Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

Beckie Nnenna Tagbo, Jason Mwenda, Christopher Eke, Tagbo Oguonu, Sebastin Ekemze, Uchechukwu Obiora Ezomike, Benedict Edelu, Ogechukwu Amadi, Ifeyinwa Okeke, Okechukwu Ani, Roservelt Okechukwu Nnani, Vina Okafor, Henrietta Uche Okafor, Egbuna Obidike, Emmanuel Abanida, Chris Elemuwa, Toyin Odetunde

Department of Paediatric Surgery, Enugu State University Teaching Hospital, Enugu, Nigeria.
Department of Paediatric Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria.
Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Institte of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Institute of Child Health and Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
National Primary Health Care Development Agency, Federal Ministry of Health, Abuja, Nigeria.
World Health Organization Regional Office for Africa (WHO/AFRO), Brazzaville, Republic of Congo.

DOI: 10.4236/wjv.2014.43015                

Abstract

Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53; 88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.

Keywords

Intussusception, Children, Rotavirus, Surgery, Bloody Stool, Nigeria

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Wyliue, R. (2000) Intussusception. In: Behrman, R.E., Kliegman, R.M. and Jenson, H.B., Eds., Nelson Textbook of Paediatrics, 16th Edition, W.B. Saunders Company, Philadelphia, 1142-1143.
[2]	Bines, J.E. and Ivanoff, B. (2002) Acute Intussusception in Infants and Children: A Global Perspective. Vaccines and Biologicals. WHO/V & B/02.19, World Health Organization, Geneva.
[3]	Swischuk, L.E., John, S.D. and Swischuk, P.N. (1994) Spontaneous Reduction of Intussusception Verification with Ultrasound. Radiology, 192, 269-271. http://dx.doi.org/10.1148/radiology.192.1.8208951
[4]	Bines, J.E., Ivanoff, B., Justice, F. and Mulholland, K. (2004) Clinical Case Definition for the Diagnosis of Acute Intussusception. Journal of Pediatric Gastroenterology & Nutrition, 39, 511-518. http://dx.doi.org/10.1097/00005176-200411000-00012
[5]	Henrikson, S., Blane, C.E., Konjok, K., Strouse, P.J., Di Pietro, M.A. and Goodsitt, M.M. (2003) The Effect of Screening Sonography on the Positive Rate of Enemas for Intussusception. Pediatric Radiology, 33, 190-193. http://dx.doi.org/10.1007/s00247-002-0848-7
[6]	Sondheimer, J.M. (2003) Intussusception. In: Hay, W.W., Levin, M., Sondheimer, J.M. and Deterding, R.R., Eds., Current Pediatric Diagnosis and Treatment, 16th Edition, McGraw-Hill Company, New York, 616-617.
[7]	Konno, T., Suzuki, H., Hutsuzawa, T., Imai, A., Katsushima, N., Sakamoto, M., et al. (1978) Human Rotavirus Infection in Infants and Young Children with Intussusception. Journal of Medical Virology, 2, 265-269. http://dx.doi.org/10.1002/jmv.1890020310
[8]	Widdowson, M.A., Bresee, J.S., Gentsch, J.R. and Glass, R.I. (2005) Rotavirus Disease and Its Prevention. Current Opinion in Gastroenterology, 21, 26-31.
[9]	Murphy, T.V., Gargiullo, P.M., Massoudi, M.S., Nelson, D.B., Jumaan, A.O., Okoro, C.A., et al. (2001) Intussusception among INFANTS Given an Oral Rotavirus Vaccine. The New England Journal of Medicine, 344, 564-572. http://dx.doi.org/10.1056/NEJM200102223440804
[10]	Vaccine and Biologicals. Acute Intussusception in Infants and Children: Incidence, Clinical Presentation and Management—A Global Perspective, WHO. http://whqlibdoc.who.int/hq/2002/WHO_V&B_02.19.pdf
