Common viruses trigger most cases of intussusception in children

Viral infections trigger more cases of intussusception, the common cause of bowel blockages in young children, than previously thought, according to a new study. 

The research, led by Murdoch Children’s Research Institute (MCRI) and published in Clinical Infectious Diseases, found during the COVID-19 lockdowns hospital admissions for intussusception, a medical emergency involving obstruction of the intestine, among young children significantly decreased.

For the study, 12 years of data was analysed across Victoria, NSW and Queensland. A total of 5,589 intussusception cases were recorded between January, 2010 and April, 2022. Of those, 3,179 were children under the age of two.

During the lockdown periods, Victoria and NSW experienced a decline in hospital admissions for intussusception among children under two by 62.7 per cent and 40.1 per cent, respectively. The rate of intussusception cases has now returned to normal levels.

MCRI and Monash University researcher Dr Ben Townley said the magnitude of the decline supported that common respiratory diseases such as colds, the flu and respiratory syncytial virus (RSV), were behind a significant proportion of intussusception cases.

“Reductions in intussusception hospital admissions were seen in all age groups, however most occurred in children less than two years of age,” he said.

“Intussusception is the leading cause of acute bowel obstruction in infants and young children and without prompt diagnosis and management, can be fatal.

“Countries with prolonged COVID-19 lockdowns and suppression strategies saw reductions in common respiratory viruses, which influenced the drop in intussusception admissions.”

Victoria experienced the greatest lockdown duration, with Melbourne having six lockdown periods, for a total of 263 days. Greater Sydney had 159 days and Brisbane had 18 days in lockdown.

MCRI Professor Jim Buttery said the decrease in intussusception cases was greater than expected given previous research into the causes of the condition.

Image: Professor Jim Buttery

“Our analysis found commons viruses play a larger role than previously recognised in triggering intussusception,” he said. Infectious triggers were thought to comprise only a minority, about 30 per cent, of cases.”

Professor Buttery said the findings raised the possibility that emerging vaccines like the new RSV vaccines may help prevent intussusception.

“When a new vaccine against common childhood respiratory viruses is introduced, we may find there are some unexpected benefits, like protecting more children from intussusception,” he said. We last saw this in 2007, when introducing the rotavirus vaccine against gastroenteritis, also reduced febrile convulsions in young children.”

Researchers from Sydney Children's Hospital Network, University of Melbourne and Queensland Health also contributed to the findings. 

Publication: Benjamin Townley, Deniz Akin, Gerardo Luis Dimaguila, Rana Sawires, Gonzalo Sepulveda Kattan, Sebastian King, Julie E Bines, Nicholas Wood, Stephen Lambert and Jim Buttery. ‘Exploring the infectious contribution to intussusception causality using the effects of COVID-19 lockdowns in Australia: An ecological study,’ Clinical Infectious Diseases. DOI: 10.1093/cid/ciae084

*The content of this communication is the sole responsibility of MCRI and does not reflect the views of the NHMRC.

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Professor Jim Buttery, MCRI Group Leader, Health Informatics 

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About Murdoch Children’s Research Institute

Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding

JEB and BT report grants from Bill and Melinda Gates Foundation, PATH US and the Australian Government Department of Health. GSK receives support from WHO, University of Melbourne via PrimeHealth Indonesia Research Grant, support for travel and/or meetings from WHO Advisory Committee for Vaccines Against AMR, Australian Government Department for Foreign Affairs and Trade, participated in Vakzine Project Management GmbH DSMB, WHO Advisory Committee for Vaccines Against AMR. NW reports funding from Australia’s Medical Research Future Fund for a COVID-19 Vaccine Trial, participated on DSMB for a clinical vaccine trial of a COVID-19 vaccine manufactured by BioNet Asia. JB received funding from the Victorian Government Department of Health and the US Centers for Disease Control. JB serves on data-safety monitoring boards for multiple organisations - MCRI receives compensation for his time.