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Imaz-Iglesia I, Carmona M, García-Carpintero EE, Pedrosa-Pérez L, Martínez-Portillo A, Alcalde-Cabero E, Linertová R, García-Pérez L. Updating and Refining of Economic Evaluation of Rotavirus Vaccination in Spain: A Cost-Utility and Budget Impact Analysis. Viruses 2024; 16:1194. [PMID: 39205168 PMCID: PMC11360725 DOI: 10.3390/v16081194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Two vaccines against rotavirus diseases, Rotarix® and RotaTeq®, are being marketed in Spain; but rotavirus is not presently among the diseases covered by universal vaccination in Spain. The aim of this study was to assess the efficiency of extending Spain's current targeted rotavirus vaccination strategy including only preterm babies, to a policy of universal vaccination. A de novo cohort-based Markov model was built to evaluate the efficiency of three compared rotavirus vaccination strategies in Spain: targeted, universal, and no vaccination. Using Rotarix® or RotaTeq®, we compared the cost-utility of these strategies from both a societal perspective and Spanish National Health System (SNHS) perspective. The model represents the most important clinical events conceivably linked to rotavirus infection. Efficacy, effectiveness, safety, costs, and utilities were identified by systematic reviews. Incremental cost-utility ratio (ICUR) is EUR 23,638/QALY (Quality-Adjusted Life Year) for targeted vaccination with Rotarix® compared with no vaccination. The ICUR for the rest of the strategies evaluated are above EUR 30,000/QALY. The sensitivity analysis shows price as the only parameter that could make the universal vaccination strategy efficient. Considering a threshold of EUR 25,000/QALY, only targeted vaccination with Rotarix® would be efficient from societal perspective. Price drops of 36.9% for Rotarix® and 44.6% for RotaTeq® would make universal vaccination efficient.
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Affiliation(s)
- Iñaki Imaz-Iglesia
- National Health School, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain; (I.I.-I.)
- Chronicity, Primary Healthcare and Health Promotion Research Network (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), 28029 Madrid, Spain; (E.E.G.-C.); (R.L.); (L.G.-P.)
| | - Montserrat Carmona
- Chronicity, Primary Healthcare and Health Promotion Research Network (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), 28029 Madrid, Spain; (E.E.G.-C.); (R.L.); (L.G.-P.)
- Health Technology Assessment Agency, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain;
| | - Esther E. García-Carpintero
- Chronicity, Primary Healthcare and Health Promotion Research Network (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), 28029 Madrid, Spain; (E.E.G.-C.); (R.L.); (L.G.-P.)
- Health Technology Assessment Agency, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain;
| | - Lucía Pedrosa-Pérez
- Health Technology Assessment Agency, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain;
| | - Alejandro Martínez-Portillo
- National Health School, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain; (I.I.-I.)
| | - Enrique Alcalde-Cabero
- National Centre of Epidemiology, Carlos III Institute of Health (Instituto de Salud Carlos III), 28029 Madrid, Spain;
- Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), 28029 Madrid, Spain
| | - Renata Linertová
- Chronicity, Primary Healthcare and Health Promotion Research Network (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), 28029 Madrid, Spain; (E.E.G.-C.); (R.L.); (L.G.-P.)
- Assessment Service of the Canary Islands Health Service (Servicio de Evaluación del Servicio Canario de Salud/SESCS), 38109 Tenerife, Spain
| | - Lidia García-Pérez
- Chronicity, Primary Healthcare and Health Promotion Research Network (Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud/RICAPPS), 28029 Madrid, Spain; (E.E.G.-C.); (R.L.); (L.G.-P.)
