Rotavirus Vaccine Coverage Research Articles

Factors Associated With Rotavirus Vaccine Coverage.

Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014-2016. We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models. We enrolled 10 603 children. In 2015, ≥1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age ≥15 weeks versus 4% for RVV (P ≤ .001). Recent birth years (2013-2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43-7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24-0.41), older age at DTaP initiation (OR 0.85; 95% CI 0.80-0.91), income between $50 000 and $100 000 (OR = 0.56; 95% CI 0.40-0.78), and higher maternal education (OR = 0.52; 95% CI 0.36-0.74) were associated with lower odds. Once RVV was initiated, recent birth years (2013-2016; OR = 1.57 [95% CI 1.32-1.88]) and higher maternal education (OR = 1.31; 95% CI 1.07-1.60) were associated with higher odds of RVV completion, whereas preterm birth (OR = 0.76; 95% CI 0.62-0.94), African American race (OR = 0.82; 95% CI 0.70-0.97) and public or no insurance (OR = 0.75; 95% CI 0.60-0.93) were associated with lower odds. Regional differences existed. RVV coverage remains lower than that for the DTaP vaccine. Timely DTaP administration may help improve RVV coverage.

Perinatal Risk Factors Associated With Gastroenteritis Hospitalizations in Aboriginal and Non-Aboriginal Children in Western Australia (2000-2012): A Record Linkage Cohort Study.

Gastroenteritis is a leading cause of childhood morbidity worldwide. We aimed to assess the maternal and infant characteristics and population attributable fractions associated with childhood gastroenteritis-related hospitalizations. We conducted a whole-of-population retrospective birth cohort study of 367,476 children live-born in Western Australia 2000-2012. We identified hospital admissions up to <15 years of age pertaining to these children, with a principal diagnosis code for infectious gastroenteritis. Cox regression was used to obtain the adjusted hazard ratios with 95% confidence intervals and the population attributable fractions associated with each risk factor in Aboriginal and non-Aboriginal children for their first gastroenteritis-related hospital admission. There were a total of 15,888 gastroenteritis-related hospital admissions (25.7% occurring among non-Aboriginal children). The overall gastroenteritis hospitalization rate for children <15 years of age was 4.6/1000 child-years for non-Aboriginal children and 21.5/1000 child-years for Aboriginal children. Male gender, <20 years of maternal age, preterm birth, low birth weight, residence in remote regions of Western Australia and birth in the pre-rotavirus vaccine era were significant independent risk factors for gastroenteritis hospitalization in both Aboriginal and non-Aboriginal children. Additionally, birth by caesarean section and low socioeconomic status were identified as being associated with gastroenteritis hospitalization in non-Aboriginal children. Population attributable fractions suggest that 39% of all gastroenteritis hospitalizations in non-Aboriginal children (38% in Aboriginal children) could be averted if all children receive the rotavirus vaccine. Given the beneficial effect of infant rotavirus vaccination in preventing all-cause gastroenteritis hospitalization, efforts should be taken to optimize rotavirus vaccine coverage in those at highest risk.

Introduction of rotavirus vaccination in a Swedish region: assessing parental decision-making, obtained vaccination coverage and resulting hospital admissions.

This study evaluated the introduction of rotavirus vaccination in Jönköping County, Sweden, starting in 2014. This project explored the parental factors that influenced the decision to vaccinate and studied the obtained vaccination coverage and its potential influence on hospital admissions due to acute gastroenteritis. This was a descriptive, cross-sectional study based on a study-specific questionnaire (n=356) and regional statistical data on vaccination coverage and hospital admissions in Jönköping County, Sweden. Central aspects when deciding on vaccination were vaccine efficacy and safety, that the vaccine was offered to all children, and recommended by healthcare professionals. One in five parents expressed uncertainty about whether they had sufficient information to make a decision. However, the rotavirus vaccination coverage was elevated from 76.1% to 81.0% and the hospital admissions due to acute gastroenteritis decreased by approximately 60%. The results highlight the necessity for Child Health Services to have solid knowledge regarding vaccinations, to understand individual parental issues and to support uncertain parents. The high vaccination coverage achieved is an indication of the trust in healthcare professionals and is considered to be a major contributing factor to the substantial reduction of hospital admissions due to acute gastroenteritis.

