Effects of the rotavirus vaccine program across age groups in the United States: analysis of national claims data, 2001\u20132016

Julia M Baker,Justin Cubilo,Umesh D Parashar,Benjamin A Lopman,Rebecca M Dahl

doi:10.1186/s12879-019-3816-7

Abstract

BackgroundThe direct effectiveness of infant rotavirus vaccination implemented in 2006 in the United States has been evaluated extensively, however, understanding of population-level vaccine effectiveness (VE) is still incomplete.MethodsWe analyzed time series data on rotavirus gastroenteritis (RVGE) and all-cause acute gastroenteritis (AGE) hospitalization rates in the United States from the MarketScan® Research Databases for July 2001–June 2016. Individuals were grouped into ages 0–4, 5–9, 10–14, 15–24, 25–44, and 45–64 years. Negative binomial regression models were fitted to monthly RVGE and AGE data to estimate the direct, indirect, overall, and total VE.ResultsA total of 9211 RVGE and 726,528 AGE hospitalizations were analyzed. Children 0–4 years of age had the largest declines in RVGE hospitalizations with direct VE of 87% (95% CI: 83, 90%). Substantial indirect effects were observed across age groups and generally declined in each older group. Overall VE against RVGE hospitalizations for all ages combined was 69% (95% CI: 62, 76%). Total VE was highest among young children; a vaccinated child in the post-vaccine era has a 95% reduced risk of RVGE hospitalization compared to a child in the pre-vaccine era. We observed higher direct VE in odd post-vaccine years and an opposite pattern for indirect VE.ConclusionsVaccine benefits extended to unvaccinated individuals in all age groups, suggesting infants are important drivers of disease transmission across the population. Imperfect disease classification and changing disease incidence may lead to bias in observed direct VE.Trial registrationNot applicable.

Highlights

Introduction and ImplementationBaltimore: Johns Hopkins Bloomberg School of Public Health; 2016. 2
From July 2001–June 2016, there were a total of 9211 rotavirus gastroenteritis (RVGE) hospitalizations and 726,528 acute gastroenteritis (AGE) hospitalizations across all age groups (Additional file 1: Table S1)
RVGE time series Young children, 0–9 years of age Among children 0–9 years of age, the pre-vaccine period displayed a consistent pattern of rotavirus illness with single annual peaks in hospitalization rates during the winter/spring months (Figs. 1 and 2)

Summary

Introduction

Introduction and ImplementationBaltimore: Johns Hopkins Bloomberg School of Public Health; 2016. 2. Rha B, Tate JE, Payne DC, Cortese MM, Lopman BA, Curns AT, et al Effectiveness and impact of rotavirus vaccines in the United States – 2006–2012. Panozzo CA, Becker-Dreps S, Pate V, Weber DJ, Jonsson Funk M, Sturmer T, et al Direct, indirect, Total, and overall effectiveness of the rotavirus vaccines for the prevention of gastroenteritis hospitalizations in privately insured US children, 2007-2010. Leshem E, Moritz RE, Curns AT, Zhou F, Tate JE, Lopman BA, et al Rotavirus vaccines and health care utilization for diarrhea in the United States (20072011). In addition to the remarkable direct effects, reductions in rotavirus disease have exceeded vaccine coverage, suggesting indirect benefits to unvaccinated children [6]. These indirect benefits may extend to children too young to be vaccinated, age-ineligible older children, adolescents, and adults among whom reductions in rotavirus gastroenteritis (RVGE) and all-cause acute gastroenteritis (AGE) have been observed [14]

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