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Omar M, Kassem E, Anis E, Abu-Jabal R, Mwassi B, Shulman L, Cohen D, Muhsen K. Factors associated with antibiotic use in children hospitalized for acute viral gastroenteritis and the relation to rotavirus vaccination. Hum Vaccin Immunother 2024; 20:2396707. [PMID: 39248509 PMCID: PMC11385160 DOI: 10.1080/21645515.2024.2396707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/29/2024] [Accepted: 08/22/2024] [Indexed: 09/10/2024] Open
Abstract
Evidence on unnecessary antibiotic use in children with acute viral gastroenteritis (AGE) is scarce. We characterized the extent and correlates of antibiotic use among children hospitalized with viral AGE. A single-center study enrolled children aged 0-59 months hospitalized for AGE between 2008 and 2015 in Israel. Information was collected on laboratory tests, diagnoses, antibiotic treatment, and rotavirus vaccination. Stool samples were tested for rotavirus antigen, GII-norovirus, and stool cultures were performed for bacterial enteropathogens. Data from 2240 children were analyzed. Rotavirus vaccine was given to 79% of eligible children. Rotavirus test was performed on 1419 (63.3%) children. Before the introduction of universal rotavirus vaccination (2008-2010), rotavirus positivity in stool samples was 37.0%, which declined to 17.3% during the universal vaccination years (2011-2015). Overall, 1395 participants had viral AGE. Of those, 253 (18.1% [95% CI 16.1-20.2]) had unnecessary antibiotic treatment, mostly penicillin 46.6%, ceftriaxone 34.0% and azithromycin 21.7%. A multivariable analysis showed an inverse association between rotavirus vaccination and unnecessary antibiotic treatment (odds ratio = 0.53 [95% CI 0.31-0.91]), while positive associations were found with performing chest-X-ray test (3.00 [1.73-5.23]), blood (3.29 [95% CI 1.85-5.86]) and urine cultures (7.12 [3.77-13.43]), levels of C-reactive protein (1.02 [1.01-1.02]) and leukocytes (1.05 [1.01-1.09]). The results were consistent in an analysis of children with laboratory-confirmed rotavirus or norovirus AGE, or after excluding children with CRP > 50 mg/L. In conclusion, antibiotic prescription was common among hospitalized children with viral AGE, which was inversely related to rotavirus vaccination, possibly due to less severe illness in the vaccinated children.
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Affiliation(s)
- Muna Omar
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Emilia Anis
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Roula Abu-Jabal
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Basher Mwassi
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Lester Shulman
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Ministry of Health, Ramat Gan, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Rennert W, Hindiyeh M, Allahham M, Mercer LD, Hamad KI, Ghuneim NI, A. M. Eljaro Z, Abu-Awwad F, Bozya Y, Hjaija D, Bhat N, Leader T, Ramlawi A, Marzouqa H. Introducing ROTAVAC® to the occupied Palestinian Territories: Impact on diarrhea incidence, rotavirus prevalence and genotype composition. Vaccine 2023; 41:945-954. [PMID: 36585280 PMCID: PMC9880560 DOI: 10.1016/j.vaccine.2022.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rotavirus infection remains an important cause of morbidity and mortality in children. The introduction of vaccination programs in more than 100 countries has contributed to a decrease in hospitalizations and mortality. This study investigates the epidemiological impact of the rotavirus vaccine ROTAVAC® in the Palestinian Territories, the first country to switch from ROTARIX® to this new vaccine. METHODS Clinical surveillance data was collected fromchildren younger than 5attendingoutpatient clinics throughout Gaza withdiarrhea between 2015 and 2020. The incidence of all-cause diarrhea was assessed using an interrupted time-series approach. Rotavirus prevalence was determined at the Caritas Baby Hospital in the West Bank usingELISA on stool specimen of children younger than 5with diarrhea. Genotyping was performed on 325 randomly selected rotavirus-positive samples from January 2015 through December 2020 using multiplex PCR analysis. RESULTS Average monthly diarrhea casesdropped by 16.7% annually fromintroduction of rotavirus vaccination in May 2016 to the beginning of the SARS-CoV-2 epidemic in March 2020 for a total of 53%. Case count declines were maintained afterthe switchto ROTAVAC® in October 2018. Rotavirus positivity in stool samples declined by 67.1% over the same period without change followingthe switch to ROTAVAC®. The distribution of predominant genotypes in rotavirus-positive stool samples changed from a pre-vaccination G1P [8] to G9P[8] and G12P[8] during the ROTARIX® period and G2P[4] after the introduction of ROTAVAC®. CONCLUSION ROTAVAC® has shown epidemiological impact on par with ROTARIX® after its introduction to the national immunization schedule in the Palestinian Territories. A molecular genotype shift from a pre-vaccination predominance of G1P[8] to a current predominance of G2P[4] requires more long-term surveillance.
