Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis

Abstract Background Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rot...

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Main Authors: Ira Praharaj, Samarasimha Nusi Reddy, Nayana Prabhakaran Nair, Jacqueline Elizabeth Tate, Sidhartha Giri, Varunkumar Thiyagarajan, Venkata Raghava Mohan, Rajendiran Revathi, Kalaivanan Maheshwari, Priya Hemavathy, Nirmal Kumar, Mohan Digambar Gupte, Rashmi Arora, Sowmiya Senthamizh, Suhasini Mekala, Krishna Babu Goru, Padmalatha Pamu, Manohar Badur, Subal Pradhan, Mrutunjay Dash, Nirmal Kumar Mohakud, Rajib Kumar Ray, Geetha Gathwala, Madhu Gupta, Ravi Kanojia, Rajkumar Gupta, Suresh Goyal, Pramod Sharma, Mannancheril Abraham Mathew, Tarun John Kochukaleekal Jacob, Balasubramanian Sundaram, Chethrapilly Purusothaman Girish Kumar, Priyadarshini Dorairaj, Ramasubramaniam Pitchumani, Raghul Maniam, Sambandan Kumaravel, Hemant Jain, Jayanta Kumar Goswami, Ashish Wakhlu, Vineeta Gupta, Jie Liu, Eric R. Houpt, Umesh D. Parashar, Gagandeep Kang
Format: Article
Language:English
Published: BMC 2024-10-01
Series:Gut Pathogens
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Online Access:https://doi.org/10.1186/s13099-024-00659-z
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author Ira Praharaj
Samarasimha Nusi Reddy
Nayana Prabhakaran Nair
Jacqueline Elizabeth Tate
Sidhartha Giri
Varunkumar Thiyagarajan
Venkata Raghava Mohan
Rajendiran Revathi
Kalaivanan Maheshwari
Priya Hemavathy
Nirmal Kumar
Mohan Digambar Gupte
Rashmi Arora
Sowmiya Senthamizh
Suhasini Mekala
Krishna Babu Goru
Padmalatha Pamu
Manohar Badur
Subal Pradhan
Mrutunjay Dash
Nirmal Kumar Mohakud
Rajib Kumar Ray
Geetha Gathwala
Madhu Gupta
Ravi Kanojia
Rajkumar Gupta
Suresh Goyal
Pramod Sharma
Mannancheril Abraham Mathew
Tarun John Kochukaleekal Jacob
Balasubramanian Sundaram
Chethrapilly Purusothaman Girish Kumar
Priyadarshini Dorairaj
Ramasubramaniam Pitchumani
Raghul Maniam
Sambandan Kumaravel
Hemant Jain
Jayanta Kumar Goswami
Ashish Wakhlu
Vineeta Gupta
Jie Liu
Eric R. Houpt
Umesh D. Parashar
Gagandeep Kang
author_facet Ira Praharaj
Samarasimha Nusi Reddy
Nayana Prabhakaran Nair
Jacqueline Elizabeth Tate
Sidhartha Giri
Varunkumar Thiyagarajan
Venkata Raghava Mohan
Rajendiran Revathi
Kalaivanan Maheshwari
Priya Hemavathy
Nirmal Kumar
Mohan Digambar Gupte
Rashmi Arora
Sowmiya Senthamizh
Suhasini Mekala
Krishna Babu Goru
Padmalatha Pamu
Manohar Badur
Subal Pradhan
Mrutunjay Dash
Nirmal Kumar Mohakud
Rajib Kumar Ray
Geetha Gathwala
Madhu Gupta
Ravi Kanojia
Rajkumar Gupta
Suresh Goyal
Pramod Sharma
Mannancheril Abraham Mathew
Tarun John Kochukaleekal Jacob
Balasubramanian Sundaram
Chethrapilly Purusothaman Girish Kumar
Priyadarshini Dorairaj
Ramasubramaniam Pitchumani
Raghul Maniam
Sambandan Kumaravel
Hemant Jain
Jayanta Kumar Goswami
Ashish Wakhlu
Vineeta Gupta
Jie Liu
Eric R. Houpt
Umesh D. Parashar
Gagandeep Kang
author_sort Ira Praharaj
collection DOAJ
description Abstract Background Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. Methods In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. Results The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06–2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05–2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% − 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% − 24.1%) had the highest population attributable fraction for intussusception. Conclusion Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.