- Assessment Service of the Canary Islands Health Service (Servicio de Evaluación del Servicio Canario de Salud/SESCS), 38109 Tenerife, Spain
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Bencina G, Costantino C, Mameli C, Sabale U, Murtagh J, Newman R, Ahern A, Bhaila R, Sanchez AO, Martinon-Torres F, Carias C. Real-world impact of rotavirus vaccination in European healthcare settings: a systematic literature review. Expert Rev Vaccines 2022; 21:1121-1136. [PMID: 35708263 DOI: 10.1080/14760584.2022.2075851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rotavirus is one of the most common pathogens causing diarrhea in children <5 years and has a major impact on childhood morbidity and mortality. Since the implementation of rotavirus vaccines into childhood immunization programs across Europe, there has been a reduction in rotavirus burden, including hospitalizations, outpatient cases, costs, and deaths. AREAS COVERED A systematic literature review identified publications describing the clinical and economic impact of rotavirus vaccinations across Europe, from their introduction in 2006 to the end of 2020. A total of 3,137 articles were identified, of which 46 were included in the review. Included articles reported the impact of rotavirus vaccination on disease in any age group. EXPERT OPINION Rotavirus vaccination has resulted in substantial reductions in hospitalizations and rotavirus-associated costs across Europe, particularly in children <5 years. There is some evidence of herd protection afforded to older age groups where vaccine uptake is high among infants, highlighting the potential for vaccination to confer a greater societal benefit as programs become more established. Increasing vaccination coverage and continuing investment in widespread rotavirus vaccination programs across countries will likely increase the substantial public health benefits associated with vaccination and further reduce the clinical and economic burden of disease.
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Affiliation(s)
- Goran Bencina
- Center for Observational and Real-World Evidence (CORE), MSD, Madrid, Spain
| | - Claudio Costantino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialties "G. D'Alessandro," University of Palermo, Palermo, Italy.,Department of Science for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Ugne Sabale
- Center for Observational and Real-World Evidence (CORE), MSD, Stockholm, Sweden
| | - Janice Murtagh
- Medical Affairs Vaccines, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | - Alejandro Orrico Sanchez
- Department of Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
| | - Federico Martinon-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain.,Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Cristina Carias
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
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Ruiz-Contreras J, Alfayate-Miguelez S, Carazo-Gallego B, Onís E, Díaz-Munilla L, Mendizabal M, Méndez Hernández M, Ferrer-Lorente B, Unsaín-Mancisidor M, Ramos-Amador JT, Croche-Santander B, Centeno Malfaz F, Rodríguez-Suárez J, Cotarelo M, San-Martín M, Arístegui J. Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013-2018. BMC Infect Dis 2021; 21:1138. [PMID: 34742235 PMCID: PMC8572461 DOI: 10.1186/s12879-021-06841-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rotavirus (RV) vaccines are available in Spain since 2006 but are not included in the National Immunization Program. RV vaccination has reached an intermediate vaccination coverage rate (VCR) but with substantial differences between provinces. The aim of this study was to assess the ratio of RV gastroenteritis (RVGE) admissions to all-cause hospitalizations in children under 5 years of age in areas with different VCR. METHODS Observational, multicenter, cross-sectional, medical record-based study. All children admitted to the study hospitals with a RVGE confirmed diagnosis during a 5-year period were selected. The annual ratio of RVGE to the total number of all-cause hospitalizations in children < 5 years of age were calculated. The proportion of RVGE hospitalizations were compared in areas with low (< 30%), intermediate (31-59%) and high (> 60%) VCR. RESULTS From June 2013 to May 2018, data from 1731 RVGE hospitalizations (16.47% of which were nosocomial) were collected from the 12 study hospitals. RVGE hospital admissions accounted for 2.82% (95 CI 2.72-3.00) and 43.84% (95% CI 40.53-47.21) of all-cause and Acute Gastroenteritis (AGE) hospitalizations in children under 5 years of age, respectively. The likelihood of hospitalization due to RVGE was 56% (IC95%, 51-61%) and 27% (IC95%, 18-35%) lower in areas with high and intermediate VCR, respectively, compared to the low VCR areas. CONCLUSIONS RVGE hospitalization ratios are highly dependent on the RV VCR. Increasing VCR in areas with intermediate and low coverage rates would significantly reduce the severe burden of RVGE that requires hospital management in Spain. Clinical trial registration Not applicable.
