Jungen sind 1,7-mal häufiger von einer IV betroffen als Mädchen (95%KI: 1,6–1,8).

Schlussfolgerung: Die berechnete durchschnittliche Inzidenz für Säuglinge (<1 Jahr) bestätigt vorherige Schätzungen aus Deutschland und der Schweiz. Die Variation der altersspezifischen Inzidenz während des ersten Lebensjahres ist jedoch beträchtlich. Bei der Überwachung einer möglichen Assoziation zwischen der Rotavirus-Impfung und dem Auftreten von Invaginationen muss dies berücksichtigt werden.

intussusception - incidence - capture-recapture method (CRC) - rotavirus vaccine - ESPED (German Paediatric Surveillance Unit) - ICD-10

Invagination - Inzidenz - Capture-Recapture Methode - Rotavirus-Impfung - ESPED (Erhebungseinheit für seltene pädiatrische Erkrankungen) - ICD-10

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