Abstract
Background: Dehydration secondary to diarrhoea is a major cause of hospitalization and mortality in children aged less than five years. Most diarrhoea cases in childhood are caused by rotavirus, and routine introduction of rotavirus vaccine is expected to reduce the incidence and severity of dehydration secondary to diarrhoea in vaccinated infants. Previously, studies have examined changes in admissions with stools positive for rotavirus but this study reports on all admissions with dehydration secondary to diarrhoea regardless of stool rotavirus results. We aimed to assess the changes in all-cause severe diarrhoea and dehydration (DAD) admissions following the vaccine’s introduction. Methods: We examined changes in admissions of all clinical cases of DAD before and after introduction of routine vaccination with rotavirus vaccine in July 2014 in Kenya. We use data from 13 public hospitals currently involved in a clinical network, the Clinical Information Network (CIN). Routinely collected data for children aged 2-36 months were examined. We used a segmented mixed effects model to assess changes in the burden of diarrhoea and dehydration after introduction of rotavirus vaccine. For sensitivity analysis, we examined trends for non-febrile admissions (surgical or burns). Results: There were 17,708 patients classified as having both diarrhoea and dehydration. Average monthly admissions due to DAD for each hospital before vaccine introduction (July 2014) was 35 (standard deviation: ±22) and 17 (standard deviation: ±12) after vaccine introduction. Segmented mixed effects regression model showed there was a 33% (95% CI, 30% to 38%) decrease in DAD admissions immediately after the vaccine was introduced to the Kenya immunization program in July 2014. There was no change in admissions due to non-febrile admissions pre-and post-vaccine introduction. Conclusion: The rotavirus vaccine, after introduction into the Kenya routine immunization program resulted in reduction of all-cause admissions of diarrhoea and dehydration in children to public hospitals.
Highlights
Diarrhoea, passage of three or more loose stools in one day, causes dehydration when fluid loss exceeds intake or replacement, and rotavirus is a predominant infectious cause of diarrhoea in early childhood (Kirk et al, 2017)
Studies investigating the impact of the routine introduction of rotavirus vaccine in Kenya have shown a reduction in rotavirus positive diarrhoea cases, but these studies have been based on surveillance of rotavirus in stools of children admitted to sentinel hospitals and miss the critical secondary effects of rotavirus vaccine in all-cause diarrhoea admissions (Muendo et al, 2018; Otieno et al, 2020)
Study area and setting We use observational data collected from routine medical records from 13 public hospitals in Kenya participating in a Clinical Information Network (CIN)
Summary
Passage of three or more loose stools in one day, causes dehydration when fluid loss exceeds intake or replacement, and rotavirus is a predominant infectious cause of diarrhoea in early childhood (Kirk et al, 2017). Studies investigating the impact of the routine introduction of rotavirus vaccine in Kenya have shown a reduction in rotavirus positive diarrhoea cases, but these studies have been based on surveillance of rotavirus in stools of children admitted to sentinel hospitals and miss the critical secondary effects of rotavirus vaccine in all-cause diarrhoea admissions (Muendo et al, 2018; Otieno et al, 2020). We use routinely collected data to assess, using an interrupted time series design, the changes in all-cause severe diarrhoea admissions following the vaccine’s introduction. We aimed to assess the changes in all-cause severe diarrhoea and dehydration (DAD) admissions following the vaccine’s introduction. Methods: We examined changes in admissions of all clinical cases of DAD before and after introduction of routine vaccination with rotavirus vaccine in July 2014 in Kenya. Average monthly admissions due to DAD for each hospital before vaccine introduction (July 2014) was 35
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