What are the ways to prevent intussusception?

Prevention of Intussusception

Rotavirus vaccination is the most important preventive measure against intussusception, as newer rotavirus vaccines have been shown to be safe and effective without significantly increasing intussusception risk, unlike earlier versions. 1

Understanding Intussusception and Its Relationship to Rotavirus

Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is the leading cause of bowel obstruction in infants, particularly those under 2 years of age.

Risk Factors and Causes:

• Adenovirus infection has been strongly associated with intussusception (OR 2.67) 2
• Human herpes virus 6 (HHV-6) has also been linked to intussusception (OR 3.50) 2
• Wild-type rotavirus itself has not been definitively associated with intussusception (OR 1.07) 2

Preventive Strategies

1. Rotavirus Vaccination

Rotavirus vaccination is crucial because:

• Rotavirus is a leading cause of severe gastroenteritis in children
• Severe gastroenteritis can lead to complications that may trigger intussusception
• Modern rotavirus vaccines have favorable safety profiles regarding intussusception risk

Available Vaccines:

• RotaTeq® (RV5): Pentavalent human-bovine reassortant rotavirus vaccine
• RotaRix® (RV1): Monovalent vaccine based on attenuated human rotavirus strain

Vaccination Timing (Critical for Safety):

• First dose must be administered between 6 and 12 weeks of age (by 12 weeks 0 days) 1
• Subsequent doses at 4-10 week intervals 1
• Complete all doses by 32 weeks of age (by 32 weeks 0 days) 1
• Do not initiate vaccination in infants older than 12 weeks due to potential safety concerns 1

Safety Considerations:

• Unlike the withdrawn RRV-TV (Rotashield®) vaccine from 1998, current rotavirus vaccines have not shown significant association with intussusception in large pre-licensure trials 3
• Post-marketing surveillance has shown a small increased risk with RV1 (estimated at 5.3 per 100,000 infants vaccinated) 4
• RV5 has shown a better safety profile regarding intussusception in post-marketing studies 4

2. Special Considerations for High-Risk Groups

Previous History of Intussusception:

• Practitioners should carefully weigh risks and benefits of vaccination in infants with previous intussusception 1
• Infants with prior intussusception are at higher risk for repeat episodes 1

Preterm Infants:

• Preterm infants should receive rotavirus vaccine according to chronological age (not adjusted age) 1
• Vaccination should occur when the infant is:
  • Clinically stable
  • Age-eligible (6-14 weeks for first dose)
  • At or after discharge from NICU/nursery 1

Infants with Pre-existing Gastrointestinal Conditions:

• Benefits of vaccination generally outweigh theoretical risks for infants with:
  • Congenital malabsorption syndromes
  • Hirschsprung's disease
  • Short-gut syndrome 1
• These infants should not be on immunosuppressive therapy 1

3. Contraindications and Precautions

Acute Gastroenteritis:

• Postpone vaccination in infants with moderate-to-severe gastroenteritis until condition improves 1
• Infants with mild gastroenteritis can be vaccinated, especially if delay might make them ineligible 1

Moderate or Severe Acute Illness:

• Delay vaccination until recovery from acute phase of illness 1
• Mild respiratory or other mild illnesses with or without fever are not contraindications 1

Monitoring and Surveillance

Proper monitoring is essential since:

• Intussusception rates based solely on inpatient data may underestimate true incidence by >40% 5
• Many cases are managed in short-stay or emergency department settings 5

By following these preventive measures, particularly appropriate rotavirus vaccination, the risk of intussusception can be significantly reduced while protecting against severe rotavirus disease and its complications.