Epidemiology of rotavirus gastroenteritis and need of high rotavirus vaccine coverage with early completion of vaccination schedule for protection against rotavirus diarrhea in India: A narrative review

Rotavirus is a leading cause of severe pediatric diarrhea worldwide, with about 199,000 childhood deaths in 2015, of which 90% in low-income countries. India alone accounts for 22% of the global rotavirus gastroenteritis (RVGE)-related deaths among children below 5 years of age. The World Health Organization recommends introducing rotavirus vaccines (RVVs) as a priority in developing countries where high rates of RVGE are observed. To have the desired impact, RVV should be administered the earliest possible, ideally before the first episode of RVGE. In India, four RVVs are available for use in infants ≥6 weeks of age: the single-strain, two-dose, live-attenuated human RVV Rotarix; the five-strain, three-dose, human-bovine reassortant RVV Rotateq; the single-strain, three-dose, naturally reassortant human-bovine RVV Rotavac; and the five-strain, three-dose, human-bovine RVV Rotasiil; all of them proven to be efficacious and well tolerated. Whereas Rotarix and Rotateq have shown high efficacy/effectiveness against severe RVGE in developed countries (≥90%), they have been observed to be lower in developing countries (~40%-70%). Rotavac and Rotasiil have shown similar efficacy in low-income settings, but further studies are needed to assess their effectiveness. Rotarix and Rotateq have not shown increased intussusception (IS) risk in clinical trials. Postmarketing surveillances were able to show a very tiny increased risk of IS after the first dose of vaccine, but the extensive benefits of rotavirus vaccination far outweigh the low-level risk of IS. In India, where the disease is a major problem and occurs in very early months of life, RVVs should have high coverage and vaccination schedule should be completed as early as possible (≥6 weeks of age) to maximize the vaccine impact.

Effect of Rotavirus Vaccination on Acute Diarrheal Hospitalizations Among Low and Very Low Birth Weight US Infants, 2001-2015.

The effectiveness of rotavirus vaccines in low and very low birth weight infants (LBW and VLBW) weighing <2500 and <1500 g at birth, respectively, a high-risk population for severe rotavirus gastroenteritis, has not been well examined. We analyzed inpatient commercial claims data for US children <5 years of age from July 2001 to June 2015. Claims for acute gastroenteritis (AGE) and rotavirus-coded hospitalizations and LBW, VLBW and normal birth weight (NBW) infants were identified. Receipt of rotavirus vaccine was defined using Current Procedural Terminology. Rate reductions were calculated using prevaccine (2001-2006) and postvaccine (2007-2015) annual AGE and rotavirus hospitalization rates. As of December 2014, rotavirus vaccine coverage was 87%, 82% and 64%, for NBW, LBW and VLBW infants, respectively. For 2014-2015, among NBW, LBW and VLBW children <5 years of age, AGE hospitalization rate reductions relative to the prevaccine introduction period were 60% [95% confidence interval (CI): 58%-61%], 64% (95% CI: 57%-70%) and 55% (95% CI: 39%-67%), respectively. Rotavirus hospitalization rate reductions were 91% (95% CI: 90%-92%), 98% (95% CI: 93%-100%) and 93% (95% CI: 70%-98%). Rotavirus vaccines resulted in a 62% (95% CI: 51%-71%), 72% (95% CI: 44%-86%) and 71% (95% CI: 7%-91%) reduction in AGE hospitalization rates comparing vaccinated versus unvaccinated NBW, LBW and VLBW children 3-23 months of age, respectively. Rotavirus vaccines have substantially reduced AGE hospitalizations and are highly effective in LBW and VLBW infants, similar to NBW infants. Efforts to improve vaccination coverage, particularly in LBW and VLBW infants, should continue.

