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Yoshikawa T. Implementing vaccination policies based upon scientific evidence in Japan. Vaccine 2021; 39:5447-5450. [PMID: 34373119 PMCID: PMC8346366 DOI: 10.1016/j.vaccine.2021.07.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 01/29/2023]
Abstract
The theme of the 24th Annual Meeting of the Japanese Society for Vaccinology was “Sustainable Future Medical Care Created by Vaccines.” This theme includes topics such as the proposal to reduce the medical costs incurred by societies with aging populations through prophylactic vaccination. The coronavirus disease 2019 (COVID-19) pandemic alerted us to the important roles that preventive measures, such as vaccines, play in fighting infectious diseases. In order to inform the public of the benefits of vaccines, it is important to provide society with information regarding new vaccine developments, adjuvants, the cost–benefit ratio of vaccine introduction, and vaccine effectiveness and safety. Clinical research is essential for obtaining evidence of vaccine effectiveness and safety. The United States Centers for Disease Control and Prevention (CDC) conducts active surveillance in defined areas before and after the introduction of vaccines and documents the reduction in infection rates as a measure of vaccine effectiveness. However, vaccine efficacy and side effects may vary by country and ethnicity. Therefore, it is necessary for individual countries to develop their own evidence-based surveillance programs. We have studied vaccine efficacy and documented side-effects observed in patients for the varicella and rotavirus vaccines in Japan. This review outlines the importance of providing scientific evidence for vaccine effectiveness and safety.
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Affiliation(s)
- Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Arakaki L, Tollefson D, Kharono B, Drain PK. Prevalence of rotavirus among older children and adults with diarrhea: A systematic review and meta-analysis. Vaccine 2021; 39:4577-4590. [PMID: 34244008 DOI: 10.1016/j.vaccine.2021.06.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older children and adults are susceptible to rotavirus, but the extent to which rotavirus affects this population is not fully understood, hindering accuracy of global rotavirus estimations. OBJECTIVE To determine what proportion of diarrhea cases are due to rotavirus among persons ≥ 5 years old and to estimate this proportion by age strata. METHODS We conducted a systematic review and meta-analysis using the PRISMA guidelines. We included studies that reported on conditional rotavirus prevalence (i.e., percent of diarrhea due to rotavirus) in persons ≥ 5 years old who were symptomatic with diarrhea/gastroenteritis and had laboratory confirmation for rotavirus infection. Studies on nosocomial infections and outbreak investigations were excluded. We collected age group-specific conditional rotavirus prevalence and other variables, such as study geography, study setting, and study type. We calculated pooled conditional rotavirus prevalence, corresponding 95% confidence intervals (95% CI), heterogeneity (I2) estimates, and prediction intervals (PI). RESULTS Sixty-six studies from 32 countries met the inclusion criteria. Conditional rotavirus prevalence ranged from 0% to 30% across the studies. The total pooled prevalence of rotavirus among persons ≥ 5 years old with diarrhea was 7.6% (95% CI: 6.2-9.2%, I2 = 99.6%, PI: 0-24%). The pooled prevalence of rotavirus among older children and adolescents was 8.7% (95% CI: 6.2-11.7%, I2 = 96%, PI:0-27%), among younger adults was 5.4% (95% CI: 1.4-11.8%, I2 = 96%, PI:0-31%), and among older adults was 4.7% (95% CI: 2.8-7.0%, I2 = 96%, PI:0-16%). Pooled conditional rotavirus prevalences did not differ by other variables. CONCLUSION In this systematic review and meta-analysis of rotavirus among persons ≥ 5 years old with diarrhea, we found relatively low pooled conditional rotavirus prevalence compared to what is typically reported for children < 5 years; however, results should be interpreted with caution as the wide prediction intervals suggest large heterogeneity.
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Affiliation(s)
- Lola Arakaki
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Epidemiology, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Deanna Tollefson
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Brenda Kharono
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Paul K Drain
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
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Rotavirus outbreak among adults in a university hospital in Germany. J Clin Virol 2020; 129:104532. [PMID: 32650277 DOI: 10.1016/j.jcv.2020.104532] [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: 03/30/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Rotaviruses are the main cause of acute viral gastroenteritis in children under five years of age. Adults seem to be less frequently affected by rotaviruses most likely due to partial immunity resulting from prior infections. OBJECTIVES To describe a hospital-associated outbreak of rotavirus infections among adults. STUDY DESIGN Routine diagnostics and contact screening of symptomatic patients hospitalized at the university hospital of Freiburg. For rotavirus-positive patients, we performed rotavirus genotyping of all rotavirus RT-PCR positive samples and phylogenetic analysis. RESULTS Between December 2016 and April 2017 routine diagnostics showed an unexpectedly high number of rotavirus infections among adults with the exception of one pediatric case. In total, 32 temporal-associated cases were identified. Among these, two asymptomatic cases were detected. Genotyping showed that all isolates belonged to rotavirus G2P[4]. Phylogenetic analysis confirmed an outbreak. Infection prevention and control successfully contained further spread. CONCLUSIONS Infections with rotavirus are rare among adults but may spread between patients making timely recognition of rotavirus infections important for infection control. Rapid phylogenetic analysis is crucial for proactive infection control.
