Any active intervention would then convert a potential transient intussusception to level 1

diagnostic certainty. Therefore, standardized clinical algorithms for decision on radiological or surgical intervention would be central Ibrutinib to sentinel surveillance programs for intussusception that categorize intussusception based on Brighton criteria. It is important to note that the Brighton criteria were evolved as a tool for use in relating an adverse event to vaccination [16] and not for use in clinical diagnosis of intussusception. It is likely that the sensitive screening criteria and heightened awareness of the risk of intussusception in the context of a phase III rotavirus trial among the study physicians, increased the probability of referral for symptoms that might normally be ignored. The relatively early referral and ultrasound screening of suspected cases clearly contributed to transient, spontaneously

resolving intussusceptions being picked buy Trametinib up on radiological examination. Of the intussusceptions identified during the vaccine trial, 9 of 16 were small bowel intussusceptions, and the majority resolved spontaneously and none required surgical intervention. A study which examined small bowel intussusceptions, showed that most ileal intussusceptions (84%) were transient and the only cases where ileal intussusceptions were persistent or interventions were required, there was underlying pathology such as infection, stricture or abscess [14]. In the retrospective analysis, the number of cases of intussusception had tripled at this referral facility in Vellore since the last report by Bhowmik between 2001 and 2004 [21]. This may reflect a number of factors including the improved diagnostic facilities, widening catchment population and changes in health seeking

practices. About 51% of intussusceptions presenting in the tertiary care hospital were referred to the center after receiving preliminary treatment elsewhere, and fewer children had an evident lead point for intussusception in below this cohort as compared to previous studies from Vellore [21] and [22], but those studies included older children as well. This study demonstrates intussusceptions identified through active surveillance and those identified through retrospective hospital based surveillance, differ in the presentation, severity of illness, need for intervention and outcomes. Transient intussusception happens frequently in children and rarely requires intervention [14], and most likely is without a temporal relationship to vaccination. When considering intussusception as a possible consequence of rotavirus vaccination, it is important to consider which outcomes are important for safety monitoring.