What Is Intussusception?

On average  your body has  twenty-five feet of organic tubing, the intestines.  Like an assembly line in reverse, the intestines  break down morsels. As food travels through, the small intestine extracts nutrients and the large intestine leaches water. Normally, this is how our bodies obtain sustenance. But what happens when the intestines fold into themselves? This condition is called intussusception, often described by websites as a “telescoping” of the intestines. Although it may happen to anyone, it most typically strikes young children below the age of three, especially boys.

Intussusception denies the living intestinal tissue blood, which in turn may kill the tissue, tear the intestinal lining, and cause infections. People suffering from intussusception experience intense, sometimes infrequent abdominal pain. A classic sign of this in children is when the child lifts his knees to his chest while wailing. Often a person affected by intussusception  will pass bloody, jelly-like stools. Sometimes the telescoping  will reveal itself by creating a “lump in the abdomen,” to use the terminology in the above cited links.

Of course, the Mayo Clinic warns that “[n]ot everyone has all of the symptoms.” Worse, intussusception shares some common symptoms with other illnesses. For example, patients may vomit, have diarrhea, feel lethargic, or run a high fever. But doctors can diagnose intussusception several ways. X-rays and ultrasounds may allow a clear picture of the intestines. Likewise, a “contrast enema,” using barium and air can reveal intussusception and even correct it in some situations.

Intussusception is unpleasant and dangerous if untreated. However, patients treated in time  typically recover without long-term consequences. In many cases an air contrast enema can successfully correct the problem while in others, physicians may resort to surgery. The type of surgery performed depends  on the particular circumstances.

Before continuing, I should note that the human body is a complicated system. Often a correct diagnosis hinges on the particular circumstances of a patient. Furthermore, no website knows your specific medical history. If you think you or your child is suffering from intussusception, or from any other serious medical condition, the best thing is to see a healthcare provider. Intussusception in particular, as I said above, does share some common symptoms with other illnesses and is a serious condition; if in doubt at all, you should seek medical attention immediately.

How does intussusception relate to vaccines?

In 1999, authorities determined that RotaShield®, a now discontinued rotavirus vaccine, increased the risk of intussusception in those individuals that received the vaccine more than was acceptable. The manufacturer therefore stopped selling RotaShield® and it is not available today. Today we instead use either RotaTeq® or Rotarix®. (safety information here)  RotaTeq® is a pentavalent vaccine while Rotarix® is monovalent.

With the introduction of these new vaccines, doctors have frequently studied the rate of intussusception in children who receive rotavirus vaccines. To quote this September 2016 study from Pediatrics, “[a]lthough the evidence is building that there is an increased risk, albeit uncommon, of intussusception with the receipt of rotavirus vaccine, the benefits of the rotavirus vaccination program have been dramatic.”

Not every study has determined there was an increased risk of intussusception from the new rotavirus vaccine. A study from Africa published in the April 2018 New England Journal of Medicine found, “The risk of intussusception after administration of monovalent human rotavirus vaccine was not higher than the background risk of intussusception in seven lower-income sub-Saharan African countries.”[1] Likewise this study, despite identifying an increased risk of intussusception after the first dose in Mexico, did not identify it in Brazil. Rather, the study observed risk after the second dose in Brazil. “However,” the authors caution, “given the fairly small increased risk observed with dose 2, the association [2] may be spurious and warrants further study.” As discussed here, the World Health Organization noted the risk of intussusception after receiving a rotavirus vaccine seems to vary by country.

Studies in the United States seem to suggest there is an increased risk. This particular study from the New England Journal of Medicine found a significant increase of risk after the first dose of RotaTeq (but not after the first dose of Rotarix). Another study perceived an increased risk of intussusception after Rotarix®; but, not Rotateq®. Lastly, this study from Pediatrics indicated a higher rate of infants being hospitalized for intussusception when those infants were between eight and eleven weeks. (As the study observes, most American infants receive the first dose of rotavirus vaccine at that age.)

It’s very important to remember two things. First, the increased risks found in these studies do not mean it is likely, overall, for a child to suffer intussusception after being vaccinated for rotavirus. The odds remain slight[3]. Second, rotavirus occurs much more often than intussusception and spreads easily. For these reasons, among others, doctors continue to recommend and prescribe rotavirus vaccines. As an Advisory Committee of the World Health Organization puts it:

“Overall, the Committee continues to be reassured that the benefit of rotavirus vaccination in preventing severe diarrhoea is greater than the small potential risk of intussusception identified in most, but not all post-licensure studies.”

How have authorities responded?

In 2011, the Centers for Disease Control warned that “[r]otavirus vaccination is now contraindicated for… infants with a history of intussusception.” (Specifically, this covers only children who have already suffered from intussusception.) In 2013, the Secretary of Health and Human Resources proposed adding intussusception as a “table injury” to the Vaccine Injury Compensation Table.

What’s a table injury? What’s the Vaccine Injury Compensation Table?

To answer these questions, I need to tell you about the National Vaccine Injury Compensation Program (“VICP”). This no-fault program was designed to compensate individuals who can show they more likely than not suffered severe injury as a result of vaccination. To be eligible for compensation, you have to have received one of the vaccines covered under the VICP and suffered a severe injury. If you meet the criteria proscribed by the VICP you can bring suit in a special vaccine court which is presided over by a special master. Because you are ostensibly suing the Secretary of Health and Human Services, an attorney from the Department of Justice argues against your side.

The Vaccine Injury Table is a list of all the vaccines covered by the VICP. A “table injury” is any of the injuries listed for each covered vaccine. If you suffer a table injury within the time indicated the burden of proof shifts onto the government to establish that the vaccine did not cause the injury.

Intussusception, as defined by the Vaccine Injury Table means:

The invagination of a segment of intestine into the next segment of intestine, resulting in bowel obstruction, diminished arterial blood supply, and blockage of the venous blood flow.  This is characterized by a sudden onset of abdominal pain that may be manifested by anguished crying, irritability, vomiting, abdominal swelling, and/or passing of stools mixed with blood and mucus.

Intussusception between one and twenty-one days after vaccination, for example, is the only table injury for rotavirus vaccines. Of course, by no means do you have to have a table injury to receive compensation. The burden of proof will just rest on you to show more likely than not that the vaccine caused the injury.

If you think you or a loved one has suffered an injury because of a vaccine, you will need a thorough, steadfast ally. Contact the Sands Anderson Vaccine Injury Legal Team today to discuss your potential claim.

[1] Also, the clinical trials (i.e. those conducted before the vaccines reached the open market) did not identify an increased risk. See this abstract

[2] Namely, the association observed in Brazilian cases.

[3] According to this abstract, “…post-licensure studies have documented a risk in several high and middle income countries, at a rate of ∼1-6 excess cases per 100,000 vaccinated infants…”