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Affiliation(s)
| | - S Alfayate-Miguelez
- Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - B Carazo-Gallego
- Pediatrics, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - E Onís
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
| | - L Díaz-Munilla
- Pediatrics, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Mendizabal
- Pediatrics, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - B Ferrer-Lorente
- Pediatrics, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - J T Ramos-Amador
- Pediatrics, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - F Centeno Malfaz
- Pediatrics, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - M Cotarelo
- Medical Affairs Department, MSD Spain, C/Josefa Valcárcel, 38, 28027, Madrid, Spain
| | - M San-Martín
- Medical Affairs Department, MSD Spain, C/Josefa Valcárcel, 38, 28027, Madrid, Spain.
| | - J Arístegui
- Pediatrics, Hospital Universitario de Basurto, Bilbao, Spain
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Toczylowski K, Jackowska K, Lewandowski D, Kurylonek S, Waszkiewicz-Stojda M, Sulik A. Rotavirus gastroenteritis in children hospitalized in northeastern Poland in 2006-2020: Severity, seasonal trends, and impact of immunization. Int J Infect Dis 2021; 108:550-556. [PMID: 34089885 DOI: 10.1016/j.ijid.2021.05.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The introduction of the rotavirus vaccine in 2006 significantly reduced childhood incidence of acute gastroenteritis (AGE) worldwide. The rotavirus vaccine was included in Poland's national immunization program in 2021. Our study aimed to summarize the epidemiology of AGE in northeastern Poland prior to 2021 and to evaluate the effectiveness of voluntary, out-of-pocket rotavirus childhood vaccination on the incidence of rotavirus AGE. METHODS A review of patients aged 0-17 years with gastroenteritis hospitalized between 2006 and 2020 in northeastern Poland in the context of rotavirus vaccine coverage in the region. RESULTS Rotavirus was the most common agent of gastroenteritis in hospitalized patients. The seasonality of rotavirus gastroenteritis peaked between February and May in each year of study, except for 2020, when the COVID-19 pandemic skewed any viable comparison of seasonality. Rotavirus vaccine coverage in northeastern Poland did not exceed 25% during the study period and had no impact on hospitalization numbers. CONCLUSIONS Rotavirus was the primary causative agent of AGE in children hospitalized in northeastern Poland during the study period. Voluntary vaccinations did not affect the number of hospitalizations due to rotavirus AGE. Our data suggest that universal immunization is key to achieving a significant reduction of rotavirus-associated diarrhea.
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Affiliation(s)
- Kacper Toczylowski
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Katarzyna Jackowska
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Dawid Lewandowski
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Sandra Kurylonek
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Marlena Waszkiewicz-Stojda
- Department of Pediatric Emergency Medicine, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland.
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Kim KG, Kee HY, Park HJ, Chung JK, Kim TS, Kim MJ. The Long-Term Impact of Rotavirus Vaccines in Korea, 2008-2020; Emergence of G8P[8] Strain. Vaccines (Basel) 2021; 9:406. [PMID: 33923945 PMCID: PMC8073504 DOI: 10.3390/vaccines9040406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
This study evaluated the long-term impact of rotavirus vaccination on prevalence, seasonality, and genotype distribution in Gwangju, Korea for 13 seasons. Rotavirus was identified using ELISA and then sequenced for G and P genotypes by Reverse Transcription Polymerase Chain Reactions for diarrhoeagenic patient specimens from local hospitals between January 2008 and August2020. Of 26,902 fecal samples, 2919 samples (10.9%) were ELISA positive. The prevalence declined from 16.3% in pre-vaccine era to 5.4% in post-vaccine era. In the pre-vaccine period, G1P[8] was the most common genotype, followed by G2P[4], G3P[8], and G9P[8], etc. In the transitional period, the proportion of G2P[4] became the dominant genotype and G1P[8] was still commonly identified. In contrast, the novel genotype G8P[8] was predominant in the post-vaccine period. Meanwhile, G2P[4] and G8P[8] were major genotypes in both Rotarix and RotaTeq groups. The substantial decline of G1P[8] prevalence, reemergence of G1P[8], G3P[8], and G2P[4] rotavirus strains, and surge of the rare G8P[8] after vaccine introduction were interesting points to note. The continuous surveillance on the genotypes of RV will be needed to understand rotavirus epidemiology and their evolutionary patterns, as caution is required when interpreting temporal changes in RV genotype dynamic.
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Affiliation(s)
| | | | | | | | | | - Min Ji Kim
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Korea; (K.g.K.); (H.-y.K.); (H.j.P.); (J.K.C.); (T.s.K.)