Effects of geographic and economic heterogeneity on the burden of rotavirus diarrhea and the impact and cost-effectiveness of vaccination in Pakistan

Globally, rotavirus is a leading cause of childhood diarrhea and related mortality. Although rotavirus vaccination has been introduced in many countries worldwide, there are numerous low- to middle-income countries that have not yet introduced. Pakistan is one of the countries with the highest number of rotavirus deaths in children under five years. Although rotavirus infection is almost universal among children, mortality is often a result of poor nutrition and lack of access to health care and other aspects of poverty. We assess the impact and cost-effectiveness of introducing childhood rotavirus vaccination in Pakistan. We use household data from the 2012–2013 Demographic Health survey in Pakistan to estimate heterogeneity in rotavirus mortality risk, vaccination benefits, and cost-effectiveness across geographic and economic groups. We estimate two-dose rotavirus vaccination coverage that would be distributed through a routine vaccination program. In addition, we estimate rotavirus mortality (burden), and other measures of vaccine cost-effectiveness and impact by subpopulations of children aggregated by region and economic status. Results indicate that the highest estimated regional rotavirus burden is in Sindh (3.3 rotavirus deaths/1000 births) and Balochistan (3.1 rotavirus deaths/1000 births), which also have the lowest estimated vaccination coverage, particularly for children living in the poorest households. In Pakistan, introduction could prevent 3061 deaths per year with current routine immunization patterns at an estimated $279/DALY averted. Increases in coverage to match the region with highest coverage (Islamabad) could prevent an additional 1648 deaths per year. Vaccination of children in the highest risk regions could result in a fourfold mortality reduction as compared to low risk children, and children in the poorest households have a three to four times greater mortality reduction benefit than the richest. Based on the analysis presented here, the benefits and cost-effectiveness of rotavirus vaccination can be maximized by reaching economically and geographically vulnerable children.

Effects of geographic and economic heterogeneity on rotavirus diarrhea burden and vaccination impact and cost-effectiveness in the Lao People’s Democratic Republic

Rotavirus enteritis is responsible for nearly 200,000 child deaths worldwide in 2015. Globally, many low- and middle-income countries have introduced rotavirus vaccine, resulting in documented reductions in hospitalizations and child mortality. We examined the potential impact and cost-effectiveness of introducing rotavirus vaccination in Lao People’s Democratic Republic using an Excel-based spreadsheet model. We estimated mortality risk factors, patterns of care seeking, and vaccination access to predict outcomes for regional, provincial, and socioeconomic subpopulations for one birth cohort through their first five years of life and life course in Disability-Adjusted Life Years estimates. Socioeconomic status was defined by categorizing households into regional wealth quintiles based on a national asset index. We modeled a two-dose ROTARIX vaccine under current Gavi pricing and efficacy estimates from Bangladesh and Vietnam. DPT1 and DPT2 coverages were used to estimate rotavirus vaccination coverage. Probabilistic sensitivity analysis was used to assess the impact of uncertainty on model parameters on predicted incremental cost-effectiveness ratios (ICERs), including scenarios of increases in vaccination coverage. Rotavirus vaccination would prevent 143 child deaths/year, or 28% of annual rotavirus burden. The estimated national level ICER for rotavirus vaccination was $140/DALY, with regional socioeconomic subpopulation estimates ranging from $72/DALY for the poorest in the Central region to $353/DALY for the richest in the North region, indicating high cost-effectiveness. Within regions, ICERs are most favorable for children in the poorer and poorest quintiles. However, the full benefits of rotavirus vaccination will only be realized by reducing disparities in vaccination coverage, access to treatment, and environmental health. Improving vaccination coverage to equitable levels alone would prevent 87 additional child deaths per year.