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Affiliation(s)
- Wolfgang Rennert
- Rostropovich Vishnevskaya Foundation, 1776 K Street, NW, Washington, D.C. 20006, USA,MedStar Georgetown University, 4200 Wisconsin Ave NW, Suite 200, Washington D.C2. 200162, USA,Corresponding author.
| | - Musa Hindiyeh
- Caritas Baby Hospital, Caritas Street, Bethlehem, West Bank, Palestine
| | - Majd Allahham
- Caritas Baby Hospital, Caritas Street, Bethlehem, West Bank, Palestine
| | - Laina D. Mercer
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Khalil I. Hamad
- Health Department, UNRWA, Al-Azhar Road, Rimal Quarter, Gaza, Palestine
| | - Nedal I. Ghuneim
- Preventive Medicine Department, Ministry of Health, Tal-Sultan-190/82, Rafah, Gaza, Palestine
| | | | - Fakhr Abu-Awwad
- Rostropovich Vishnevskaya Foundation, 1776 K Street, NW, Washington, D.C. 20006, USA
| | - Yaser Bozya
- Public Health General Directorate, Ministry of Health, Ramallah, Palestine
| | - Diaa Hjaija
- Public Health General Directorate, Ministry of Health, Ramallah, Palestine
| | - Niranjan Bhat
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Troy Leader
- PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA
| | - Asad Ramlawi
- Rostropovich Vishnevskaya Foundation, 1776 K Street, NW, Washington, D.C. 20006, USA
| | - Hiyam Marzouqa
- Caritas Baby Hospital, Caritas Street, Bethlehem, West Bank, Palestine
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3
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Elbashir I, Aldoos NF, Mathew S, Al Thani AA, Emara MM, Yassine HM. Molecular epidemiology, genetic diversity, and vaccine availability of viral acute gastroenteritis in the middle East and North Africa (MENA) region. J Infect Public Health 2022; 15:1193-1211. [PMID: 36240530 DOI: 10.1016/j.jiph.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Acute gastroenteritis is the cause of considerable mortality and morbidity worldwide, particularly among children under five years in underdeveloped countries. Most acute gastroenteritis (AGE) cases are attributed to viral etiologies, including rotavirus, norovirus, adenovirus, astrovirus, and sapovirus. This paper aimed to determine the prevalence rate of different viral etiologies of AGE in the Middle East and North Africa (MENA) region. Moreover, this paper explored rotavirus phylogenetic relatedness, compared VP7 and VP4 antigenic regions of rotavirus with vaccine strains, and explored the availability of vaccines in the MENA region. The literature search identified 160 studies from 18 countries from 1980 to 2019. The overall prevalence of rotavirus, norovirus, adenovirus, astrovirus, and sapovirus were 29.8 %, 13.9 %, 6.3 %, 3.5 %, and 3.2 % of tested samples, respectively. The most common rotavirus genotype combinations in the MENA region were G1P[8], G9P[9], and G2P[4], whereas GII.4 was the predominant norovirus genotype all of which were reported in almost all the studies with genotyping data. The comparison of VP7 and VP4 between circulating rotavirus in the MENA region and vaccine strains has revealed discrete divergent regions, including the neutralizing epitopes. Rotavirus vaccine was introduced to most of the countries of the MENA region; however, only a few studies have assessed the effectiveness of vaccine introduction. This paper provides a comprehensive update on the prevalence of the different viral agents of AGE in the MENA region.
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Affiliation(s)
- Israa Elbashir
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Noor F Aldoos
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
| | - Shilu Mathew
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar; Department of Biomedical Sciences, College of Health Science-QU Health, Qatar University, Doha 2713, Qatar
| | - Mohamed M Emara
- Basic Medical Sciences Department, College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar.