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Gönüllü E, Soysal A, Yıldız İ, Karaböcüoğlu M. Impact of self-financed rotavirus vaccination on acute gastroenteritis in young children in Turkey. Hum Vaccin Immunother 2021; 17:510-516. [PMID: 32702249 DOI: 10.1080/21645515.2020.1776043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Rotavirus (RV) vaccines have been available in Turkey since 2006. These vaccines are not funded by the National Health System, so consequently their coverage rate in children has reached only 13-18%. We conducted a retrospective record review including all children ≤60 months of age presenting to study hospitals with suspected or clinical acute gastroenteritis (AGE) between 2012 and 2018. During the study, 109,605 children ≤60 months of age were admitted to pediatric out-patient clinics and pediatric emergency room, of which 15,501 (14%) were diagnosed with AGE. Incidence of RV-positive AGE decreased from 4.47 per 1,000 children in 2012 to 2.48 per 1,000 in 2018. A total of 4,805 (31%) such children were hospitalized with RV-positive AGE, a decrease from 1.9 per 1,000 children in 2012 to 0,45 per 1,000 in 2018. The length of hospital stays (LOS) of RV-positive AGE was 2.47 ± 1.15 days compared to LOS of RV-negative AGE 1.59 ± 1.17 days (p < .001). The overall cost of RV-positive AGE ($335 ± 200) was higher than that for RV-negative AGE ($280 ± 148) cases (p = .015). Vaccine effectiveness against any case of RV-positive AGE was 75,1% (95% CI: 65-86%). Despite the low level of vaccine coverage, the introduction of RV vaccination had a positive impact on the incidence of RV-positive AGE and related hospitalizations in young children.
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Affiliation(s)
- Erdem Gönüllü
- Clinic of Pediatrics, Ataşehir Memorial Hospital , Istanbul, Turkey
| | - Ahmet Soysal
- Clinic of Pediatrics, Ataşehir Memorial Hospital , Istanbul, Turkey
| | - İsmail Yıldız
- Clinic of Pediatrics, Şişli Memorial Hospital , Istanbul, Turkey
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Azor-Martinez E, Garcia-Fernandez L, Strizzi JM, Cantarero-Vallejo MD, Jimenez-Lorente CP, Balaguer-Martinez JV, Torres-Alegre P, Yui-Hifume R, Sanchez-Forte M, Gimenez-Sanchez F. Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial. Am J Infect Control 2020; 48:1315-1321. [PMID: 32303373 DOI: 10.1016/j.ajic.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
We aimed to assess the effectiveness of an educational and hand hygiene program in daycare centers (DCCs) and homes on acute gastroenteritis (AGE) incidence in children attending DCCs. METHODS A randomized, controlled, and open study of 911 children aged 0-3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up was employed. Two intervention groups of DCCs families performed educational and hand hygiene measures, 1 with soap and water (soap and water group; n = 274), another with hand sanitizer (hand sanitizer group [HSG]; n = 339), and the control group (CG; n = 298) followed usual handwashing procedures. We compared AGE episode rates with Poisson regression model. RESULTS seven hundred fourteen AGE episodes were registered, significant differences between HSG and CG children were found during December and January. A multivariate model was applied and the adjusted incidence rate ratios by rotavirus vaccination found significant differences when children were previously vaccinated, the children in the soap and water group had a higher risk of AGE episodes (incidence rate ratio: 1.28, 95% confidence interval:1.0-1.64), compared with those in the HSG. CONCLUSIONS This study demonstrated that hand hygiene programs that included hand sanitizer were most effective in the winter months. Further, the largest reduction of AGE episodes occurred in the children that followed hand hygiene programs including hand sanitizer and educational measures for DCC staff, parents, and children, and were vaccinated for rotavirus.