Monitoring vaccination coverage by electronic immunization registry in medium-sized city, Brazil

Introduction Electronic immunization registries (EIR) enable real-time monitoring of vaccination data and they are important for surveillance, disease control and relevant databases for research. While EIR has been used for decades in high-income countries, there are few experiences in middle-income countries. In Brazil, the EIR of the National Immunization Program has been implemented only from 2014. However, there were already some local initiatives, and the EIR of the city of Araraquara (SP) (Juarez System) is the oldest one. The Juarez System has individual vaccination data since 1986 and it is linked with the entire municipal healthcare network, which is responsible for feeding the system. It is an important tool to ensure high vaccination coverage in this city by identifying and calling children that are missing vaccination. Analyzes of inconsistencies are performed routinely in order to obtain high accuracy data. In addition, this EIR integrates in a single environment data of vaccination, notification of diseases, healthcare, laboratory and pharmaceutical assistance. The objective of this study was to analyze trend of vaccination coverage in Araraquara (SP), Brazil, using data from Juarez System, in 2000–2016 when the Brazilian Immunization Program introduced several vaccines in the basic schedule. Methods This is an ecological time series study. We analyzed data from 51,241 individuals born in 2000–2016 registered in the Juarez System. Araraquara is a medium-sized Brazilian city, with a population of 230,000 inhabitants and Human Development Index of 0.815. Immunopreventable diseases were controlled since decade of 1990 in this city. We evaluated vaccination coverage (number of vaccinated children/number of children registered in the system) per year of birth. We analyzed coverage of vaccination until 12 months for Bacillus Calmette–Guerin (BCG), hepatitis B, poliomyelitis, tetanus, diphtheria and pertussis (TDP), rotavirus, pneumococcus, meningococcus, yellow fever, hepatitis A and measles, mumps, and rubella (MMR) vaccines. We used the Prais–Winsten method for linear regression, with a significance level of 5%. Ethical clearance was provided by Ethics in Research Committee. Results Vaccination coverages were quite high. Almost all of them were above 95% in 2016. MMR, yellow fever and hepatitis A vaccination coverages were 92.3%, 93.5% and 89.1%, respectively, for 2015's birth cohort. BCG, TDP, poliomyelitis and hepatitis B vaccination coverages have increased about 0.5% per year. Rotavirus vaccination coverage has increased 1.2% (95% CI: 0.6–1.9%) per year since 2007. Yellow fever vaccination coverage has increased 2.5% (1.3–3.7%) per year since 2009. Pneumococcus, meningococcus and hepatitis A vaccination coverage remained stationary (P > 0.05). Data quality indicators showed that about 99.5% live births of Araraquara are registered in Juarez System and there is a low proportion of duplicate records (0.45%). Conclusions This study showed the potential of an EIR in the assessment of vaccine coverage in a medium-sized city of middle-income country. The improvement of the vaccination schedule over 17 years with the introduction of 10 new vaccines did not affect vaccination coverage trend and they are still increasing. Then, the control of immunopreventable diseases in Araraquara (since the 1990s) could be attributed not only to the good organization of the immunization program, but also to the good performance of the EIR, which ensures the adequate monitoring of vaccine coverage and calls for vaccination. In this way, the confidence and, consequently, the population's adherence to the immunization program are strengthened. Certainly, the Juarez System had its role in assisting the articulation of vaccination and surveillance activities, and offers a suitable database for research.

Evaluation of the Impact of a Rotavirus Vaccine Program on Pediatric Acute Gastroenteritis Hospitalizations: Estimating the Overall Effect Attributable to the Program as a Whole and as a Per-Unit Change in Rotavirus Vaccine Coverage.

Estimation of the overall effect of a vaccine program is essential, but the effect is typically estimated for a whole program. We estimated the overall effect of the Quebec rotavirus vaccine program, launched in November 2011, and the effect for each 10% increase in rotavirus vaccine coverage on pediatric hospitalizations for all-cause acute gastroenteritis. We implemented negative binomial regressions adjusted for seasonality, long-term trends, and infection dynamics, to estimate the effect of the vaccine program as: 1) a dichotomous variable, representing program presence/absence, and linear term to account for changes in trend in the period after the program began; and 2) a continuous variable, representing rotavirus vaccine coverage. Using exposure 1, the vaccine program was associated with a 51.2% (95% confidence interval (CI): 28.5, 66.7) relative decline in adjusted weekly hospitalization rates for all-cause acute gastroenteritis as of December 28, 2014. Using exposure 2, a 10% increase in rotavirus ≥1-dose coverage was associated with a 7.1% (95% CI: 3.5, 10.5) relative decline in adjusted weekly rates, with maximum coverage of 87.0% associated with a 47.2% (95% CI: 26.9, 61.9) relative decline. Estimation of the overall effect attributable to a change in vaccine coverage might be a useful addition to standard measurement of the overall effect.

