1
|
Oluwaseun S, Cagnan L, Xausa I, Nachbar RB, Levy Bachelot L, Chen YH, Carias C. Projected Public Health Impact of a Universal Rotavirus Vaccination Program in France. Pediatr Infect Dis J 2024; 43:902-908. [PMID: 39163534 PMCID: PMC11319077 DOI: 10.1097/inf.0000000000004448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE In June 2022, French health authorities issued a universal recommendation for routine administration and reimbursement of rotavirus vaccines in infants. Given this recent recommendation by French health authorities, we sought to understand the public health impact of a universal rotavirus vaccination strategy compared with no vaccination. MATERIALS AND METHODS A deterministic, age-structured, nonlinear dynamic transmission model, accounting for herd immunity, was developed. We considered 3 vaccination coverage scenarios: high (95%), medium (75%) and low (55%). Model parameter values were based on published modeling and epidemiological literature. Model outcomes included rotavirus gastroenteritis (RVGE) cases and healthcare resource utilization due to RVGE (hospitalizations, general practitioner or emergency department visits), as well as the number needed to vaccinate to prevent 1 RVGE case (mild or severe) and 1 RVGE-related hospitalization. Model calibration and analyses were conducted using Mathematica 11.3. RESULTS Over 5 years following implementation, RVGE cases for children under 5 years are estimated to be reduced by 84% under a high vaccination coverage scenario, by 72% under a medium vaccination coverage scenario and by 47% under a low vaccination coverage scenario. Across all scenarios, the number needed to vaccinate to avert 1 RVGE case and hospitalization varied between 1.86-2.04 and 24.15-27.44, respectively. CONCLUSIONS Rotavirus vaccination with high vaccination coverage in France is expected to substantially reduce the number of RVGE cases and associated healthcare resource utilization.
Collapse
Affiliation(s)
| | - Lauren Cagnan
- Market Access Department, MSD France, Courbevoie Cedex, France
| | - Ilaria Xausa
- Wolfram Solutions Department, Wolfram Research Inc, Champaign, IL
| | | | | | | | | |
Collapse
|
2
|
López-Lacort M, Muñoz-Quiles C, Díez-Domingo J, Orrico-Sánchez A. Effectiveness of self-financed rotavirus vaccines on acute gastroenteritis primary care episodes using real-world data in Spain: a propensity score-matched analysis of cohort study. Eur J Pediatr 2024; 183:2843-2853. [PMID: 38584228 DOI: 10.1007/s00431-024-05536-0] [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: 01/17/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
The objective of this study was to estimate, by a novel spatiotemporal approach in an environment of non-funded rotavirus (RV) vaccines, the RV vaccine effectiveness (VE) to prevent acute gastroenteritis primary care (AGE-PC)-attended episodes, demonstrating how indirect protection leads to underestimation of direct VE under high vaccine coverage (VC). This population-based retrospective cohort study used electronic healthcare registries including all children 2 months-5 years old, born from 2009 to 2018 in the Valencia Region (Spain). Direct RV VE preventing AGE-PC episodes was estimated using propensity score matching and Poisson regressions stratified by VC, adjusted by age and calendar season. Indirect VE was estimated by Poisson regression comparing AGE-PC rates in unvaccinated children among the different VC levels. A total of 563,442 children were included for the RV VC estimation; of them, 360,576 were included in the birth-cohort for VE analysis. RV VC showed strong variability among districts and seasons, rising on average from 21% in 2009/2010 to 55% in 2017/2018. The highest direct VE was found in vaccinated children from districts with 0-30% RV VC (16.4%) and the lowest in those from districts with ≥ 70% RV VC (9.7%). The indirect protection in unvaccinated children raised from 6 to 16.6% for those living with 20-30% and ≥ 70% VC, respectively. CONCLUSION Considering that RV is the causative agent in 20% of AGE cases, a direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with VC over 70% because of indirect protection. WHAT IS KNOWN • The effectiveness of RV vaccines preventing hospitalizations due to RV-acute gastroenteritis (RV-AGE) has been extensively studied. However, RV also burdens the primary care (PC) setting, and data on vaccine effectiveness (VE) in preventing AGE-PC visits are scarce. • The RV vaccine distribution in Spain (non-funded), with large differences in vaccine coverage (VC) among healthcare districts, provides an ideal scenario to assess the actual VE in preventing AGE-PC consultations, including the direct and indirect protection. WHAT IS NEW • A direct effectiveness of 82% preventing AGE-PC episodes due to RV could be deduced using a novel spatiotemporal approach. A reduction of 17% of AGE-PC episodes in unvaccinated was observed in areas with high VC because of indirect protection. • These findings, together with existing data on the impact on hospitalizations due to RV-AGE, offer valuable insights for implementing vaccination initiatives in countries that have not yet commenced such programs.