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López-Lacort M, Orrico-Sánchez A, Martínez-Beneito MÁ, Muñoz-Quiles C, Díez-Domingo J. Spatio-temporal impact of self-financed rotavirus vaccination on rotavirus and acute gastroenteritis hospitalisations in the Valencia region, Spain. BMC Infect Dis 2020; 20:656. [PMID: 32894071 PMCID: PMC7487659 DOI: 10.1186/s12879-020-05373-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Several studies have shown a substantial impact of Rotavirus (RV) vaccination on the burden of RV and all-cause acute gastroenteritis (AGE). However, the results of most impact studies could be confused by a dynamic and complex space-time process. Therefore, there is a need to analyse the impact of RV vaccination on RV and AGE hospitalisations in a space-time framework to detect geographical-time patterns while avoiding the potential confusion caused by population inequalities in the impact estimations. METHODS A retrospective population-based study using real-world data from the Valencia Region was performed among children aged less than 3 years old in the period 2005-2016. A Bayesian spatio-temporal model was constructed to analyse RV and AGE hospitalisations and to estimate the vaccination impact measured in averted hospitalisations. RESULTS We found important spatio-temporal patterns in RV and AGE hospitalisations, RV vaccination coverage and in their associated adverted hospitalisations. Overall, ~ 1866 hospital admissions for RV were averted by RV vaccination during 2007-2016. Despite the low-medium vaccine coverage (~ 50%) in 2015-2016, relevant 36 and 20% reductions were estimated in RV and AGE hospitalisations respectively. CONCLUSIONS The introduction of the RV vaccines has substantially reduced the number of RV hospitalisations, averting ~ 1866 admissions during 2007-2016 which were space and time dependent. This study improves the methodologies commonly used to estimate the RV vaccine impact and their interpretation.
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Affiliation(s)
- Mónica López-Lacort
- Vaccine Research Department FISABIO-Public Health, Avenida Cataluña, 21, 46020, Valencia, Spain.
| | | | - Miguel Ángel Martínez-Beneito
- Departament d'Estadística i Investigació Operativa. Universitat de Valencia, Valencia, Spain
- Unitat Mixta de Recerca en Mètodes Estadístics per a Dades Biomédiques i Sanitàries, Valencia, Spain
| | - Cintia Muñoz-Quiles
- Vaccine Research Department FISABIO-Public Health, Avenida Cataluña, 21, 46020, Valencia, Spain
| | - Javier Díez-Domingo
- Vaccine Research Department FISABIO-Public Health, Avenida Cataluña, 21, 46020, Valencia, Spain
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Díez-Domingo J, Garcés-Sánchez M, Giménez-Sánchez F, Colomina-Rodríguez J, Martinón-Torres F. What have we learnt about rotavirus in Spain in the last 10 years? ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Díez-Domingo J, Garcés-Sánchez M, Giménez-Sánchez F, Colomina-Rodríguez J, Martinón-Torres F. [What have we learnt about rotavirus in Spain in the last 10 years?]. An Pediatr (Barc) 2019; 91:166-179. [PMID: 30971385 DOI: 10.1016/j.anpedi.2019.01.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Vaccines against rotavirus (RV) have been available in Spain since 2006, but they are neither recommended nor financed by the National Health System. Nevertheless, through recommendations of the Spanish Association of Paediatrics vaccination has achieved intermediate coverage. MATERIAL AND METHODS A systematic literature review was performed on studies carried out in Spain in the last 12 years (2006-2018) on RV infection and vaccination. RESULTS A total of 43 studies were identified that met the inclusion criteria. The disease burden in children less than 5 years in the Primary Care setting ranged from 15 to 19 cases per 1,000 children, and between 120 and 480 cases per 100,000 in the hospital setting, which has a significant economic and social impact. Vaccines against RV have shown an effectiveness of between 83% and 96%, and an impact of up to 70% in reducing hospital admissions, which is dependent on the achieved vaccine coverage. New research lines are identified, such as the role of the rotavirus vaccine and protection against seizures or the impact on the gut microbiota. CONCLUSIONS The current available information supports the significant burden of rotavirus disease in Spain and the high effectiveness of the available vaccines. This evidence should allow for an updated re-evaluation of the national recommendations on rotavirus vaccination.
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Orrico-Sánchez A, López-Lacort M, Muñoz-Quiles C, Díez-Domingo J. Lack of impact of rotavirus vaccines on seizure-related hospitalizations in children under 5 years old in Spain. Hum Vaccin Immunother 2018; 14:1534-1538. [PMID: 29393748 PMCID: PMC6037443 DOI: 10.1080/21645515.2018.1435225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION 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.