[11]	Tagbo, B.N., Mwenda, J.M., Armaha, Obidike, E.O., Okafor, H.U., Oguonu, T., et al. (2014) Epidemiology of Rotavirus Diarrhoea among Children Younger than 5 Years in Enugu, South East Nigeria. Pediatric Infectious Disease Journal, 33, S19-S22. http://dx.doi.org/10.1097/INF.0000000000000047
[12]	Tate, J.E., Burton, A.H., Boschi-Pinto, C., et al. (2012) WHO—Coordinated Global Rotavirus Surveillance Network. 2008 Estimate of Worldwide Rotavirus Associated Mortality in Children Younger than 5 Years before the Introduction of Universal Rotavirus Vaccination Programmes: A Systematic Review and Metaanalysis. The Lancet Infectious Diseases, 12, 136-141. http://dx.doi.org/10.1016/S1473-3099(11)70253-5
[13]	Parasher, U.D., Hummelman, E.G., Bresse, J.S., et al. (2003) Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerging Infectious Diseases, 9, 565-572. http://dx.doi.org/10.3201/eid0905.020562
[14]	Glass, R.I., Bresee, J.S., Turcios, R., Fischer, T.K., Parashar, U.D. and Steele, A.D. (2005) Rotavirus Vaccine; Targeting the Developing World. Journal of Infectious Diseases, 92, S160-S166. http://dx.doi.org/10.1086/431504
[15]	Steele, A.D., Patel, M., Parashar, U.D., Victor, J.C., Aguado, T. and Neuzil, K.M. (2009) Rotavirus Vaccines for Infants in Developing Countries in Africa and Asia: Considerations from a World Health Organization-Sponsored Consultation. The Journal of Infectious Diseases, 200, S63-S69. http://dx.doi.org/10.1086/605042
[16]	Vesiwkari, T., Matson, D.O., Dennehy, P., Van Damme, P., Santosham, M., Rodriguez, Z., et al. (2006) Safety and Efficacy of a Pentavalent Human-Bovine (WC3) Re-Assortment Rotavirus Vaccine. The New England Journal of Medicine, 354, 23-33. http://dx.doi.org/10.1056/NEJMoa052664
[17]	Ruiz-Palacios, G.M., Pérez-Schael, I.P., Velázquez, F.R., Abate, H., Breuer, T., Clmens, C., et al. (2006) Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis. The New England Journal of Medicine, 354, 11-22. http://dx.doi.org/10.1056/NEJMoa052434
[18]	Bine, J.E., Patel, M. and Parashar, U.D. (2009) Assessment of Postlicensure Safety of Rotavirus Vaccines with Emphasis on Intussusception. The Journal of Infectious Diseases, 200, S282-S290. http://dx.doi.org/10.1086/605051
[19]	Bines, J.E., Bentsi-Enchill, A. and Steele, A.D. (2009) Post-Marketing Surveillance of Rotavirus Vaccine Safety. World Health Organization, Geneva.
[20]	Velazquez, F.R., Colindres, R.E., Grajales, C., Hernández, M.T., Mercadillo, M.G., Torres, F.J., et al. (2012) Postmarketing Surveillance of Intussusception Following Mass Introduction of Attenuated Human Rotavirus Vaccine in Mexico. Pediatric Infectious Disease Journal, 31, 736-744. http://dx.doi.org/10.1097/INF.0b013e318253add3
[21]	Parashar, U.D., Gentsch, J., Shiel, W.J., Zaki, S.R., Glass, R., Bahn, M.K., et al. (2009) Population-Based Incidence of Intussusceptions and a Case-Control Study to Examine the Association of Intussusception with Natural Rotavirus Infection among Indian Children. The Journal of Infectious Diseases, 200, S277-S281. http://dx.doi.org/10.1086/605045
[22]	Bines, J.E., Kohl, K.S., Forster, J., Zanardi, L.R., Davis, R.L., Hansen, J., Murphy, T.M., Music, S., Niu, M., Varriccho, F., Vermeer, P. and Wong, E.J. (2004) Acute Intussusception in Infants and Children as an Adverse Events Following Immunization: Case Definition and Guidelines of Data Collection, Analysis, and Presentation. Vaccine, 22, 569-574. http://dx.doi.org/10.1016/j.vaccine.2003.09.016