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spelling doaj-art-d2496181da984a139b5dc79b0a5b930c2025-08-20T02:11:18ZengBMCGut Pathogens1757-47492024-10-011611910.1186/s13099-024-00659-zInfectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysisIra Praharaj0Samarasimha Nusi Reddy1Nayana Prabhakaran Nair2Jacqueline Elizabeth Tate3Sidhartha Giri4Varunkumar Thiyagarajan5Venkata Raghava Mohan6Rajendiran Revathi7Kalaivanan Maheshwari8Priya Hemavathy9Nirmal Kumar10Mohan Digambar Gupte11Rashmi Arora12Sowmiya Senthamizh13Suhasini Mekala14Krishna Babu Goru15Padmalatha Pamu16Manohar Badur17Subal Pradhan18Mrutunjay Dash19Nirmal Kumar Mohakud20Rajib Kumar Ray21Geetha Gathwala22Madhu Gupta23Ravi Kanojia24Rajkumar Gupta25Suresh Goyal26Pramod Sharma27Mannancheril Abraham Mathew28Tarun John Kochukaleekal Jacob29Balasubramanian Sundaram30Chethrapilly Purusothaman Girish Kumar31Priyadarshini Dorairaj32Ramasubramaniam Pitchumani33Raghul Maniam34Sambandan Kumaravel35Hemant Jain36Jayanta Kumar Goswami37Ashish Wakhlu38Vineeta Gupta39Jie Liu40Eric R. Houpt41Umesh D. Parashar42Gagandeep Kang43The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeCenters for Disease Control and PreventionThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeDepartment of Community Health, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeTranslational Health Science and Technology InstituteTranslational Health Science and Technology InstituteThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeKurnool Medical College and Government General HospitalGovernment General Hospital and Rangaraya Medical CollegeKing George Hospital and Andhra Medical CollegeSri Venkateshwara Medical CollegeSardar Vallabh Bhai Patel Post Graduate Institute of PaediatricsInstitute of Medical Sciences, SUM HospitalKalinga Institute of Medical SciencesHi-Tech HospitalPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical SciencesPost Graduate Institute of Medical Education and ResearchPost Graduate Institute of Medical Education and ResearchSawai Man Singh Medical CollegeRabindranath Tagore Medical CollegeDr. Sampurnanand Medical CollegeMalankara Orthodox Syrian Church Medical College HospitalDepartment of Pediatric Surgery, Christian Medical CollegeKanchi Kamakoti Child Trust HospitalNational Institute of EpidemiologyInstitute of Child HealthGovernment Rajaji Hospital and Madurai Medical CollegeCoimbatore Medical CollegeJawaharlal Nehru Institute of Post-graduate Medical Education & ResearchMahatma Gandhi Memorial Medical CollegeGovernment Medical CollegeKing George Medical CollegeInstitute of Medical Sciences, Banaras Hindu UniversityDivision of Infectious Diseases and International Health, University of VirginiaDivision of Infectious Diseases and International Health, University of VirginiaThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical CollegeAbstract Background Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. Methods In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. Results The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06–2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05–2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% − 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% − 24.1%) had the highest population attributable fraction for intussusception. Conclusion Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.https://doi.org/10.1186/s13099-024-00659-zIntussusceptionCase-controlAdenovirusViral pathogensPAF
spellingShingle Ira Praharaj
Samarasimha Nusi Reddy
Nayana Prabhakaran Nair
Jacqueline Elizabeth Tate
Sidhartha Giri
Varunkumar Thiyagarajan
Venkata Raghava Mohan
Rajendiran Revathi
Kalaivanan Maheshwari
Priya Hemavathy
Nirmal Kumar
Mohan Digambar Gupte
Rashmi Arora
Sowmiya Senthamizh
Suhasini Mekala
Krishna Babu Goru
Padmalatha Pamu
Manohar Badur
Subal Pradhan
Mrutunjay Dash
Nirmal Kumar Mohakud
Rajib Kumar Ray
Geetha Gathwala
Madhu Gupta
Ravi Kanojia
Rajkumar Gupta
Suresh Goyal
Pramod Sharma
Mannancheril Abraham Mathew
Tarun John Kochukaleekal Jacob
Balasubramanian Sundaram
Chethrapilly Purusothaman Girish Kumar
Priyadarshini Dorairaj
Ramasubramaniam Pitchumani
Raghul Maniam
Sambandan Kumaravel
Hemant Jain
Jayanta Kumar Goswami
Ashish Wakhlu
Vineeta Gupta
Jie Liu
Eric R. Houpt
Umesh D. Parashar
Gagandeep Kang
Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
Gut Pathogens
Intussusception
Case-control
Adenovirus
Viral pathogens
PAF
title Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
title_full Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
title_fullStr Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
title_full_unstemmed Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
title_short Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis
title_sort infectious etiology of intussusception in indian children less than 2 years old a matched case control analysis
topic Intussusception
Case-control
Adenovirus
Viral pathogens
PAF
url https://doi.org/10.1186/s13099-024-00659-z
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