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
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Zaitoon H, Hanna S, Bamberger E. Impact of rotavirus vaccine implementation on Israeli children: a comparison between pre- and post-vaccination era. World J Pediatr 2022; 18:417-425. [PMID: 35389194 DOI: 10.1007/s12519-022-00547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Worldwide rotavirus vaccination has resulted in a substantial decrease in rotavirus-induced severe gastroenteritis and related hospitalizations among children. Still, the characterization of patients warranting hospitalization needs to be further elucidated. The purpose of the study is to compare the clinical and laboratory features of children hospitalized with acute rotavirus infection before and after the introduction of routine vaccination. METHODS This is a retrospective observational study. Participants were pediatric patients who presented to the Bnai Zion Medical Center pediatric emergency department and were diagnosed with rotavirus acute gastroenteritis between 2017 and 2019. RESULTS During the pre-vaccination period (2007-2009), 114 infants and young children (median age: 14 months, range: 1-72 months; 59 male, 55 female) were hospitalized for rotavirus-induced acute gastroenteritis with a rate of 11.71 positive rotavirus tests per 1000 emergency room visits. In the post-vaccination period (2012-2019), 168 infants and young children (median age: 17 months, range: 0-84 months; 90 male, 78 female) were hospitalized with a rate of 4.18 positive rotavirus tests per 1000 emergency room visits. There were no statistical differences between the two groups in gender, breast-feeding rates and sibling(s). The proportion of cases with moderate-to-severe dehydration was higher in the post-vaccination children than in the pre-vaccination children. CONCLUSIONS Rates of rotavirus-attributed acute gastroenteritis hospitalizations declined from the pre- to the post-vaccination period. Higher rates of dehydration were found in the post-vaccination children. Ongoing surveillance is warranted to better understand the implications of the vaccine.
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Affiliation(s)
- Hussein Zaitoon
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 47 Golomb St., 31048, Haifa, Israel.
| | - Shaden Hanna
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ellen Bamberger
- Department of Pediatrics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 47 Golomb St., 31048, Haifa, Israel
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5
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Hallowell BD, Chavers T, Parashar U, Tate JE. Global Estimates of Rotavirus Hospitalizations Among Children Below 5 Years in 2019 and Current and Projected Impacts of Rotavirus Vaccination. J Pediatric Infect Dis Soc 2022; 11:149-158. [PMID: 34904636 DOI: 10.1093/jpids/piab114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rotavirus vaccine impact on rotavirus hospitalizations is not well documented globally. We performed a systematic review to estimate the number of rotavirus hospitalizations that (1) occur annually, (2) are currently prevented by rotavirus vaccines, and (3) could be prevented with improved vaccine coverage and universal vaccine introduction. METHODS We systematically reviewed articles indexed in the PubMed database published from January 1, 2000, to December 31, 2019. We included all primary peer-reviewed studies with rotavirus hospitalization rates for children below 5 years that reported data prior to vaccine introduction, utilized at least one continuous year of data collection, and collected hospitalization data after 2000 using active surveillance. We grouped pre-vaccine country estimates by childhood mortality strata and calculated the median rate among each group. We then assigned the mortality stratum-specific hospitalization rates to each country and calculated the number of rotavirus hospitalizations by country, mortality strata, and World Health Organization region. RESULTS Our search strategy identified 4590 manuscripts, of which 32 were included in the final dataset. In 2019, an estimated 1 760 113 (interquartile range [IQR]: 1 422 645-2 925 372) rotavirus hospitalizations occurred globally, with 524 871 (IQR: 415 987-814 835) prevented by rotavirus vaccination. With universal introduction of rotavirus vaccines and increased vaccine coverage, we estimate that an additional 751 609 (IQR: 607 671-1 318 807) rotavirus hospitalizations can be prevented annually. CONCLUSIONS This analysis highlights the continued burden of rotavirus hospitalizations among children below 5 years. A large, preventable proportion of this burden could be eliminated by expanding introductions to new countries and increasing rotavirus vaccine coverage to levels seen with other childhood vaccinations.