Collapse
Affiliation(s)
- Mónica López-Lacort
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Cintia Muñoz-Quiles
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain.
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
| | - Javier Díez-Domingo
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001, Valencia, Spain
| | - Alejandro Orrico-Sánchez
- Vaccine Research Unit, Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Avda. Cataluña, 21. 46020, Valencia, Spain
- CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Universidad Católica de Valencia San Vicente Mártir, Carrer de Quevedo, 2, 46001, Valencia, Spain
| |
Collapse
|
3
|
Standaert B. The Economic Value of Rotavirus Vaccination When Optimally Implemented in a High-Income Country. Vaccines (Basel) 2023; 11:vaccines11050917. [PMID: 37243021 DOI: 10.3390/vaccines11050917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Rotavirus vaccination was introduced in high-income countries starting in 2006, with no recommendation for optimal implementation. Economic evaluations were presented before launch projecting potential impacts. Few economic reassessments have been reported following reimbursement. This study compares the short- to long-term economic value of rotavirus vaccination between pre-launch predictions and real-world evidence collected over 15 years, proposing recommendations for optimal vaccine launch. A cost-impact analysis compared rotavirus hospitalisation data after the introduction of vaccination between pre-launch modelled projections and observed data collected in the RotaBIS study in Belgium. A best model fit of the observed data was used to simulate launch scenarios to identify the optimal strategy. Data from other countries in Europe were used to confirm the potential optimal launch assessment. The Belgian analysis in the short term (first 8 years) indicated a more favourable impact for the observed data than predicted pre-launch model results. The long-term assessment (15 years) showed bigger economic disparities in favour of the model-predicted scenario. A simulated optimal vaccine launch, initiating the vaccination at least 6 months prior the next seasonal disease peak with an immediate very high vaccine coverage, indicated important additional potential gains, which would make vaccination very cost impactful. Finland and the UK are on such a route leading to long-term vaccination success, whereas Spain and Belgium have difficulties in achieving optimum vaccine benefits. An optimal launch of rotavirus vaccination may generate substantial economic gains over time. For high-income countries that are considering implementing rotavirus vaccination, achieving an optimal launch is a critical factor for long-term economic success.