Impact of rotavirus vaccine on diarrheal hospitalization and outpatient consultations in the Philippines: First evidence from a middle-income Asian country

BackgroundMonovalent rotavirus (RV) vaccine was introduced in the Philippines in a phased manner beginning in 2012. To assess the impact of RV vaccine, we conducted a retrospective review of diarrheal admissions in two hospitals. MethodsRecords of physician-diagnosed diarrheal admissions were reviewed in D.O. Plaza Hospital (DOPH) from 2009 to 2016 in Agusan del Sur where RV vaccine was introduced in the immunization program; and in Cotabato Regional Medical Center (CRMC) from 2011 to 2016 in a region where the vaccine was not introduced. Reports from consultations in public health clinics in Agusan Del Sur and RV vaccine coverage were obtained. ResultsAll-cause diarrheal admissions among children <5 years old in DOPH declined from 2013 to 2016 following RV vaccine introduction in 2012. Using the 2009–2011 mean number of hospitalizations as baseline (X‾ = 1,141), the reductions were 28% (n = 821), 56% (n = 507), 63% (n = 417) and 59% (n = 466) in 2013, 2014, 2015 and 2016, respectively. In comparison, no substantial declines in diarrheal hospitalizations were seen in CRMC from 2011 to 2016. A declining trend was also seen in outpatient consultations in Agusan del Sur following RV vaccine introduction with declines of 27% (n = 2,333), 33% (n = 2,143), 45% (n = 1,764) and 67% (n = 1,059) in 2013, 2014, 2015 and 2016. From September 2012 to December 2016, the 1 and 2-dose RV vaccine coverage gradually increased from 5% and 4% in 2012 to 92% and 88% in 2015, but decreased in 2016 to 53% and 52%, respectively. DiscussionRV vaccine introduction was associated with a substantial decline in diarrheal hospitalizations and outpatient consultations for diarrhea in Agusan del Sur, Philippines.

Lack of impact of rotavirus vaccines on seizure-related hospitalizations in children under 5 years old in Spain

ABSTRACTIntroduction: Up to date the impact of rotavirus (RV) vaccines on seizures has been poorly evaluated, with some studies but not all, showing different degrees of protection.Objectives: To assess the impact of RV vaccines on convulsions-related hospitalizations among children under 5 years of age residing in the Region of Valencia, Spain.Methods: A population-based, ecological study using the hospital discharge record (MBDS), the population-based administrative database (SIP) and the vaccine register (SIV), among Valencia Region's children <5 years old, during 2003 – 2015. Impact of vaccination on seizures-related hospitalization rates (780.3* ICD-9-MC code) was estimated by a multivariate Bayesian mixed Poisson regression model.Results: Since RV vaccines licensure in 2007, its coverage rate increased up to around 42%. When the impact of vaccination against seizures was controlled for potential confounders in the multivariate analysis, there was a non-statistically significant protective effect.Conclusions: We could not find any impact of RV vaccine coverage on seizure-related hospitalizations in children <5 years.

