This committee was led by a senior pediatric surgeon and had a pediatric radiologist and a pediatrician as members. Brighton level 1 criteria require the presence of surgical and/or radiologic evidence of intussusception or the demonstration of intra abdominal mass by abdominal ultrasound with specific characteristics, which is proven to be reduced by hydrostatic enema on post reduction ultrasound. All children who received at least one dose of vaccine/placebo were included in the analysis. Incidence rate of intussusception along with a 95% CI was calculated assuming a Poisson distribution of events.

The relative risk was also assessed for the 7-day, 14-day, and 60-day periods after any dose and for the 365-day period after the first dose. Sensitivity and specificity of screening criteria was calculated assuming all those who did not have intussusception of any NVP-AUY922 in vivo diagnostic certainty as negative for intussusception and those meeting level 1 diagnostic certainty Selleck BIBW2992 as positive for intussusception. The sample size of the clinical trial was driven by efficacy considerations. The phase III clinical trial enrolled 6799 children across three sites (Delhi-3799, Pune-1500, Vellore-1500), 4532 children received vaccine and 2267

placebo. A total of 4419 (97.5%) children in the vaccine arm and 2191 (96.6%) in the placebo arm remained in the study till the age of two years contributing

8506 child-years of observation in the vaccine arm and 4248 child-years in the placebo arm. We noted a high level of compliance to study procedures with 96.3% of the subjects receiving all three doses. The analysis included all children who received at least one dose of vaccine. During the study, 1432 events of suspected intussusception were reported in 1063 children. Of these, 46 events in 29 children in the vaccine arm and 25 events in 18 children in the placebo arm were based on caregiver’s complaints of abdominal distension in the child and were unaccompanied by objective confirmation of distension or any other sign and symptom of intussusception. Although the study team followed Unoprostone up the cases, no ultrasound examination was considered necessary and medical intervention was not required. A total of 1361 events, 914 in the vaccine group and 447 in the placebo group were considered possible intussusceptions. These included 831 from Delhi, 111 from Pune and 419 events from Vellore. Ultrasound examination was not performed for 17 cases either because the family refused or because events were identified during routine contact with the family after the child had recovered. In all but four events ultrasound examinations were performed within eight hours of the event being identified (Fig. 1).