Evaluation of intussusception after oral monovalent rotavirus vaccination in South Africa

Michelle J. Groome*, Jacqueline E. Tate, Marion Arnold, Milind Chitnis, Sharon Cox, Corné de Vos, Mari Kirsten, Susanna M. le Grange, Jerome Loveland, Sello Machaea, Ashwini Maharaj, Nick Andrews, Shabir A. Madhi, Umesh D. Parashar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


Background. Postlicensure studies have shown an association between rotavirus vaccination and intussusception. We assessed the risk of intussusception associated with Rotarix (RV1) administration, at 6 and 14 weeks of age, in an upper-middle-income country, South Africa. Methods. Active prospective surveillance for intussusception was conducted in 8 hospitals from September 2013 through December 2017. Retrospective case enrollment was done at 1 hospital from July 2012 through August 2013. Demographic characteristics, symptom onset, and rotavirus vaccine status were ascertained. Using the self-controlled case-series method, we estimated age-adjusted incidence rate ratios within 1-7, 8-21, and 1-21 days of rotavirus vaccination in children aged 28-275 days at onset of symptoms. In addition, age-matched controls were enrolled for a subset of cases (n = 169), and a secondary analysis was performed. Results. Three hundred forty-six cases were included in the case-series analysis. Post-dose 1, there were zero intussusception cases within 1-7 days, and 5 cases within 8-21 days of vaccination. Post-dose 2, 15 cases occurred within 1-7 days, and 18 cases within 8-21 days of vaccination. There was no increased risk of intussusception 1-7 days after dose 1 (no cases observed) or dose 2 (relative incidence [RI], 1.71 [95% confidence interval {CI}.83-3.01]). Similarly, there was no increased risk 8-21 days after the first (RI, 4.01 [95% CI,.87-10.56]) or second dose (RI,.96 [95% CI,.52-1.60]). Results were similar for the case-control analysis. Conclusions. The risk of intussusception in the 21 days after the first or second dose of RV1 was not higher than the background risk among South Africa infants.

Original languageEnglish
Pages (from-to)1606-1612
Number of pages7
JournalClinical Infectious Diseases
Issue number8
Publication statusPublished - 15 Apr 2020

Bibliographical note

Publisher Copyright:
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.


  • Infant
  • Intussusception
  • Rotavirus vaccine
  • Safety


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