Collapse
Affiliation(s)
- Baudouin Standaert
- Department Care and Ethics, Faculty of Medicine and Life Sciences, University Hasselt, 3590 Diepenbeek, Belgium
- HEBO bv, 2020 Antwerpen, Belgium
| |
Collapse
|
4
|
Hemming-Harlo M, Gylling A, Herse F, Haavisto I, Nuutinen M, Pasternack M, Kanibir MN, Hartwig S, Carias C. Long-term surveillance of rotavirus vaccination after implementation of a national immunization program in Finland (2008-2018). Vaccine 2022; 40:3942-3947. [PMID: 35641360 DOI: 10.1016/j.vaccine.2022.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rotavirus (RV) vaccination was included in the Finnish National immunization Program (NIP) in 2009. RotaTeq (RV5) has been used exclusively with a national average vaccination coverage rate (VCR) of > 90%. While previous studies have demonstrated that inpatient rotavirus gastroenteritis (RVGE) admissions declined by as much as 96% in Finnish children ≤ 5 years old following RV vaccination introduction, no study has evaluated long-term protection after vaccination in Finland. In this study, we analyze incidence of hospital outpatient visits and inpatient admissions of gastroenteritis in children up to 7 years of age. METHODS We first describe the incidence of RVGE, viral gastroenteritis (VGE), and acute gastroenteritis (AGE) for all Finnish children born during 2008-2011. Children were stratified by the year of birth into not-eligible, partially eligible and rotavirus vaccine-eligible (born in 2008, 2009, 2010 and 2011, respectively). Hospital inpatient and outpatient data was collected from the National Care Register for all children from birth until December 31st, 2018. We also studied RVGE incidence during 2014-2017 for children<3 years of age in municipalities with VCRs of 90% and above and municipalities with VCRs below 90%. RESULTS RVGE incidence decreased significantly soon after implementation of RV vaccination in the NIP. In vaccine-eligible cohorts, no clear peak incidence in the youngest age groups could be observed, and no RVGE cases were observed beyond 6 years after vaccination, in contrast to vaccine ineligible and partially eligible cohorts. Despite an overall high VCR in Finland, regions with high VCR had lower incidence of RVGE than regions with lower VCR. CONCLUSION Incidence of RVGE has remained low in all age groups during the 10 years following introduction of RV vaccine in the Finnish NIP. Differences in RVGE incidence were observed in regions with high as compared with lower VCR, highlighting the importance of maintaining high vaccination coverage.
Collapse
Affiliation(s)
- Maria Hemming-Harlo
- Centre for Child Health Research, Tampere University and University Hospital, Elämänaukio 2, 33520 Tampere, Finland; University of Helsinki and Helsinki University Hospital, Children's Hospital and Pediatric Research Center, Stenbäckinkatu 9, 00290 Helsinki, Finland.
| | | | - Fredrik Herse
- NHG Finland, Vattuniemenranta 2, 00210 Helsinki, Finland.
| | - Ira Haavisto
- NHG Finland, Vattuniemenranta 2, 00210 Helsinki, Finland.
| | - Mikko Nuutinen
- NHG Finland, Vattuniemenranta 2, 00210 Helsinki, Finland.
| | | | - M Nabi Kanibir
- MSD International Business GmbH, Tribschenstrasse 60, CH-6005 Lucerne, Switzerland.
| | | | - Cristina Carias
- Merck & Co., Inc., 90 E Scott Ave, Rahway, NJ 07065, United States.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Selection of new COVID-19 genotypes following mass vaccination: The Rotavirus model. VACUNAS (ENGLISH EDITION) 2022. [PMCID: PMC9374319 DOI: 10.1016/j.vacune.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
7
|
Lapolla P, Familiari P, Bruzzaniti P. Selection of new COVID-19 genotypes following mass vaccination: The Rotavirus model. VACUNAS 2022; 23:144-146. [PMID: 35018145 PMCID: PMC8735814 DOI: 10.1016/j.vacun.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pierfrancesco Lapolla
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Pietro Familiari
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Placido Bruzzaniti
- Department of Human Neurosciences, Division of Neurosurgery, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
8
|
Standaert B, Benninghoff B. Defining the Recipe for an Optimal Rotavirus Vaccine Introduction in a High-Income Country in Europe. Viruses 2022; 14:425. [PMID: 35216018 PMCID: PMC8879258 DOI: 10.3390/v14020425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022] Open
Abstract
Observational data over 15 years of rotavirus vaccine introduction in Belgium have indicated that rotavirus hospitalisations in children aged <5 years plateaued at a higher level than expected, and was followed by biennial disease peaks. The research objective was to identify factors influencing these real-world vaccine impact data. We constructed mathematical models simulating rotavirus-related hospitalisations by age group and year for those children. Two periods were defined using different model constructs. First, the vaccine uptake period encompassed the years required to cover the whole at-risk population. Second, the post-uptake period covered the years in which a new infection/disease equilibrium was reached. The models were fitted to the observational data using optimisation programmes with regression and differential equations. Modifying parameter values identified factors affecting the pattern of hospitalisations. Results indicated that starting vaccination well before the peak disease season in the first year and rapidly achieving high coverage was critical in maximising early herd effect and minimising secondary sources of infection. This, in turn, would maximise the reduction in hospitalisations and minimise the size and frequency of subsequent disease peaks. The analysis and results identified key elements to consider for countries initiating an optimal rotavirus vaccine launch programme.