Annual changes in rotavirus hospitalization rates before and after rotavirus vaccine implementation in the United States

BackgroundHospitalizations for rotavirus and acute gastroenteritis (AGE) have declined in the US with rotavirus vaccination, though biennial peaks in incidence in children aged less than 5 years occur. This pattern may be explained by lower rotavirus vaccination coverage in US children (59% to 73% from 2010–2015), resulting in accumulation of susceptible children over two successive birth cohorts.MethodsRetrospective cohort analysis of claims data of commercially insured US children aged <5 years. Age-stratified hospitalization rates for rotavirus and for AGE from the 2002–2015 rotavirus seasons were examined. Median age and rotavirus vaccination coverage for biennial rotavirus seasons during pre-vaccine (2002–2005), early post-vaccine (2008–2011) and late post-vaccine (2012–2015) years.ResultsAge-stratified hospitalization rates decreased from pre-vaccine to early post-vaccine and then to late post-vaccine years. The clearest biennial pattern in hospitalization rates is the early post-vaccine period, with higher rates in 2009 and 2011 than in 2008 and 2010. The pattern diminishes in the late post-vaccine period. For rotavirus hospitalizations, the median age and the difference in age between biennial seasons was highest during the early post-vaccine period; these differences were not observed for AGE hospitalizations. There was no significant difference in vaccination coverage between biennial seasons.ConclusionsThese observations provide conflicting evidence that incomplete vaccine coverage drove the biennial pattern in rotavirus hospitalizations that has emerged with rotavirus vaccination in the US. As this pattern is diminishing with higher vaccine coverage in recent years, further increases in vaccine coverage may reach a threshold that eliminates peak seasons in hospitalizations.

Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada.

BackgroundIn August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix™ vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario.MethodsWe assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program’s introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression.ResultsA total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61–2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24–1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05–2.04), and having no siblings (aOR = 1.62; 95%CI,1.30–2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39–2.10) and third year (aOR = 2.02; 95% CI 1.56–2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88–0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91–0.97, per 100 patients rostered). Additional associations were identified for series completion.ConclusionsFamily physician delivery achieved moderately high coverage in the program’s first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports.

Indirect Rotavirus Vaccine Effectiveness for the Prevention of Rotavirus Hospitalization: A Systematic Review and Meta-Analysis.

.Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects remains unknown. We systematically reviewed the literature and quantified indirect rotavirus vaccine effectiveness (VE) for preventing rotavirus hospitalization in children aged less than 5 years. From 148 identified abstracts, 14 studies met our eligibility criteria. In our main analysis using a random-effects model, indirect rotavirus VE was 48% (95% confidence interval [CI]: 39–55%). In a subgroup analysis by country income level, indirect VE was greater in high-income countries (52%; 95% CI: 43–60%) than in low- and middle-income countries (LMICs) (25%; 95% CI: 5–41%). In a sensitivity analysis using a quality-effects model, the indirect VE in LMICs was not statistically significant (25%; 95% CI: 0–44%). Our findings highlight the importance of increasing rotavirus vaccine coverage, particularly in LMICs where evidence for indirect VE is limited and rotavirus burden is high.

Immunization coverage of oral live attenuated rotavirus vaccines and its influencing factors among children under 5 years old in Jinshan District of Shanghai

Objective To investigate the immunization coverage of oral live attenuated rotavirus vaccines and its influencing factors among children under 5 years old in Jinshan District of Shanghai in order to provide references for optimizing vaccination management in this area. Methods A cross-sectional study was conducted in 6 community vaccination clinics randomly selected from 12 vaccination clinics in Jinshan District. In each selected clinic, 145 children under 5 years old were continuously recruited. Information on immunization status, demographics of children, family socioeconomic status and parents′ knowledge of vaccination were collected through questionnaire interview. Logistic regression was used to analyze factors influencing immunization status by using SPSS22.0. Results Among the 863 participating children, the immunization coverage rate of oral live attenuated rotavirus vaccines was 61.07%. Multivariate analysis revealed that children having an urban registration status (OR=2.21), better family income (OR=1.47) and parents with high recognition of rotavirus diarrhea (OR=8.56) and stronger intention to following doctor′s suggestions (OR=1.96) were more likely to accept oral live attenuated rotavirus vaccines, while those from families with a medical professional were less likely to be vaccinated (OR=0.57). Conclusion The immunization coverage rate of oral live attenuated rotavirus vaccines among children in Jinshan District were influenced by various factors such as children′s household registration status, household income, parents′ knowledge regarding vaccination and doctors′suggestions. Health education on immunization should be strengthened and tailor-made to improve the coverage of oral rotavirus vaccination. Key words: Children; Oral live attenuated rotavirus vaccine; Immunization coverage rate; Influencing factor

Rotavirus gastroenteritis hospitalization rates and correlation with rotavirus vaccination coverage in Sicily.