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Affiliation(s)
- Benjamin D Hallowell
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
| | - Tyler Chavers
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA
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Iflah M, Kassem E, Rubinstein U, Goren S, Ephros M, Cohen D, Muhsen K. Convulsions in children hospitalized for acute gastroenteritis. Sci Rep 2021; 11:15874. [PMID: 34354134 PMCID: PMC8342430 DOI: 10.1038/s41598-021-95202-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/21/2021] [Indexed: 11/09/2022] Open
Abstract
The study aim was to examine possible correlates of convulsions in children hospitalized for acute gastroenteritis (AGE). Data collected in a prospective study of AGE hospitalizations in children aged 0-59 months in 3 hospitals in Israel during 2008-2015 were analyzed. Stool samples were tested for rotavirus using immunochromatography and stool culture was performed for the detection of Salmonella, Shigella and Campylobacter We compared clinical and demographic characteristics of children hospitalized for AGE who had convulsions (n = 68, cases) with children hospitalized for AGE without convulsions (n = 3505, controls). Age differed between children with and without convulsions (p = 0.005); the former were mostly toddlers aged 12-23 months (51%) compared to 30% of the control group. A higher percentage of cases tested positive for Shigella (11% vs. 4%, p = 0.002), the opposite was found for rotavirus (2% vs. 30% p < 0.001). A multivariable model showed that body temperature (OR 2.91 [95% CI 1.78-4.76], p < 0.001) and high blood glucose level (> 120 mg/dL) (OR 5.71 [95% CI 1.27-25.58] p = 0.023) were positively related to convulsions in children with AGE, while severe AGE (Vesikari score ≥ 11) was inversely related with convulsions (OR 0.09 [95% CI 0.03-0.24], p < 0.001). Conclusion: Elevated body temperature is associated with convulsions in children with AGE, but not severity of AGE, while hyperglycemia might reflect a neuroendocrine stress reaction to convulsions, AGE or both.
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Affiliation(s)
- Moti Iflah
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Moshe Ephros
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel.,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6139001, Tel Aviv, Israel.
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7
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Blumenfeld O, Lawrence G, Shulman LM, Laron Z. Use of the Whole Country Insulin Consumption Data in Israel to Determine the Prevalence of Type 1 Diabetes in Children <5 Years of Age Before and During Rotavirus Vaccination. Pediatr Infect Dis J 2021; 40:771-773. [PMID: 34250976 DOI: 10.1097/inf.0000000000003148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies showed that rotavirus vaccination may affect the prevalence of type 1 diabetes (T1D). The aim of the study was to determine the prevalence of early childhood (<5 years) T1D before and during the introduction of rotavirus vaccination in Israel by syndromic surveillance. METHODS Data on insulin purchases reported by Israel's four Health Maintenance Organizations (HMOs) were retrieved from the National Program for Quality Indicators in Community Healthcare. RESULTS During the prevaccination years (2002-2007), a steady increase in insulin purchases was reported in the young (<5 years). The period percent change (PC) of children <5 years old diagnosed with T1D inferred from purchased insulin prescriptions increased by 50.0%, and the annual percent change (APC) increased by 10.0% (p = 0.01). During the period of free, universal Rotavirus vaccination (2011-2018), the PC for T1D diagnoses among children <5 years of age decreased by 3.8% with an APC of -2.5% (p = 0.14). There was a significant difference (p = 0.002) between the increasing trend in insulin use before vaccination versus the decreasing trend after vaccination. CONCLUSION Rotavirus vaccination correlated with attenuation of the increasing rate in the prevalence of T1D in <5-year-old children in Israel.
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Affiliation(s)
- Orit Blumenfeld
- From the National Diseases Registries Unit, Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Gabriella Lawrence
- Laboratory of Environmental Virology, Central Virology Laboratory, Public Health Services Israel Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
| | - Lester M Shulman
- Laboratory of Environmental Virology, Central Virology Laboratory, Public Health Services Israel Ministry of Health, Sheba Medical Center, Tel Hashomer, Israel
| | - Zvi Laron
- Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center, Petah Tikva, Israel
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8
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Klivitsky A, Algabria S, Paret G, Michaan N, Goldberg L, Halutz O, Grisaru‐Soen G. Impact of rotavirus vaccine on admissions due to acute gastroenteritis and rotavirus gastroenteritis in Israel. Acta Paediatr 2021; 110:634-640. [PMID: 32654273 DOI: 10.1111/apa.15480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
AIM We examined the impact of insertion of the Rotavirus vaccine (RVV) into the Israeli National Immunisation Programme (NIP) on hospitalisations due to both acute gastroenteritis (AGE) and Rotavirus gastroenteritis (RVGE) in children. METHODS We retrospectively analysed the medical records of children aged <5 years admitted with a diagnosis of AGE between 2008 and 2016 in two children's hospitals in central Israel. Clinical, laboratory, microbiological data and RV immunisation status were retrieved. Data were compared before and after the introduction of the RVV into the NIP. RESULTS A total of 2042 children were admitted with AGE. Hospitalisations due to AGE and RVGE decreased from 3310 to 1950 and from 1027 to 585 per 100 000 admissions, respectively, after the RVV (relative risk reduction (RRR) of 41% and 43%, respectively). RV remained the most common pathogen in both study periods. There was no significant difference in the clinical course between immunised and non-immunised children admitted with RVGE. CONCLUSION The introduction of the RVV to the NIP significantly reduced the admissions due to both AGE and RVGE in children <5 years. However, RV is still the most common agent for admissions due to AGE in this age group.
