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Comment on ''Intussusception in Children Presenting to the Emergency Department'' Maria Carmela Lenti, Niccolò Lombardi, Alessandro Mugelli, Alessandra Pugi and Alfredo Vannacci CLIN PEDIATR 2014 53: 610 originally published online 14 March 2014 DOI: 10.1177/0009922814526986 The online version of this article can be found at: http://cpj.sagepub.com/content/53/6/610
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526986
research-article2014
CPJXXX10.1177/0009922814526986Lenti et alClinical PediatricsClinical Pediatrics
Letter to the Editor
Comment on “Intussusception in Children Presenting to the Emergency Department”
Clinical Pediatrics 2014, Vol. 53(6) 610 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814526986 cpj.sagepub.com
Maria Carmela Lenti, PharmD1,2, Niccolò Lombardi, PharmD1,2, Alessandro Mugelli, MS, MD1,2, Alessandra Pugi, PharmD1,2, and Alfredo Vannacci, MD, PhD1,2 We read with great interest the article “Intussusception in Children Presenting to the Emergency Department” by Lochhead et al,1 describing the clinical presentation, treatment, and outcome of children admitted to the emergency department (ED) due to a bowel intussusception (BI). The authors underline the importance of an early diagnosis and a prompt nonoperative intervention to obtain a good resolution of the event. We agree with this consideration and believe that it would be important to underline that BI could also be determined by an adverse drug reaction (ADR). Intussusception is an important cause of mortality and morbidity in children, so a timely diagnosis is essential to prevent unfavorable outcome.2 In addition to clinical and instrumental examinations, we think that an accurate drug history with particular attention to rotavirus immunization would be desirable by ED professionals. Rotaviruses are the major cause of gastroenteritis among children, and the World Health Organization recommended including rotavirus vaccines (RVs) in national immunization programs. A low-level risk of BI after RVs, ~1 to 2 cases per 100 000 vaccinees, exists in some settings.3,4 Two recent international postlicensure evaluations have observed a statistically significant increased risk of nearly 5-fold for BI in the first week after administration of the first dose of both vaccines.3,4 We would like to emphasize the possibility of an underestimation of this serious ADR also caused by the difficulty to fully ascertain its causality assessment. It is our opinion that ED pediatricians should consider this potential association in daily clinical practice to reduce time of diagnosis especially when this event occurs during the first 3 to 6 days following vaccination.5 In conclusion, to better manage BI in children who present at the ED with abdominal pain, nonspecific illness, or crying, it is necessary for health care professionals to consider also RV vaccine administration among the risk factors of this occurrence.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by a grant for Pharmacovigilance by Italian Medicines Agency (AIFA) and Tuscany Region.
References 1. Lochhead A, Jamjoom R, Ratnapalan S. Intussusception in children presenting to the emergency department. Clin Pediatr (Phila). 2013;52:1029-1033. 2. Schwartz JL. Rotavirus vaccines, intussusception, and risk-benefit assessments. JAMA Pediatr. 2013;167: 1093-1094. 3. Buttery JP, Danchin MH, Lee KJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine. 2011;29:3061-3066. 4. Patel MM, Lopez-Collada VR, Bulhoes MM, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. 2011;364:2283-2292. 5. Haber P, Patel M, Pan Y, et al. Intussusception after rotavirus vaccines reported to US VAERS, 2006-2012. Pediatrics. 2013;131:1042-1049.
1
Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy 2 Tuscan Regional Centre of Pharmacovigilance, Florence, Italy Corresponding Author: Niccolò Lombardi, University of Florence, Viale Pieraccini, Florence 6, 50139, Italy. Email: [email protected]
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Comment on ''Intussusception in Children Presenting to the Emergency Department'' Maria Carmela Lenti, Niccolò Lombardi, Alessandro Mugelli, Alessandra Pugi and Alfredo Vannacci CLIN PEDIATR 2014 53: 610 originally published online 14 March 2014 DOI: 10.1177/0009922814526986 The online version of this article can be found at: http://cpj.sagepub.com/content/53/6/610
Published by: http://www.sagepublications.com
Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - May 8, 2014 OnlineFirst Version of Record - Mar 14, 2014 What is This?
Downloaded from cpj.sagepub.com at TEXAS SOUTHERN UNIVERSITY on November 11, 2014
526986
research-article2014
CPJXXX10.1177/0009922814526986Lenti et alClinical PediatricsClinical Pediatrics
Letter to the Editor
Comment on “Intussusception in Children Presenting to the Emergency Department”
Clinical Pediatrics 2014, Vol. 53(6) 610 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814526986 cpj.sagepub.com
Maria Carmela Lenti, PharmD1,2, Niccolò Lombardi, PharmD1,2, Alessandro Mugelli, MS, MD1,2, Alessandra Pugi, PharmD1,2, and Alfredo Vannacci, MD, PhD1,2 We read with great interest the article “Intussusception in Children Presenting to the Emergency Department” by Lochhead et al,1 describing the clinical presentation, treatment, and outcome of children admitted to the emergency department (ED) due to a bowel intussusception (BI). The authors underline the importance of an early diagnosis and a prompt nonoperative intervention to obtain a good resolution of the event. We agree with this consideration and believe that it would be important to underline that BI could also be determined by an adverse drug reaction (ADR). Intussusception is an important cause of mortality and morbidity in children, so a timely diagnosis is essential to prevent unfavorable outcome.2 In addition to clinical and instrumental examinations, we think that an accurate drug history with particular attention to rotavirus immunization would be desirable by ED professionals. Rotaviruses are the major cause of gastroenteritis among children, and the World Health Organization recommended including rotavirus vaccines (RVs) in national immunization programs. A low-level risk of BI after RVs, ~1 to 2 cases per 100 000 vaccinees, exists in some settings.3,4 Two recent international postlicensure evaluations have observed a statistically significant increased risk of nearly 5-fold for BI in the first week after administration of the first dose of both vaccines.3,4 We would like to emphasize the possibility of an underestimation of this serious ADR also caused by the difficulty to fully ascertain its causality assessment. It is our opinion that ED pediatricians should consider this potential association in daily clinical practice to reduce time of diagnosis especially when this event occurs during the first 3 to 6 days following vaccination.5 In conclusion, to better manage BI in children who present at the ED with abdominal pain, nonspecific illness, or crying, it is necessary for health care professionals to consider also RV vaccine administration among the risk factors of this occurrence.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by a grant for Pharmacovigilance by Italian Medicines Agency (AIFA) and Tuscany Region.
References 1. Lochhead A, Jamjoom R, Ratnapalan S. Intussusception in children presenting to the emergency department. Clin Pediatr (Phila). 2013;52:1029-1033. 2. Schwartz JL. Rotavirus vaccines, intussusception, and risk-benefit assessments. JAMA Pediatr. 2013;167: 1093-1094. 3. Buttery JP, Danchin MH, Lee KJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine. 2011;29:3061-3066. 4. Patel MM, Lopez-Collada VR, Bulhoes MM, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. 2011;364:2283-2292. 5. Haber P, Patel M, Pan Y, et al. Intussusception after rotavirus vaccines reported to US VAERS, 2006-2012. Pediatrics. 2013;131:1042-1049.
1
Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy 2 Tuscan Regional Centre of Pharmacovigilance, Florence, Italy Corresponding Author: Niccolò Lombardi, University of Florence, Viale Pieraccini, Florence 6, 50139, Italy. Email: [email protected]
Downloaded from cpj.sagepub.com at TEXAS SOUTHERN UNIVERSITY on November 11, 2014
