Abstract

BackgroundKiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken.MethodsInpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010–December 2013 (pre-rotavirus vaccine) and January 2016–September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction.ResultsThe incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction.ConclusionsAGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.

Highlights

  • The median percentage reduction in acute gastroenteritis (AGE) hospitalizations overall was 38% and for those rotavirus AGE hospitalizations and emergency department visits an overall reduction of 67% were observed [12], with greater vaccine coverage leading to greater reductions [13]

  • The percentage of AGE contributing to all-cause admissions declined by 43.7% (12.8% vs. 7.2%, p < 0.001), and by 64.2% for allcause mortality (15.9% vs. 5.7%, p = 0.006), postrotavirus vaccine introduction

  • We found a 64.2% reduction in allcause childhood mortality due to AGE which is much higher than the median reduction of 40% reported in the global review post-rotavirus vaccine introduction, in high child mortality settings [21]

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Summary

Introduction

To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. About one third to half of hospitalized cases of diarrheal illness in under 5 s are associated with rotavirus, with a peak incidence in children 6–24 months old [3, 4]. The effectiveness of rotavirus vaccine in gastroenteritis-related hospitalizations appears to be lower in low-income countries compared with high-income countries (~ 50% vs 98%) [14]. A study from Malawi found that stunted infants less than 12 months old had a non-significant lower vaccine effectiveness compared with their well-nourished counterparts [14]. Understanding the situation of malnutrition is important when assessing the impact of rotavirus vaccine in a population

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