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Affiliation(s)
- Amir Klivitsky
- Pediatric Infectious Disease Unit Dana Children's Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Salam Algabria
- Pediatric Infectious Disease Unit Dana Children's Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gideon Paret
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatric Intensive Care Sheba Medical Center Safra Children's Hospital Tel Hashomer Israel
| | - Nadav Michaan
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Obstetrics and Gynecology Lis Maternity Hospital Tel Aviv Israel
| | - Lior Goldberg
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatric Intensive Care Sheba Medical Center Safra Children's Hospital Tel Hashomer Israel
| | - Ora Halutz
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Microbiology Laboratory Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Galia Grisaru‐Soen
- Pediatric Infectious Disease Unit Dana Children's Hospital Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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9
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Epidemiological, molecular, and clinical features of rotavirus infections among pediatrics in Qatar. Eur J Clin Microbiol Infect Dis 2021; 40:1177-1190. [PMID: 33411172 DOI: 10.1007/s10096-020-04108-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022]
Abstract
Acute gastroenteritis (AGE) remains a major cause of diarrhea in developing and developed countries. Rotavirus (RV) is a leading cause of severe pediatric diarrhea worldwide. Here we report on the prevalence of circulating genotypes in association with demographics and clinical manifestations outcomes in Qatar. A total of 231 RV-positive fecal samples were collected from children suffering from AGE during 3 years study period between June 2016 and June 2019. The age of the subjects ranged between 2 months and 14 years (median of 16 months). The VP4 and VP7 were amplified and sequenced. Phylogenetic analyses were performed using MEGA7.0. Pearson's chi-squared test was used to determine significant differences for comparisons of general categorical variables. RV infections were most common in children between 1 and 3 years of age (49%), followed by those < 1 year and > 3 years of age (33% and 28%, respectively). RV infections were more frequent in males than females, with a ratio of 1.4:1. RV infections occurred throughout the year, with a noticeable increase in summer (42.8%) and a drop in winter (20.1%). RV genotypes G3P[8] (30.8%), G2P[8] (12.3%), G4P[8] (11.7%), and G1P[8] (10.4%) were the common genotypes during the study period. The G3P[8] strain detected in our study revealed similarities to the equine-like G3P[8] (10.3%; 24/231) (KT988229.1), Wa-like genomic constellation (9%; 21/231) (MF563894.1), and DS-1-like strains (6.4%; 15/231) (LC386081.1). Based on the Vesikari score system, severe clinical illness including diarrhea and vomiting (average frequency: 4 to 5 times/day) was recorded for G3P[8] group, followed by G9P[8], G4P[8], and G1P[8]. Higher incidence for G3P[8], G2P[8], G4P[8], and G1P[8] were reported in Qatari subjects compared to other nationalities. The multinational status of a small country explains the wide diversity of circulating RV genotypes in Qatar. The highest prevalence and severe illnesses were recorded to G3P[8], which is different from other surrounding countries/global levels.
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10
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Effects of rotavirus vaccine on all-cause acute gastroenteritis and rotavirus hospitalizations in Israel: A nationwide analysis. Vaccine 2020; 38:2406-2415. [PMID: 32029322 DOI: 10.1016/j.vaccine.2020.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In December 2010, the pentavalent rotavirus vaccine (RotaTeq) was added to the national immunization program in Israel. The study aim was to examine national reductions in all-cause acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children aged 0-59 months following the introduction of universal rotavirus immunization in Israel. METHODS We extracted data from the Israel National Hospital Discharge Database. Hospitalization rates were calculated by dividing the annual number of all-cause AGE and RVGE hospitalizations by the number of children aged 0-59 months residing Israel. To assess rate reductions, we compared the mean hospitalization rate for the pre-vaccine years (2002-2008) with that for the universal vaccination years (2011-2017). Interrupted time-series analyses were undertaken. During 2008-2010 rotavirus vaccines were partially available. RESULTS A total of 131,116 AGE hospitalizations were reported, of which 13,111 (10.0%) were coded as RVGE hospitalizations. The average annual all-cause AGE hospitalization rate during the pre-vaccine period was 147.9 (95% CI 146.7-149.0) per 10,000 children aged 0-59 months, and declined by 38.7-53.0% during the universal vaccination years. The average annual pre-vaccine RVGE hospitalization rate was 16.9 (95% CI 16.5-17.3) per 10,000 children, and declined by 89.1% during 2016-2017. Findings from interrupted time-series analyses showed significant impact of introducing universal rotavirus immunization on the declines of all-cause AGE and RVGE hospitalizations rates. A multivariable Autoregressive Integrated Moving Average model showed that the variable "immunization period" was a significant predictor of RVGE hospitalizations (t = 7.3, p < 0.001) for the universal vaccination years. The declines in hospitalizations rates of all-cause AGE were lower among Arab children compared to Jewish children, but the declines in RVGE rates were similar between the groups. CONCLUSIONS National hospitalization data demonstrated substantial and consistent reductions in all-cause AGE and RVGE hospitalizations following the implementation of universal rotavirus vaccination program.
