Epidemiology of Intussusception among Children Under-Two Years of Age from 2010-2017 in Odisha, India

Background: Intussusception is an adverse event associated with rotavirus vaccines (RVV). RVV was introduced phase-wise in India since April 2016. Background intussusception rates are needed to document changes with RVV introduction. We describe the epidemiology of intussusception among children aged under-two years in Odisha, India. Methods: This bidirectional surveillance (retrospective from July 2010 to March 2016 and prospective from April 2016 to September 2017) at three hospitals in Odisha recruited children aged 2-23 months with intussusception. Data on sociodemography, immunization, clinical, treatment and outcome were collected. Incidences of intussusception among infants and children > 1 year were estimated. Results: 371 children with intussusception (retrospective, n = 266; prospective, n = 105) were recruited. Among them, 78.7% were infants with median age 8 (IQR 6-12) months and 70.6% were males. Abdominal pain (60.9%), vomiting (55.5%), and bloody stools (53.4%) were the leading symptoms and triad was observed in 51.8% cases. 57.4% cases underwent surgery and 16.0% were managed by reduction. Nine (2.4%) children died. 71.4% cases met Brighton criteria Level-1. Intussusception cases increased 2014 onwards and the pooled incidence was estimated to be 5 (3.9-7.9) cases per 100000 infants per year. Conclusions: Intussusception in children was observed prior to rotavirus vaccination in Odisha, India. The risk factors for rising intussusception in children need further evaluation.