Abstract
Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n=302,445) before (2005-10) and after (2011-13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n=18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5-16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8-62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes.
Highlights
Rotavirus is the leading cause of severe acute gastroenteritis (AGE) in young children worldwide [1,2,3], accounting for 15 to 35% of AGE outpatient visits, 25 to 55% of severe AGE cases requiring hospitalisation, and 5% of the global mortality in children under five years [3,4]
The percentage of rotavirus-positive samples decreased after the introduction of universal rotavirus vaccination (Figure 3 and Table 3). In this large population study, we examined the impact of the universal rotavirus immunisation programme using RotaTeq on the burden of mild to moderate AGE and on rotavirus AGE associated with visits to primary care clinics among children younger than five years
We found that introducing RotaTeq to the national immunisation programme (NIP) in Israel was followed by an impressive reduction (59.7%) in incidence rate of mild to moderate rotavirus AGE associated with clinic visits and a more modest (14.8%) decline in clinic visits due to allcause AGE in the paediatric population of Maccabi Health Services (MHS)
Summary
Rotavirus is the leading cause of severe acute gastroenteritis (AGE) in young children worldwide [1,2,3], accounting for 15 to 35% of AGE outpatient visits, 25 to 55% of severe AGE cases requiring hospitalisation, and 5% of the global mortality in children under five years [3,4]. Post-marketing studies have shown that rotavirus vaccines are highly effective (> 80%) in preventing hospitalisations for rotavirus gastroenteritis [12,15,16,17,18] in high and middle income countries, a lower effectiveness was reported in some settings [12]. In these countries, significant reductions (49–89%) in rotavirus gastroenteritis hospitalisations of children younger than five years were documented in the period after introduction of rotavirus vaccination compared with the pre-vaccination era [12]. Fatality from diarrhoeal diseases in young children declined substantially in Mexico [19] and Brazil [20] following the introduction of rotavirus vaccination
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Schedule a callMore From: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
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