Abstract
BackgroundThe aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI).MethodsThe retrospective evaluation (2002–2009) by chart analysis included all clinically diagnosed and microbiologically confirmed RV-GE cases in a large tertiary care hospital in Austria. The pre-vaccination period (2002–2005) was compared with the recommended and early funded (2006–2007) and the funded (2008–2009) vaccination periods. Primary outcomes were RV-GE-associated hospitalizations, secondary outcomes nosocomial RV disease, secondary BSI and direct hospitalization costs for children and their accompanying persons.ResultsIn 1,532 children with RV-GE, a significant reduction by 73.9% of hospitalized RV-GE cases per year could be observed between the pre-vaccination and the funded vaccination period, which was most pronounced in the age groups 0–11 months (by 87.8%), 6–10 years (by 84.2%) and 11–18 years (88.9%). In the funded vaccination period, a reduction by 71.9% of nosocomial RV-GE cases per year was found compared to the pre-vaccination period. Fatalities due to nosocomial RV-GE were only observed in the pre-vaccination period (3 cases). Direct costs of hospitalized, community-acquired RV-GE cases per year were reduced by 72.7% in the funded vaccination period. The reduction of direct costs for patients (by 86.9%) and accompanying persons (86.2%) was most pronounced in the age group 0–11 months.ConclusionsUMV may have contributed to the significant decrease of RV-GE-associated hospitalizations, to a reduction in nosocomial RV infections and RV-associated morbidity due to secondary BSI and reduced direct hospitalization costs. The reduction in nosocomial cases is an important aspect considering severe disease courses in hospitalized patients with co-morbidities and death due to nosocomial RV-GE.
Highlights
The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI)
Austria, prompted by cost calculations [9], was one of the first European countries to recommend vaccination against RV since 2006 and to subsidize an universal mass vaccination (UMV) program in infants aged between 6 weeks and 6 months with Rotateq (Sanofi Pasteur MSD SNC, Lyon, France; market launch September 2006) between July and December 2007 and with Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium; market launch May 2006) between January 2008 and December 2009
Both vaccines are directed against the most important serotypes circulating in Austria, G1P (74.0%), G4P (8.0%) and G3P (1.8%) which were found in samples from hospitalized children due to RV-associated gastroenteritis (RV-GE) in Innsbruck, Tyrol, and Leoben, Styria [10]
Summary
The aim of the study was to evaluate the effects of universal mass vaccination (UMV) against rotavirus (RV) on the hospitalization rates, nosocomial RV infections and RV-gastroenteritis (GE)-associated secondary blood stream infections (BSI). Austria, prompted by cost calculations [9], was one of the first European countries to recommend vaccination against RV since 2006 and to subsidize an universal mass vaccination (UMV) program in infants aged between 6 weeks and 6 months with Rotateq (Sanofi Pasteur MSD SNC, Lyon, France; market launch September 2006) between July and December 2007 and with Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium; market launch May 2006) between January 2008 and December 2009. Both vaccines are directed against the most important serotypes circulating in Austria, G1P (74.0%), G4P (8.0%) and G3P (1.8%) which were found in samples from hospitalized children due to RV-GE in Innsbruck, Tyrol, and Leoben, Styria [10]. Both commercially available RV vaccines have a similar efficacy and safety profile [1,13] and have been found to be cost-effective depending on different perspectives and modeling assumptions in some European and developing countries [13,14,15,16,17] with a reduction of all-cause diarrhea-related hospitalizations among children
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