Intussusception incidence relative to rotavirus vaccine use in Honolulu

Rotavirus vaccine was in use during the period August 1998 to October 1999. Epidemics of intussusception during this period were allegedly due to rotavirus vaccine, which prompted the vaccine to be withdrawn. Hawaii's geographic location between Asia and the mainland United States may subject it to infectious disease epidemic periods midway between occurrence in Asia and occurrence in the mainland United States. In contrast, immunization recommendations are temporally identical across all 50 states. The purpose of this study was to determine whether an epidemic of intussusception was experienced in Honolulu during the period of rotavirus vaccine use. This is a retrospective study of data obtained from inpatient and emergency department discharge diagnosis codes of intussusception for children up to 36 months of age. The incidence data were plotted by time periods to identify possible epidemic periods. The data are graphed. The arrows on the graphs indicate the period of time that rotavirus vaccine was in use. These graphs are most consistent with an increase in the cases of intussusception during the period July 2000 to December 2000, and a possible decline of intussusception during the rotavirus vaccine period. These incidence data are inconsistent with a temporal association between rotavirus vaccine and an epidemic of intussusception in Honolulu.