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11
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Continuing rotavirus circulation in children and adults despite high coverage rotavirus vaccination in Finland. J Infect 2020; 80:76-83. [DOI: 10.1016/j.jinf.2019.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/26/2019] [Indexed: 12/31/2022]
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12
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Muhsen K, Kassem E, Rubenstein U, Goren S, Ephros M, Shulman LM, Cohen D. No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel. Hum Vaccin Immunother 2019; 15:1284-1293. [PMID: 30945960 DOI: 10.1080/21645515.2019.1599522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Following the introduction of universal immunization against rotavirus, concerns were raised regarding pathogen-replacement of rotavirus by norovirus. The study aim was to examine the incidence and characteristics and norovirus gastroenteritis before and after the introduction of universal rotavirus immunization in Israel. We studied 1179 stool samples collected between November 2007 and December 2014 for a prospective hospital-based surveillance study of children aged 0-59 months hospitalized for gastroenteritis. A real-time RT-PCR assay was used to identify genogroup II (GII) norovirus in extracted fecal RNA samples. Overall, the weighted percentage of norovirus positive patients was 10.9%. Norovirus positivity was similar in the pre-universal rotavirus immunisation years (2008-2010) and the universal years (2011-2014), the respective average annual incidence of norovirus gastroenteritis was 1.6 (95% CI 0.6-2.3) per 1000 and 1.1 (95% CI 0.8-1.4) per 1000 children. Rotavirus was detected in 36.8% and 19.6% of the patients in the pre-vaccine years and the universal vaccine years, with an estimated incidence of 5.5 (95% CI 3.4-7.6) per 1000 and 2.1 (95% CI 1.6-2.7) per 1000 children, respectively. Most patients (59.1%) with norovirus gastroenteritis were infants aged 0-11 months. Norovirus was detected all year round with a significant 3-month peak from September through November. In conclusion, norovirus continues to be a leading cause of acute gastroenteritis associated with hospitalizations in young children. Future norovirus vaccines should target young infants. There was no evidence of pathogen-replacement by norovirus following the introduction of universal rotavirus immunization in Israel.
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Affiliation(s)
- Khitam Muhsen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Eias Kassem
- b Department of Pediatrics , Hillel Yaffe Medical Center , Hadera , Israel
| | - Uri Rubenstein
- c Department of Pediatrics , Laniado Medical Center , Netanya , Israel
| | - Sophy Goren
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Moshe Ephros
- d Department of Pediatrics , Carmel Medical Center , Haifa , Israel.,e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Lester M Shulman
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel.,f Central Virology Laboratory , Ministry of Health , Tel Hashomer , Israel
| | - Dani Cohen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
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Bercovich S, Anis E, Kassem E, Rubinstein U, Ephros M, Cohen D, Muhsen K. Validation of parental reports of rotavirus vaccination of their children compared to the national immunization registry. Vaccine 2019; 37:2791-2796. [DOI: 10.1016/j.vaccine.2019.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/17/2019] [Accepted: 04/12/2019] [Indexed: 12/20/2022]
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Enweronu-Laryea CC, Armah G, Sagoe KW, Ansong D, Addo-Yobo E, Diamenu SK, Mwenda JM, Parashar UD, Tate JE. Sustained impact of rotavirus vaccine introduction on rotavirus gastroenteritis hospitalizations in children <5 years of age, Ghana, 2009-2016. Vaccine 2018; 36:7131-7134. [PMID: 29752020 DOI: 10.1016/j.vaccine.2018.02.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Ghana introduced monovalent rotavirus vaccine in April 2012. We sought to determine the long-term impact of routine rotavirus vaccination on rotavirus gastroenteritis hospitalizations in Ghana during the first 4 years following rotavirus vaccine introduction. METHODS Active sentinel surveillance for acute gastroenteritis hospitalizations among children <5 years of age was conducted at two sites from July 2009 through June 2016. Stool specimens were collected from enrolled children and tested by enzyme immunoassay. Changes in the proportion of all-cause gastroenteritis hospitalizations due to rotavirus pre- (July 2009-June 2012) and post-vaccine introduction (July 2012-June 2016) were compared using chi-square test. RESULTS The proportion of acute gastroenteritis hospitalizations due to rotavirus among children <5 years of age significantly declined by 42% from a pre-vaccine median of 50% (343/684) to a post-vaccine median of 29% (118/396) (p < 0.001). The age distribution of rotavirus hospitalizations shifted toward older ages with 64% (759/1197) of rotavirus hospitalizations occurring in children <12 months of age pre-vaccine introduction to 47% (212/453) occurring in children <12 months of age post-vaccine introduction (p < 0.001). DISCUSSION The decline in rotavirus hospitalizations following rotavirus vaccine introduction have been sustained over the first 4 years of the vaccination program in Ghana. Continued vaccination against rotavirus will ensure that this burden remains low.