Background and aim of the works:Rotavirus (RV) is considered the main cause of gastroenteritis in children from 0 to 59 months and vaccination represents the only strategy to prevent hospitalizations due to RV. In 2013 Sicilian Region introduced universal RV vaccination for all newborns. The present study aims to estimate the reduction rotavirus gastroenteritis (RVGE) hospitalization rates among Sicilian children and their relations with vaccination coverages of the nine Sicilian Local Health Units (LHUs). Methods: Were analyzed hospital discharge records including a diagnosis of RVGE occurred from January 2009 to December 2017 in hospitalized children aged 0 to 59 months, residents in Sicily. Were reported data on complete RV vaccination cycles among Sicilian children under 12 months of age (vaccination coverage). Results: A 49.2% overall reduction of RVGE hospitalization rates was reported after RV vaccination introduction. A more considerable reduction of hospitalization rates was observed among children aged 0 to 11 months (-61.4%), followed by children aged 12-23 months (-51.2%) and 24-35 months (-48.8%). In all the nine Sicilian Local Health Units (LHUs), a reduction of RVGE hospitalization rates was observed after RV vaccine implementation. Conclusions: This study demonstrated the significant impact of RV vaccination on RVGE hospitalization rates in Sicily, especially among children aged 0 to 23 months. The reduction in RVGE hospitalization rates observed in the Sicilian LHUs after universal vaccination program implementation, were generally higher or consistent with average vaccination coverage reported from 2013 to 2017. (www.actabiomedica.it)

Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion.

BackgroundDuring each winter the hospital quality of care (QoC) in pediatric wards decreases due to a surge in pediatric infectious diseases leading to overcrowded units. Bed occupancy rates often surpass the good hospital bed management threshold of 85%, which can result in poor conditions in the workplace. This study explores how QoC-scores could be improved by investing in additional beds and/or better vaccination programs against vaccine-preventable infectious diseases.MethodsThe Cobb–Douglas model was selected to define the improvement in QoC (%) as a function of two strategies (rotavirus vaccination coverage [%] and addition of extra hospital beds [% of existing beds]), allowing improvement-isocurves to be produced. Subsequently, budget minimization was applied to determine the combination of the two strategies needed to reach a given QoC improvement at the lowest cost. Data from Jessa Hospital (Hasselt, Belgium) were chosen as an example. The annual population in the catchment area to be vaccinated was 7000 children; the winter period was 90 days with 34 pediatric beds available. Rotavirus vaccination cost per course was €118.26 and the daily cost of a pediatric bed was €436.53. The target QoC increase was fixed at 50%. The model was first built with baseline parameter values.ResultsThe model predicted that a combination of 64% vaccine coverage and 39% extra hospital beds (≈ 13 extra beds) in winter would improve QoC-scores by 50% for the minimum budget allocation.ConclusionThe model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons.

Impact of rotavirus vaccine on rotavirus diarrhoea in countries of East and Southern Africa

