Abstract
BackgroundRotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Vaccination is free of charge to parents, with two doses delivered at 8 and 12 weeks of age. We evaluated vaccine impact across a health system in relation to socioeconomic deprivation.MethodsWe used interrupted time-series analyses to assess changes in monthly health-care attendances in Merseyside, UK, for all ages, from July 2013 to June 2016, compared to predicted counterfactual attendances without vaccination spanning 3–11 years pre-vaccine. Outcome measures included laboratory-confirmed rotavirus gastroenteritis (RVGE) hospitalisations, acute gastroenteritis (AGE) hospitalisations, emergency department (ED) attendances for gastrointestinal conditions and consultations for infectious gastroenteritis at community walk-in centres (WIC) and general practices (GP). All analyses were stratified by age. Hospitalisations were additionally stratified by vaccine uptake and small-area-level socioeconomic deprivation.ResultsThe uptake of the first and second doses of rotavirus vaccine was 91.4% (29,108/31,836) and 86.7% (27,594/31,836), respectively. Among children aged < 5 years, the incidence of gastrointestinal disease decreased across all outcomes post-vaccine introduction: 80% (95% confidence interval [CI] 70–87%; p < 0.001) for RVGE hospitalisation, 44% (95% CI 35–53%; p < 0.001) for AGE hospitalisations, 23% (95% CI 11–33%; p < 0.001) for ED, 32% (95% CI 7–50%; p = 0.02) for WIC and 13% (95% CI -3–26%; p = 0.10) for GP. The impact was greatest during the rotavirus season and for vaccine-eligible age groups. In adults aged 65+ years, AGE hospitalisations fell by 25% (95% CI 19–30%; p < 0.001).The pre-vaccine risk of AGE hospitalisation was highest in the most socioeconomically deprived communities (adjusted incident rate ratio 1.57; 95% CI 1.51–1.64; p < 0.001), as was the risk for non-vaccination (adjusted risk ratio 1.54; 95% CI 1.34–1.75; p < 0.001). The rate of AGE hospitalisations averted per 1,000 first doses of vaccine was higher among infants in the most deprived communities compared to the least deprived in 2014/15 (28; 95% CI 25–31 vs. 15; 95% CI 12–17) and in 2015/16 (26; 95% CI 23–30 vs. 13; 95% CI 11–16).ConclusionsFollowing the introduction of rotavirus vaccination, incidence of gastrointestinal disease reduced across the health-care system. Vaccine impact was greatest among the most deprived populations, despite lower vaccine uptake. Prioritising vaccine uptake in socioeconomically deprived communities should give the greatest health benefit in terms of population disease burden.
Highlights
Rotavirus causes severe gastroenteritis in infants and young children worldwide
Following the introduction of rotavirus vaccination, incidence of gastrointestinal disease reduced across the health-care system
The majority of the severe disease burden is in developing countries, rotavirus was estimated to cause approximately 80,000 general practice (GP) consultations and 750,000 diarrhoea episodes each year in the UK [8]; 45% of hospitalisations and 20% of emergency department (ED) attendances for acute gastroenteritis (AGE) in children under 5 years of age were attributable to rotavirus [9]
Summary
Rotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Prior to the introduction of rotavirus vaccination, rotavirus was the leading cause of severe gastroenteritis in children under 5 years of age worldwide, resulting in approximately 453,000 deaths per year and 40% of diarrhoeal hospital admissions [1, 2]. The majority of the severe disease burden is in developing countries, rotavirus was estimated to cause approximately 80,000 general practice (GP) consultations and 750,000 diarrhoea episodes each year in the UK [8]; 45% of hospitalisations and 20% of emergency department (ED) attendances for AGE in children under 5 years of age were attributable to rotavirus [9]. The monovalent rotavirus vaccine (Rotarix®) was introduced into the UK childhood immunisation schedule in July 2013, with two doses delivered at 8 and 12 weeks of age [10]. Studies in the UK have separately, and for varied populations and time periods, analysed vaccine impact on rotavirus laboratory detections (77% reduction in infants) [12], RVGE hospitalisations (> 80% reduction in infants) [13], all-cause AGE hospitalisations (26% in infants) [12] and GP attendances for diarrhoea related illness (20–30% in those under 5 years old) [14]
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