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Affiliation(s)
| | - George Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwamena W Sagoe
- School of Basic and Allied Health Sciences, University of Ghana, Ghana
| | - Daniel Ansong
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Addo-Yobo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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de Hoog MLA, Vesikari T, Giaquinto C, Huppertz HI, Martinon-Torres F, Bruijning-Verhagen P. Report of the 5th European expert meeting on rotavirus vaccination (EEROVAC). Hum Vaccin Immunother 2018; 14:1027-1034. [PMID: 29211629 PMCID: PMC5893188 DOI: 10.1080/21645515.2017.1412019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Fifth European Expert Meeting on Rotavirus Vaccination was convened in Utrecht, The Netherlands, in March 2017. The 2-day meeting included invited lectures as well as original oral and poster presentations and brought together experts from 21 countries. Summary findings of the meeting include: Rotavirus vaccination programmes in Europe have resulted in reductions of 60–90% in rotavirus outpatient visits and hospitalizations. Long term trends indicate this impact is sustained over the years. Herd effects, protecting unvaccinated children and neonates too young to be vaccinated have been observed in many European countries. Early evidence now also suggests that rotavirus vaccination may be instrumental in the prevention of celiac disease. Special attention should be given to preterm infants, who may age out of the vaccination window before hospital discharge and to HIV infected children who are at increased risk of severe rotavirus AGE. There is a small but increased risk of IS following rotavirus vaccination and parents should therefore be informed about possible signs and symptoms of IS. New insights in rotavirus genetic susceptibility and interactions with microbiome may open opportunities for interventions to improve protection by vaccination, in particular in LMIC. The development of several novel rotavirus vaccines discussed at the meeting is also promising in this respect.
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Affiliation(s)
- Marieke L A de Hoog
- a Julius Center for Health Sciences, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Timo Vesikari
- b Vaccine Research Centre, University of Tampere Medical School , Tampere , Finland
| | - Carlo Giaquinto
- c Department of Women and Child Health, University of Padua , Padua , Italy
| | - Hans-Iko Huppertz
- d Department of Paediatrics , Prof.-Hess-Kinderklinik and Research Laboratory , Bremen , Germany
| | - Federico Martinon-Torres
- e Department of Paediatrics and Healthcare Research Institute of Santiago , University of Santiago de Compostela , Santiago de Compostela , Spain
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Muhsen K, Anis E, Rubinstein U, Kassem E, Goren S, Shulman L, Ephros M, Cohen D. Effectiveness of rotavirus pentavalent vaccine under a universal immunization programme in Israel, 2011–2015: a case–control study. Clin Microbiol Infect 2018; 24:53-59. [DOI: 10.1016/j.cmi.2017.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
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Yoshikawa T, Matsuki T, Sato K, Mizuno M, Shibata M, Hasegawa S, Morita M, Iwasa M, Gopala K, Holl K. Impact of rotavirus vaccination on the burden of acute gastroenteritis in Nagoya city, Japan. Vaccine 2017; 36:527-534. [PMID: 29248263 DOI: 10.1016/j.vaccine.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Nagoya city, Japan, rotavirus (RV) vaccination has been available since 2011 with estimated coverage reaching 92% by 2015 after the introduction of a public subsidy in 2012. This study assessed the impact of vaccination on the RV gastroenteritis (RVGE) burden in children aged <5 years old (y) by comparing RVGE hospitalizations and outpatient visits during pre-vaccination (2007-2011), transition (2011-2012) and subsidization (2012-2016) periods. METHODS All hospitalizations and outpatient visits in children aged <5 y from 2 administrative districts of Nagoya city were identified from the hospital-based electronic databases of 4 hospitals. RVGE cases were identified by diagnostic