Collapse
Affiliation(s)
- Baudouin Standaert
- HEBO bv, 2020 Antwerpen, Belgium
- Research Group Care and Ethics, Faculty of Medicine and Life Sciences, University of Hasselt, 3500 Hasselt, Belgium
| | | |
Collapse
|
9
|
Standaert B, Strens D, Raes M, Benninghoff B. Explaining the formation of a plateau in rotavirus vaccine impact on rotavirus hospitalisations in Belgium. Vaccine 2022; 40:1948-1957. [PMID: 35190208 DOI: 10.1016/j.vaccine.2022.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Observational data on the reduction in hospitalisations after rotavirus vaccine introduction in Belgium suggest that vaccine impact plateaued at an unexpectedly high residual hospitalisation rate. The objective of this analysis was to identify factors that influence real-world vaccine impact. METHODS Data were collected on hospitalisations in children aged ≤ 5 years with rotavirus disease from 11 hospitals since 2005 (the RotaBIS study). The universal rotavirus vaccination campaign started late in 2006. A mathematical model simulated rotavirus hospitalisations in different age groups using vaccine efficacy and herd effect, influenced by vaccine coverage, vaccine waning, and secondary infection sources. The model used optimisation analysis to fit the simulated curve to the observed data, applying Solver add-in software. It also simulated an 'ideal' vaccine introduction maximising hospitalisation reduction (maximum coverage, maximum herd effect, no waning), and compared this with the best-fit simulated curve. Modifying model input values identified factors with the largest impact on hospitalisations. RESULTS Compared with the 'ideal' simulation, observed data showed a slower decline in hospitalisations and levelled off after three years at a higher residual hospitalisation rate. The slower initial decline was explained by the herd effect in unvaccinated children. The higher residual hospitalisation rate was explained by starting the vaccine programme in November, near the rotavirus seasonal peak. This resulted in low accumulated vaccine coverage during the first rotavirus disease peak season, with the consequential appearance of secondary infection sources. This in turn reduced the herd effect, resulting in a diminished net impact. CONCLUSIONS Our results indicate that countries wishing to maximise the impact of rotavirus vaccination should start vaccinating well ahead of the rotavirus seasonal disease peak. This maximises herd effect during the first year leading to rapid and high reduction in hospitalisations. Secondary infection sources explain the observed data in Belgium better than vaccine waning.
Collapse
|
10
|
Olsson-Åkefeldt S, Rotzén-Östlund M, Hammas B, Eriksson M, Bennet R. All-cause gastroenteritis hospitalisations of children decreased after the introduction of rotavirus vaccine in Stockholm. Infect Dis (Lond) 2021; 54:120-127. [PMID: 34569424 DOI: 10.1080/23744235.2021.1982142] [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] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In Stockholm, Sweden, rotavirus vaccination was offered to children born after 1 March 2014. Our aim was to describe rates of hospitalisation due to community-acquired gastroenteritis before and after the introduction of the vaccine, and aetiology, underlying medical conditions and complications in admitted children. METHODS We retrospectively included patients from our catchment area hospitalised with a diagnosis of gastroenteritis during ten infection seasons 2008/2009-2017/2018, whereof six seasons prevaccination and four seasons postvaccination. We studied virus detection data and the patients' medical records. RESULTS We included 3718 episodes in 3513 children. In 2967 (80%), stools were tested with virus isolation, ELISA, PCR, or bacterial culture; 479 (16%) tested negative. The incidence rates, with 95% confidence intervals, for children <5 years hospitalised for rotavirus gastroenteritis were 2.9 (2.8-3.1) per 1000 person-years prevaccination and 0.65 (0.56-0.74) postvaccination, for a rate ratio (RR) of 0.22 (0.19-0.26, p < .001). The rates for all-cause gastroenteritis were 5.6 (5.4-5.9) prevaccination and 2.5 (2.3-2.7) postvaccination, RR 0.45 (0.42-0.50, p < .001). In 5-17-year-old children norovirus dominated with little change over time. Of patients <5 years, those with underlying conditions constituted a larger proportion postvaccination than prevaccination (30.7% vs. 24.2%, p < .001). A complication other than dehydration, most commonly seizures, arose in 8.8% of the patients <5 years prevaccination and 11.4% postvaccination (p < .05). CONCLUSIONS Rotavirus vaccination reduced the number of children <5 years requiring hospital care for gastroenteritis. We saw no replacement of rotavirus by other viruses.