BackgroundEstablished in 2006 with four countries conducting hospital-based rotavirus surveillance, the African rotavirus surveillance network has expanded over subsequent years. By 2015, 14 countries in the World Health Organization (WHO) East and Southern Africa sub-region (Eritrea, Ethiopia, Kenya, Lesotho, Madagascar, Mauritius, Namibia, Rwanda, Seychelles, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) were participating in the rotavirus surveillance network coordinated by WHO. We monitored the proportion of rotavirus diarrhoea among children under five years of age who were hospitalized for diarrhoea in the sentinel hospitals from 2010 to 2015 among countries that introduced rotavirus vaccine during or before 2013 (Rwanda, Tanzania, Zambia and Ethiopia) and compared with the other countries in the network. MethodsChildren under the age of five years hospitalized due to acute diarrhoea were enrolled into the sentinel surveillance system and had stool samples collected and tested for rotavirus antigens by enzyme immunoassay. We described trends in rotavirus positivity among tested stool samples before and after rotavirus vaccine introduction. ResultsIn countries that introduced rotavirus vaccine by 2013 (Rwanda, Tanzania, Zambia and Ethiopia), average rotavirus vaccine coverage from 2010 to 2015 improved from 0% in 2010 and 2011, 13% in 2012, 46% in 2013, 83% in 2014 to 90% in 2015. Annual average rotavirus positivity from 2010 to 2015 was 35%, 33%, 38%, 28%, 27%, and 19%, respectively. In countries that introduced rotavirus vaccine after 2013 or had not introduced by 2015, average rotavirus vaccine coverage was 0% in 2010–2013, 13% in 2014 and 51% in 2015. In these countries, rotavirus positivity was 44% in 2010, 32% in 2011, 33% in 2012, 41% in 2013, 40% in 2014 and 25% in 2015. ConclusionCountries that introduced rotavirus vaccine by 2013 had a lower proportion of rotavirus positive hospitalizations in 2013–2015 as compared to those that had not introduced rotavirus vaccine by 2013. The decrease in rotavirus positivity was inversely related to increase in rotavirus vaccine coverage showing impact of rotavirus vaccines.

Implementation of Rotavirus Surveillance and Vaccine Introduction - World Health Organization African Region, 2007-2016.

Rotavirus is a leading cause of severe pediatric diarrhea globally, estimated to have caused 120,000 deaths among children aged <5 years in sub-Saharan Africa in 2013 (1). In 2009, the World Health Organization (WHO) recommended rotavirus vaccination for all infants worldwide (2). Two rotavirus vaccines are currently licensed globally: the monovalent Rotarix vaccine (RV1, GlaxoSmithKline; 2-dose series) and the pentavalent RotaTeq vaccine (RV5, Merck; 3-dose series). This report describes progress of rotavirus vaccine introduction (3), coverage (using estimates from WHO and the United Nations Children's Fund [UNICEF]) (4), and impact on pediatric diarrhea hospitalizations in the WHO African Region. By December 2016, 31 (66%) of 47 countries in the WHO African Region had introduced rotavirus vaccine, including 26 that introduced RV1 and five that introduced RV5. Among these countries, rotavirus vaccination coverage (completed series) was 77%, according to WHO/UNICEF population-weighted estimates. In 12 countries with surveillance data available before and after vaccine introduction, the proportion of pediatric diarrhea hospitalizations that were rotavirus-positive declined 33%, from 39% preintroduction to 26% following rotavirus vaccine introduction. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.

Italian Physicians' Opinions on Rotavirus Vaccine Implementation.

Rotavirus (RV) infection is the main cause of severe acute gastroenteritis (GE) in the pediatric population and has a major impact in both developing and industrialized countries. The reduction of severe RVGE cases, followed by death or hospitalization, is considered the main benefit of RV vaccination, even though its implementation often faces obstacles. In Italy, the recently approved National Immunization Plan aims to overcome the differences among regions, offering a universal free RV vaccination. The aim of the study was to evaluate the opinions on benefit and acceptability of RV vaccination related to the perception of the burden of RV disease. Data were collected from 108 physicians in 2015 by a questionnaire consisting of 12 questions; some answers were compared with those obtained with a similar tool in 2011. The majority of respondents (76.2%) was convinced of the benefit of the vaccine and 57.4% recommended it routinely, but more than half indicated a <25% adherence to RV vaccination among their patients. As the main reasons of vaccine refusal, skepticism about the vaccine (60.4%) and its cost (34.1%) were indicated. Our data confirm that more information and counselling are needed to increase RV vaccine coverage.