code and/or positive results of diagnostic kits. RESULTS Compared to the pre-vaccination period, there was a decrease in RVGE hospitalizations for children <5 y from 5.59 per 1000 person-year (kPY) to 3.65/kPY in the subsidization period (i.e. 34.69%). In children <1 y, the incidence of RVGE hospitalizations decreased continuously from 6.62/kPY in the pre-vaccination period to 1.84/kPY in the subsidization period (i.e. 72.19%). The highest decrease was observed in the subsidization season i.e. when high coverage was reached: 69% and 75.57% in the 2013/2014 season for 2-3 y and 3-4 y, and 74.03% in the 2014/2015 season for 4-5 y, respectively. Proportion of RVGE outpatient visits decreased by 87.44% for children <1 y and 57.05% for <5 y from the pre-vaccination to the subsidization period. This decrease started the first year of subsidization for children <1 y, 1-2 y and 2-3 y (78.89%, 18.86% and 5.80%) and the second year (2013/2014 season) for children 3-4 y and 4-5 y (87.73% and 51.78%). CONCLUSIONS Although yearly fluctuations have been observed, the introduction of vaccination significantly decreased pediatric RVGE hospitalizations and outpatient visits, especially in the age group eligible for vaccination. During the second and third year of subsidization, we observed a herd protection effect on other age groups <5 y who were not eligible for vaccination. Clinicaltrial.gov.registered#:NCT01733862.
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Affiliation(s)
- Tetsushi Yoshikawa
- Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Taizo Matsuki
- GSK, 1-8-1 Akasaka, Minato-ku, Tokyo 107-0052, Japan.
| | - Keiko Sato
- GSK, 1-8-1 Akasaka, Minato-ku, Tokyo 107-0052, Japan.
| | - Mihoko Mizuno
- Daido Hospital, 9 Hakusui-cho, Minami-ku, Nagoya, Aichi 457-8511, Japan.
| | - Motohiro Shibata
- Japan Community Healthcare Organization Chukyo Hospital, 1-1-10, Sanjo, Minami-ku, Nagoya, Aichi 457-8510, Japan.
| | - Shinji Hasegawa
- Nagoya Memorial Hospital, 4-305, Hirabari, Tempaku-ku, Nagoya, Aichi 468-8520, Japan.
| | - Makoto Morita
- Nagoya Memorial Hospital, 4-305, Hirabari, Tempaku-ku, Nagoya, Aichi 468-8520, Japan.
| | - Mitsuji Iwasa
- Japanese Red Cross Nagoya Daini Hospital, 2-9, Myomi-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
| | - Kusuma Gopala
- GSK, #5, Embassy Links, Cunningham Road, SRT Road, Bangalore 560052, India.
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Abstract
We present an overview of the impact of universal rotavirus immunization with the pentavalent vaccine, RotaTeq, which was introduced in Israel in 2010. The vaccine is given free of charge at age 2, 4 and 6 months, with an 80% coverage that was shortly achieved during the universal immunization period. Compared to pre-universal immunization years (2008-2010), a reduction of 66-68% in the incidence of rotavirus gastroenteritis (RVGE) hospitalizations was observed in 2011-2015 among children aged 0-23 months in central and northern Israel. In southern Israel a reduction of 80-88% in RVGE hospital visit rate was found among Jewish children aged 0-23 months in 2011-2013. Among Bedouins, the respective decline was 62-75%. A significant reduction of 59% was also observed in RVGE clinic visits, presumably representing less severe illness. Indirect benefit was evident in children aged 24-59 months who were ineligible for universal immunization. Vaccine effectiveness against RVGE hospitalization was estimated at 86% in children aged 6-23 months. Changes in the circulating rotavirus genotypes occurred but the contribution of vaccine induced immune pressure is unclear. Universal rotavirus immunization was followed by an impressive decrease in the burden of RVGE in young children in Israel, likely attributed to good vaccine coverage and effectiveness.
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Affiliation(s)
- Khitam Muhsen
- a Department of Epidemiology and Preventive Medicine , School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Ramat Aviv , Tel Aviv , Israel
| | - Daniel Cohen
- a Department of Epidemiology and Preventive Medicine , School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Ramat Aviv , Tel Aviv , Israel
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