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Affiliation(s)
- Alejandro Orrico-Sánchez
- a Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y, Biomédica de la Comunitat Valenciana, FISABIO-Public Health , Valencia , Spain
| | - Mónica López-Lacort
- a Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y, Biomédica de la Comunitat Valenciana, FISABIO-Public Health , Valencia , Spain.,b Universidad Católica de Valencia 'San Vicente Martir' , Valencia , Spain
| | - Cintia Muñoz-Quiles
- a Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y, Biomédica de la Comunitat Valenciana, FISABIO-Public Health , Valencia , Spain.,b Universidad Católica de Valencia 'San Vicente Martir' , Valencia , Spain
| | - Javier Díez-Domingo
- a Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y, Biomédica de la Comunitat Valenciana, FISABIO-Public Health , Valencia , Spain.,b Universidad Católica de Valencia 'San Vicente Martir' , Valencia , Spain
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Boix R, Cano R, Gallego P, Vallejo F, Fernández-Cuenca R, Noguer I, Larrauri A. Hepatitis C hospitalizations in Spain, 2004-2013: a retrospective epidemiological study. BMC Health Serv Res 2017; 17:461. [PMID: 28679375 PMCID: PMC5498875 DOI: 10.1186/s12913-017-2410-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 06/27/2017] [Indexed: 01/29/2023] Open
Abstract
Background Hepatitis C is an important public health problem about which there is currently scarce epidemiological information. The objective of this study is to describe and analyse the demographic and epidemiological characteristics of hospitalized cases of hepatitis C in the Spanish population between 2004 and 2013. Methods The study uses the Hospital Discharge Records Database of the Spanish National Health System. It is a retrospective descriptive epidemiological study. The variables analysed were year of infection, age, sex, diagnostic category, days admitted and co-morbidity. Results There have been a total of 351,996 hospitalizations; 225,138 men (64%) and 126,858 women (36%). They are divided between acute hepatitis 8161 (2.3%); chronic hepatitis 325,185 (92.4%) and unspecified hepatitis 18,650 (5.3%). The mean age for men is 53.7 (+/−15.2) and for women 62.3 (+/−17.3). 22.8% also present with an Human immunodeficiency virus (HIV) disease coinfection, and 14.7% with opioid dependencies. The trend is for a gradual increase in cases without statistical significance. Conclusions The Hepatitis C cases hospitalized had high levels of chronicity, which entails two distinct patterns of illness in men and women – who are affected in different age ranges.
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Affiliation(s)
- R Boix
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - R Cano
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - P Gallego
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - F Vallejo
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - R Fernández-Cuenca
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - I Noguer
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain
| | - A Larrauri
- National Centre of Epidemiology, Institute of Health Carlos III, C/Monforte de Lemos, 5, 28029, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), C/ Monforte de Lemos, 3-5, 28029, Madrid, Spain
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13
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Orrico-Sanchez A, López-Lacort M, Pérez-Vilar S, Díez-Domingo J. Long-term impact of self-financed rotavirus vaccines on rotavirus-associated hospitalizations and costs in the Valencia Region, Spain. BMC Infect Dis 2017; 17:267. [PMID: 28399824 PMCID: PMC5387249 DOI: 10.1186/s12879-017-2380-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/04/2017] [Indexed: 01/05/2023] Open
Abstract
Background Rotavirus vaccines are available in Spain from 2007. They are recommended by the Spanish Pediatric Association, but not funded by the National Health System (NHS) and its coverage rate reached 40-50%. The hospitalization rate reduction of rotavirus caused gastroenteritis (RVAGE) directly attributable to vaccination remains unclear due to the large differences described in published studies, ranging from 14 to 44.5% in children <5 years of age, even with similar vaccination coverage. These results could be partly explained by variability in hospitalization policies, different study designs and the timeframe of observation. In addition, the direct economic impact of the reduction of hospitalizations has never been estimated. Therefore, there is a need to analyze the long-term impact of rotavirus vaccines on RVAGE and all cause gastroenteritis (AGE) hospitalizations and the national health system associated costs, minimizing potential confounders or biases. Methods A population-based, ecological study using the hospital discharge registry’s Minimum Basic Data Set (MBDS) and the vaccine register (SIV) was performed, among Valencia Region’s children <5 years old, during 2002 - 2015. RVAGE and AGE hospitalization risk was analyzed by vaccine coverage and adjusted by the total hospitalization rate for all causes to avoid external biases. The