[23]	Ekenze, S.O., Mgbor, S.O. and Okwesili, O.R. (2010) Routine Surgical Intervention for Childhood Intussusception in a Developing Country. Annals of African Medicine, 9, 27-30. http://dx.doi.org/10.4103/1596-3519.62621
[24]	Buettcher, M., Baer, G., Bonhoeffer, J., Schaad, U.B. and Heininger, U. (2007) Three-Year Surveillance of Intussusception in Children in Switzerland. Pediatrics, 120, 473-480. http://dx.doi.org/10.1542/peds.2007-0035
[25]	(2014) Rotavirus Vaccines—Balancing Intussusception Risks and Health Benefits. http://www.rotacouncil.org/news/commentary/rotavirus-vaccines-balancing-intussusception
[26]	Boundrille, I.C., Phuna, K.B., Quak, S.H., Lee, B.W., Han, H.H., Verstraeten, T., et al. (2006) The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004. Annals of the Academy of Medicine, Singapore, 35, 674-679.
[27]	Fischer, T.K., Bihrmann, K., Perch, M., Koch, A., Wohlfahrt, J., Kare, M., et al. (2004) Intussusception in Early Childhood: A Cohort Study of 1.7 Million Children. Pediatrics, 114, 782-785. http://dx.doi.org/10.1542/peds.2004-0390
[28]	HO, W.L., Yang, T.W., Chi, W.C., Chang, H.J., Huang, L.M. and Chang, M.H. (2005) Intussusception in Taiwanese Children: Analysis of Incidence, Length of Hospitalization and Hospital Costs in Different Age Groups. Journal of the Formosan Medical Association, 104, 398-401.
[29]	Chouikha, A., Fodha, I., Maazoun, K., Brahim, M.B., Hidouri, S., Nouri, A., Trabelsi, A. and Steele, A.D. (2009) Rotavirus Infection and Intussusception in Tunisian Children: Implications for Use of Attenuated Rotavirus Vaccine. Journal of Pediatric Surgery, 44, 2133-2138.
[30]	Chen, S.C., Wang, J.D., Hsu, H.Y., Leong, M.M., Tok, T.S. and Chin, Y.Y. (2010) Epidemiology of Childhood Intussusception and Determinants of Recurrence and Operation: Analysis of National Health Insurance Data between 1998 and 2007 in Taiwan. Pediatrics & Neonatology, 51, 285-291. http://dx.doi.org/10.1016/S1875-9572(10)60055-1
[31]	Nelson, E.A., Tam, J.S., Glass, R.I., Parashar, U.D. and Fok, T.F. (2002) Incidence of Rotavirus Diarrhoea and Intussusception in Hong Kong Using Standardized Hospital Discharge Data. Pediatric Infectious Disease Journal, 21, 701-703. http://dx.doi.org/10.1097/00006454-200207000-00019
[32]	O’ Ryan, M., Lacero, Y., Pena, A. and Valenzuela, M.T. (2003) Two Year Review of Intestinal Intussusception in Six Large Public Hospitals in Santiago, Chile. Pediatric Infectious Disease Journal, 22, 717-721. http://dx.doi.org/10.1097/01.inf.0000078374.82903.e8
[33]	Ameh, E.A. (2002) The Morbidity and Mortality of Laparotomy for Uncomplicated Intussusception in Children. West African Journal of Medicine, 21, 115-116.
[34]	Carneiro, P.M. and Kisusi, D.M. (2004) Intussusception in Children Seen at Muhimbili National Hospital, Dar es Salam. East African Medical Journal, 81, 439-442. http://dx.doi.org/10.4314/eamj.v81i9.9217
[35]	Adejuigbe, O., Jeje, E.A. and Owa, J.A. (1991) Childhood Intussusception in Ile-Ife, Nigeria. Annals of Tropical Paediatrics International Child Health, 11, 123-127.
[36]	Archibong, A.E., Usoro, I.N., Ikpi, E. and Inyang, A. (2001) Paediatric Intussusceptions in Calabar, Nigeria. East African Medical Journal, 78, 19-21. http://dx.doi.org/10.4314/eamj.v78i1.9106
[37]	Usang, E.U., Inah, G.B., Inyang, A.W. and Ekabua, A. (2013) Intussusception in Children: Comparison between Ultra-sound Diagnosis and Operative Findings in a Tropical Developing Country. African Journal of Pediatric Surgery, 10, 87-90. http://dx.doi.org/10.4103/0189-6725.115029