Incidence of intussusception in early infancy: a capture-recapture estimate for Germany.

BACKGROUND: Rotavirus (RV) vaccination with the first generation vaccine (Rotashield) has been associated with intussusception (IS). Reliable age specific baseline incidence data for children ≤6 months of age in particular is fundamental for further post marketing monitoring of potential effects of recently introduced new RV vaccines. METHODS: IS incidence was estimated by a 2-source capture-recapture calculation (CRC) based on ESPED (German Paediatric Surveillance Unit) reports and on hospital discharge records for 2006 and 2007. ESPED as well as hospital records were validated according to the Brighton Collaboration's Group definition for definite IS. PATIENTS: Children that have been treated for IS in a hospital in one of two states of Germany (North-Rhine Westphalia and Bavaria). RESULTS: The annual IS incidence for infants <1 year in Germany calculated with the CRC estimate in Germany was 61.7/100 000 (95% CI: 54.5-70.1). However, the incidence appeared to vary by month of age over a range of 19.2/100 000 cases (95% CI: 12.5-30.4) in the first 3 months of life to 98.5/100 000 cases (95% CI: 80.9-120.6) during the 6 (th) to 8 (th) month. The male to female ratio for infants was 1.7:1 (95%CI: 1.6-1.8). CONCLUSION: The average incidence estimate for IS in infants (< 1 year) confirms previous estimates in Germany and Switzerland. However, age specific baseline incidence estimates for IS substantially vary during the first year of life. This has to be taken into account when analysing episodes of IS potentially associated with RV vaccination.

DTPa(+)/Hib combination vaccines: the German experience

Background The introduction of polysaccharide-protein conjugate vaccines against Haemophilus influenzae type b (Hib) in the 1990's resulted in a dramatic reduction in the number of cases of invasive Hib disease. In Germany, following the launch of DTPa/Hib combination vaccines in late 1996 and DTPa-IPV/Hib in 1998, the majority of Hib immunisations are made with such combinations. It is well established that such combinations elicit lower anti-Hib antibody concentrations than the equivalent Hib conjugate administered as a separate injection. While there are good reasons to assume that this is of no clinical relevance the clinical impact of this phenomenon has not yet been fully evaluated. Methods and Findings To assess the impact of DTPa/Hib combination vaccines on the incidence of invasive Hib disease in Germany two independent, one hospital- and one laboratory-based, surveillance systems were used during 1998-99 for detection of cases. Tetra- and penta- valent DTPa-Hib vaccines accounted for 92.1 % of all Hib vaccines used in 1999. During the 2 year study period the annual number of invasive Haemophilus influenzae b disease decreased further from 28 in 1998 to 13 in 99. National vaccination coverage rates for 1998/99 revealed that only 70 % of children given DTPa/Hib or DTPa-IPV/Hib received the recommended 3 doses in their first year of life, the overall effectiveness of the most used combination vaccine was high at 97.4 % (95 % CI: 96.0-98.3) for those who had received at least one dose of such a vaccine. In subjects who received the full 3-dose schedule effectiveness was 98.8 % (95 % CI: 98.1-99.2). Conclusion These data show that the lower anti-Hib antibody concentrations observed with DTPa/Hib combination vaccines are of no clinical relevance (AU)

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