impact of AGE-associated health care utilization in prevaccine (2003–2006) versus postvaccine (2008–2014) years was also assessed. Results After vaccines licensure, the incidence of RVAGE-associated hospitalizations decreased markedly. A general vaccine coverage-related reduction in RVAGE or AGE-hospitalizations risk was observed in all age groups. Compared with unvaccinated children, RVAGE hospitalization risk decreased by 67% (95% CI: 55-67), 71% (95% CI: 58-81) and 68% (95% CI: 18-92) in children 0, 1 and 4 years of age, respectively, with a vaccination coverage between 40 and 42%. Overall, the hospital related costs were reduced around EUR 6 Mill per 105 children in 7 years. Conclusions Despite the low-medium vaccine coverage, the introduction of rotavirus vaccines had a specific coverage-related response impact in the hospitalizations for RVAGE and AGE in children <5 years and their use substantially reduced hospital related costs. The model used reassures that the estimated impact is due to the vaccination and not to other external factors. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2380-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alejandro Orrico-Sanchez
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Public Health, Avenida de Cataluña 21, CP, 46020, Valencia, Spain
| | - Mónica López-Lacort
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Public Health, Avenida de Cataluña 21, CP, 46020, Valencia, Spain
| | - Silvia Pérez-Vilar
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Public Health, Avenida de Cataluña 21, CP, 46020, Valencia, Spain
| | - Javier Díez-Domingo
- Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana, FISABIO-Public Health, Avenida de Cataluña 21, CP, 46020, Valencia, Spain. .,Universidad Católica de Valencia 'San Vicente Martir', Valencia, Spain.
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14
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Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period. Epidemiol Infect 2017; 145:1773-1785. [PMID: 28367780 DOI: 10.1017/s0950268817000620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (β-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.
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15
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Arístegui J, Ferrer J, Salamanca I, Garrote E, Partidas A, San-Martin M, San-Jose B. Multicenter prospective study on the burden of rotavirus gastroenteritis in children less than 3 years of age in Spain. BMC Infect Dis 2016; 16:549. [PMID: 27724892 PMCID: PMC5057213 DOI: 10.1186/s12879-016-1890-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background Rotavirus is acknowledged as an important cause of paediatric gastroenteritis worldwide. In Spain, comprehensive data on the burden of rotavirus disease was lacking. Methods A prospective, multicenter, observational study was carried out, during the winter season, from October to April 2014 in selected areas of Spain (Catalonia, Basque Country, Andalusia) to estimate the frequency and characteristics of acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) in children ≤3 years of age seeking medical care in primary care and emergency department centres. Results Of the 1087 episodes of AGE registered, 33.89 % were RVGE positive. The estimated incidence of RVGE, was 40.3 (95 % CI 36.1–44.8) episodes per 10,000 child-months in children ≤ 3 years of age and the 5-month (December-April) seasonal RVGE incidence rate was 2.01 [1.81–2.24] per 100 children. No vaccination and attending a day care centre were the main risk factors for RV infection. RVGE infected children presented more frequently with fever (63.9 % vs. 45.1 %, p = 0.009), vomiting (61.2 % vs. 44.3 %, p = 0.015), suffered more dehydration, and were hospitalised and went to the emergency room more often (41.7 % vs. 15.7 %, p <0.001) than non-RVGE infected ones. Children were usually more tired (77.5 % vs. 54.2 %, p <0.001), tearful, (47.2 % vs. 34.8 %, p <0.001), and easily irritated (76.5 % vs. 59.8 %, p <0.001), and parents were more concerned (41.7 % vs. 15.7 %, p <0.001) and suffered more working rhythm disturbances (39.0 % vs. 22.9 %, p <0.001). The cost for families of RVGE cases was significantly higher than the cost of non-RVGE infected ones (47.3 vs 36.7 euros, p = 0.011). Vaccinated children suffered less clinical symptoms and no hospitalization. Therefore, vaccination decreases the psychosocial stressors caused by the disease in the family. Conclusions Rotavirus infections are responsible for a substantial proportion of AGE cases in children ≤3 years of age in Spain attended at primary care visits. RVGE episodes are associated with greater clinical severity, greater alterations in the child´s behaviour, and higher parental distress. The outcomes of the present study recommend that routine rotavirus vaccination in infants ≤3 years of age could considerably reduce the serious burden of this potentially serious childhood disease. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1890-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Arístegui
- Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain.