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Higgins RR, Peci A, Cardona M, Gubbay JB. Validation of a Laboratory-Developed Triplex Molecular Assay for Simultaneous Detection of Gastrointestinal Adenovirus and Rotavirus in Stool Specimens. Pathogens 2020; 9:pathogens9050326. [PMID: 32349251 PMCID: PMC7281709 DOI: 10.3390/pathogens9050326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 01/31/2023] Open
Abstract
Enteric viral pathogens causing gastroenteritis include adenovirus and rotavirus, among others. Rotavirus is the leading cause of severe diarrhea in infants and young children worldwide. Among the adenoviruses known to cause gastroenteritis are those of species F (serotypes 40, 41). Here, we describe the development and validation of a laboratory-developed gastrointestinal triplex rRT-PCR (triplex) assay that targets adenovirus and rotavirus. Stool specimens were tested from patients across Ontario. Specimens were previously tested for adenovirus and/or rotavirus by electron microscopy (EM) or immunochromatographic test (ICT). Triplex sensitivity, specificity, positive and negative predictive values compared to Seegene assay (a commercial assay used here as the standard reference method) were 100%, 97.8%, 86.0%, 100% for adenovirus, and 99.1%, 98.4%, 96.3%. 99.6% for rotavirus, respectively. The triplex assay had a 95.2% and 97.3% overall percent agreements (OPAs) when compared to EM for adenovirus or rotavirus detection, respectively, and an OPA of 90.9% when compared to rotavirus ICT for rotavirus detection. Triplex assay exhibited similar performance to the Seegene assay for both adenovirus and rotavirus and detected more adenovirus and rotavirus than traditional testing methods. The high performance along with lower cost and reduced turnaround time makes the triplex assay a desirable testing method for a clinical microbiology laboratory.
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Affiliation(s)
- Rachel R. Higgins
- Public Health Ontario Laboratory, 661 University Avenue, Toronto, ON M5G 1M1, Canada; (A.P.); (M.C.); (J.B.G.)
- Correspondence: ; Tel.: +1-647-792-3440
| | - Adriana Peci
- Public Health Ontario Laboratory, 661 University Avenue, Toronto, ON M5G 1M1, Canada; (A.P.); (M.C.); (J.B.G.)
| | - Mark Cardona
- Public Health Ontario Laboratory, 661 University Avenue, Toronto, ON M5G 1M1, Canada; (A.P.); (M.C.); (J.B.G.)
| | - Jonathan B. Gubbay
- Public Health Ontario Laboratory, 661 University Avenue, Toronto, ON M5G 1M1, Canada; (A.P.); (M.C.); (J.B.G.)
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 2V8, Canada
- The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Wilson SE, Rosella LC, Wang J, Renaud A, Le Saux N, Crowcroft NS, Desai S, Harris T, Bolotin S, Gubbay J, Deeks SL. Equity and impact: Ontario's infant rotavirus immunization program five years following implementation. A population-based cohort study. Vaccine 2019; 37:2408-2414. [PMID: 30765171 DOI: 10.1016/j.vaccine.2019.01.061] [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] [Received: 09/11/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ontario implemented a publicly-funded rotavirus (RV) immunization program in 2011. Our objectives were to evaluate its impact on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) five years after implementation. METHODS We performed a population-based longitudinal retrospective cohort study to identify hospitalizations and ED visits for RV-AGE and overall AGE in all age groups using ICD-10 codes between August 1, 2005 and March 31, 2016. A negative binomial regression model that included the effect of time was used to calculate rates, rate ratios (RRs) and 95% confidence intervals (CIs) for AGE before and after the program's implementation, after adjusting for age, seasonality and secular trends. We examined the seasonality of RV-AGE hospitalizations among children under five before and after the program and explored its equity impact. RESULTS Following program implementation, RV-AGE hospitalizations and ED visits among children under five years declined by 76% (RR 0.24, 95% CI 0.20-0.28) and 68% (RR 0.32, 95% CI 0.21-0.50), respectively. In addition, hospitalizations and ED visits for overall AGE declined by 38% (RR 0.62, 95% CI 0.59-0.65) and 26% (RR 0.74, 95% CI 0.73-0.76), respectively, among children under age five. Significant reductions in both outcomes were also found across a range of age-strata. In the pre-program period, the mean monthly hospitalization rate for RV-AGE among children residing in the most marginalized neighbourhoods was 33% higher than those residing in the least marginalized (RR 1.33, 95% CI 1.17-1.52), this disparity was not evident in the program period (RR 0.95, 95% CI 0.69-1.32). We found no evidence of a seasonal shift in rotavirus pediatric hospitalizations. INTERPRETATION The introduction of routine infant rotavirus immunization has had a substantial population impact in Ontario. Our study confirms herd effects and suggests the program may have reduced previous inequities in the burden of pediatric rotavirus hospitalizations.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Laura C Rosella
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Nicole Le Saux
- Division of Infectious Disease, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ontario, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shalini Desai
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tara Harris
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shelley L Deeks
- Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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