Collapse
Affiliation(s)
- Selma Olsson-Åkefeldt
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Rotzén-Östlund
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
| | - Berit Hammas
- Department of Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Rutger Bennet
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
11
|
van Dongen JAP, Rouers EDM, Schuurman R, Bonten MJM, Bruijning-Verhagen P. Acute Gastroenteritis Disease Burden in Infants With Medical Risk Conditions in the Netherlands. Pediatr Infect Dis J 2021; 40:300-305. [PMID: 33230056 PMCID: PMC7952044 DOI: 10.1097/inf.0000000000003002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infants with medical risk conditions are vulnerable to childhood infections including acute gastroenteritis (AGE). To guide prevention programs, we quantified AGE incidence, severity and virus prevalence among medical risk infants in the Netherlands. METHODS This prospective cohort-study was part of the RIVAR-project recruiting infants with prematurity, low birth weight or severe congenital conditions in 13 hospitals. Follow-up included 18 monthly health questionnaires detailing AGE symptoms and healthcare usage. Parents were also instructed to notify when an infant developed AGE, to collect a stool sample and complete a daily severity score (Modified Vesikari Severity). Stool samples were analyzed by real-time polymerase chain reaction for rotavirus, norovirus, adenovirus and astrovirus. RESULTS Between November 2014 and October 2017, 631 infants participated during 9125 person-months of observation. In total, 559 episodes were identified. The mean AGE incidence rate was 73.5 per 100 person-years (PY) (95% confidence interval: 67.6-79.9) and increased with age [incidence rate: 48.3 (39.8-58.3) vs. 80.2 (73.0-88.1)/100 PY for ages 1-5 vs. 6-18 months, respectively]. Healthcare was attended for 38.1% (213/559) and 26.8% (68/254) were classified as severe based on the Modified Vesikari Severity. Stool samples were obtained from 254 AGE episodes. Norovirus was identified in 65 (25.6%) and rotavirus in 44 (17.7%). Adenovirus and astrovirus together accounted for 8.3% (N = 21). Severe AGE occurred most frequently in rotavirus positive episodes. CONCLUSION The observed AGE incidence, severity and healthcare usage among medical risk infants confirms substantial disease burden. Norovirus and rotavirus are the dominant pathogens and severe episodes occurred most frequently in children with rotavirus infection. AGE prevention in medical risk infants should be prioritized.
Collapse
Affiliation(s)
- Josephine A. P. van Dongen
- From the Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases, UMCU Utrecht
| | - Elsbeth D. M. Rouers
- From the Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases, UMCU Utrecht
- National Institute for Public Health and the Environment, Center for infectious disease control, Bilthoven
| | - Rob Schuurman
- University Medical Center Utrecht, department of Medical Microbiology, Utrecht, the Netherlands
| | - Marc J. M. Bonten
- From the Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases, UMCU Utrecht
- National Institute for Public Health and the Environment, Center for infectious disease control, Bilthoven
- University Medical Center Utrecht, department of Medical Microbiology, Utrecht, the Netherlands
| | - Patricia Bruijning-Verhagen
- From the Julius Center for Health Sciences and Primary Care, Epidemiology of Infectious Diseases, UMCU Utrecht
- National Institute for Public Health and the Environment, Center for infectious disease control, Bilthoven
| |
Collapse
|