| | - J Ferrer
- Pediatría, CAP Roquetes Canteres, Barcelona, Spain
| | - I Salamanca
- Pediatría, Instituto Hispalense de Pediatría,, Sevilla, Spain
| | - E Garrote
- Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain
| | - A Partidas
- Unidad de Infectología Pediátrica, Hospital de Basurto, Universidad del País Vasco (UPV/EHU), Avenida de Montevideo 18, 48013, Bilbao, Vizcaya, Spain
| | - M San-Martin
- Medical Department. Sanofi Pasteur MSD, Madrid, Spain
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16
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Giménez Sánchez F, Nogueira EJ, Sánchez Forte M, Ibáñez Alcalde M, Cobo E, Angulo R, Garrido Fernández P. Impact of vaccination uptake on hospitalizations due to rotavirus acute gastroenteritis in 2 different socioeconomic areas of Spain. Hum Vaccin Immunother 2016; 12:1035-9. [PMID: 26810147 PMCID: PMC4962960 DOI: 10.1080/21645515.2015.1118592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/19/2015] [Accepted: 11/06/2015] [Indexed: 12/22/2022] Open
Abstract
Rotavirus is the leading cause of hospitalization due to acute gastroenteritis (AGE) in infants and toddlers. However, rotavirus vaccination has been associated with a decline in hospitalization rates due to rotavirus AGE. A descriptive retrospective study was conducted to analyze the impact of rotavirus vaccination on the rate of hospitalizations due to AGE among children ≤2 years old in 2 areas of the province of Almería, Spain. After eight years of rotavirus vaccination, rates of hospitalizations due to rotavirus AGE are diminished. This decline is closely related to vaccine coverage in the studied areas.
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Affiliation(s)
- Francisco Giménez Sánchez
- Instituto Balmis de Vacunas, Unidad de Infectología Pediátrica, Hospital Torrecárdenas, Almería, Spain
- Institiuto Hispalense de Pediatria, Granada, Spain
| | | | | | | | - Elvira Cobo
- Department of Pediatrics, Hospital Torrecárdenas, Almería, Spain
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Effectiveness and impact of rotavirus vaccines in Europe, 2006–2014. Vaccine 2015; 33:2097-107. [DOI: 10.1016/j.vaccine.2015.03.016] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 11/17/2022]
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Redondo O, Cano R, Simón L. Decline in rotavirus hospitalizations following the first three years of vaccination in Castile-La Mancha, Spain. Hum Vaccin Immunother 2015; 11:769-75. [PMID: 25644531 DOI: 10.1080/21645515.2015.1009339] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Rotavirus is a major burden on the Spanish Healthcare System. Rotarix(®) and RotaTeq(®) were simultaneously commercialized in Spain by February, 2007. The objective is to analyze the incidence and seasonality of rotavirus hospitalizations (RH) in Castile-La Mancha (CLM), following the first 3 y of commercialization. A cross-sectional study of the hospital discharge registry's Minimum Basic Data Set (MBDS) in CLM between 2003 and 2009 was performed. We used the Poisson regression model to quantify the percentage of change in the rotavirus incidence rate (IR) for 2007-09 vs. 2003-05, adjusting for age, sex, and province. To analyze changes between epidemic seasons the chi-square test was used. The median IR in 2003-09 was 224.71 per 10(5) [interquartile range (IQR): 185.24-274.70], which represents 60% of hospital admissions due to infectious acute gastroenteritis. The median rate in 2007-09 decreased [incidence rate ratio (IRR): 0.86, 95% CI: 0.78-0.96], significantly in Toledo (IRR: 0.54, 95% CI: 0.39-0.75). An incipient decline at the beginning of the last cold season was observed, preceded by a significant decrease of 68% in the autumn season of 2009. Despite its limited coverage, the rotavirus vaccine may have contributed to decrease RH in CLM.
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Affiliation(s)
- Olga Redondo
- a Research Support Unit; La Mancha Centro General Hospital; Alcázar de San Juan , Spain
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