The pathogensis of intussusception is not fully understood. The development of intussusception following adminsitration of a rotavirus vaccine could be related to either the LDK378 concentration immune response to vaccination or the level of shedding following vaccination. Additional data regarding

shedding and immune response from a variety of settings may help in the understanding this as a possible mechanism. Animal models have provided insights into understanding the pathogenesis of intussusception after the RotaShield experience. However, the use of animal models to investigate the pathophysiology of intussusception has been challenging as spontaneous intussusception is rare in animals, not all animals can be infected with rotavirus, some animal models do not accurately reflect human gastrointestinal physiology, and adult animal models may not reflect the pathophysiology of intussusception occurring in young infants during gastrointestinal development and weaning [47]. However, animal studies may be useful in the identification of potential triggers for intussusception and could provide valuable insights for future human studies aimed at identifying the pathogensis of intussusception in infants. A recent study suggested that bacterial enteritis could increase the risk of intussusception [48]. Further studies examining in situ resection material and

stools from infants with intussusception may provide some information about possible etiologies that may increase an infant’s risk of intussusception. Prospective studies to collect and test appropriate specimens could be conducted by recruiting surgeons and pediatricians from varied settings. Although some studies have identified the presence of wild-type rotavirus in the stool or intestine of infants with intussusception, this association seems uncommon. To date, there has not been a sufficiently powered study to assess a low level

of risk of wild-type rotavirus infection of ∼1–2 per 100,000 Idoxuridine infants as has been identified in post-marketing surveillance of rotavirus vaccines. To specifically address the question of whether natural rotavirus infection can cause intussusception, patients that present with intussusception can be examined for rotavirus to determine the biological plausibility of this hypothesis. To further understand possible causes of intussusception, blood samples from children with intussusception should be collected to look for markers of inflammation rather than antigen to help determine if intussusception could be triggered via immune stimulation by EPI vaccines other than rotavirus vaccines. Finally, limited data from clinical trials suggest that rotavirus vaccination resulted in lower overall rates of intussusception among infants <1 year of age suggesting that rotavirus vaccine may trigger intussusception in infants who might have had natural intussusception later in infancy. Additional data is needed to explore this hypothesis more fully.