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Middleton BF, Danchin M, Fathima P, Bines JE, Macartney K, Snelling TL. Review of the health impact of the oral rotavirus vaccine program in children under 5 years in Australia: 2006 - 2021. Vaccine 2023; 41:636-648. [PMID: 36529591 DOI: 10.1016/j.vaccine.2022.12.008] [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: 10/12/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
Oral rotavirus vaccines were incorporated into the National Immunisation Program (NIP) for all Australian infants in July 2007. Initially each of the eight jurisdictions implemented Rotarix or RotaTeq rotavirus vaccine, however from July 2017 all states and territories have administered Rotarix only. This review evaluates the health impact of the oral rotavirus vaccine program for Australian children less than 5 years old over the first 15 years of the rotavirus vaccine program, observing long-term changes in rotavirus-related health care attendances, public health notifications, and vaccine effectiveness and safety data for both Rotarix and RotaTeq rotavirus vaccines. We searched Medline for studies published between January 2006 and May 2022 using the search terms 'rotavirus', 'rotavirus vaccine' and 'Australia'. Of 491 items identified, 76 items - 36 peer-reviewed articles and 40 reports - were included in the review. We found evidence that the introduction of the oral rotavirus vaccine program in Australia was associated with a prompt reduction in rotavirus-coded and all-cause gastroenteritis hospitalisations of vaccine-eligible children. In the context of less complete coverage, reduced vaccine timeliness and lower vaccine effectiveness, a less substantial and inconsistent reduction in severe rotavirus disease was observed among Aboriginal and Torres Strait Islander children, particularly those living in rural and remote northern Australia. Additional studies report no evidence for the emergence of non-vaccine serotypes and/ or replacement serotypes in Australia during the vaccine era. While the health impact for young children and consequent cost-savings of the oral rotavirus vaccine program have been high, it is important to find strategies to improve rotavirus vaccine impact for Aboriginal and Torres Strait Islander populations to ensure health benefits for all Australian children.
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Affiliation(s)
- Bianca F Middleton
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Parveen Fathima
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Julie E Bines
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Gastroenterology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kristine Macartney
- Department of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance (NCIRS), Sydney, New South Wales, Australia
| | - Thomas L Snelling
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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2
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Du Y, Chen C, Zhang X, Yan D, Jiang D, Liu X, Yang M, Ding C, Lan L, Hecht R, Zhu C, Yang S. Global burden and trends of rotavirus infection-associated deaths from 1990 to 2019: an observational trend study. Virol J 2022; 19:166. [PMID: 36266651 PMCID: PMC9585833 DOI: 10.1186/s12985-022-01898-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background Rotavirus is the leading global pathogen of diarrhea-associated mortality and poses a great threat to public health in all age groups. This study aimed to explore the global burden and 30-year change patterns of rotavirus infection-associated deaths. Methods Based on the Global Burden of Disease 2019 Study (GBD 2019), we analyzed the age-standardized death rate (ASDR) of rotavirus infection by sex, geographical region, and sociodemographic index (SDI) from 1990 to 2019. A Joinpoint regression model was used to analyze the global trends in rotavirus infection over the 30 years, SaTScan software was used to detect the spatial and temporal aggregations, and a generalized linear model to explore the relationship between sociodemographic factors and death rates of rotavirus infection. Results Globally, rotavirus infection was the leading cause of diarrheal deaths, accounting for 19.11% of deaths from diarrhea in 2019. Rotavirus caused a higher death burden in African, Oceanian, and South Asian countries in the past three decades. The ASDR of rotavirus declined from 11.39 (95% uncertainty interval [95% UI] 5.46–19.48) per 100,000 people in 1990 to 3.41 (95% UI 1.60–6.01) per 100,000 people in 2019, with an average annual percentage change (AAPC) (− 4.07%, P < 0.05). However, a significant uptrend was found in high-income North America (AAPC = 1.79%, P < 0.05). The death rate was the highest among children under 5 years worldwide. However, the death rates of elderly individuals over 70 years were higher than those of children under 5 years in 2019 among high, high-middle, middle, and low-middle SDI regions. Current health expenditure, gross domestic product per capita, and the number of physicians per 1000 people were significantly negatively correlated with death rates of rotavirus. Conclusions Although the global trends in the rotavirus burden have decreased substantially over the past three decades, the burden of rotavirus remained high in Africa, Oceania, and South Asia. Children under 5 years and elderly individuals over 70 years were the populations most at risk for rotavirus infection-associated deaths, especially elderly individuals over 70 years in relatively high SDI regions. More attention should be paid to these areas and populations, and effective public health policies should be implemented in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-022-01898-9.
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Affiliation(s)
- Yuxia Du
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Can Chen
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Xiaobao Zhang
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Danying Yan
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Daixi Jiang
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Xiaoxiao Liu
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Mengya Yang
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Cheng Ding
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Lei Lan
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China
| | - Robert Hecht
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, 06520, USA
| | - Changtai Zhu
- Department of Laboratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shigui Yang
- Department of Public Health, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China.
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3
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Karakusevic A, Devaney P, Enstone A, Kanibir N, Hartwig S, Carias CDS. The burden of rotavirus-associated acute gastroenteritis in the elderly: assessment of the epidemiology in the context of universal childhood vaccination programs. Expert Rev Vaccines 2022; 21:929-940. [PMID: 35535677 DOI: 10.1080/14760584.2022.2066524] [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 Rotaviruses (RVs) cause acute gastroenteritis (AGE) in infants and young children worldwide and also in older adults (≥60 years), however the burden among this age group is not well understood. Herd immunity through pediatric RV vaccination may reduce the burden of RVGE across all ages, however the impact of pediatric vaccination on burden in older adults is poorly understood. AREAS COVERED This systematic review was undertaken to identify studies related to the following objectives: understand the burden of RV in older adults, RV seroprevalence, and the impact of pediatric vaccination on this burden and highlight evidence gaps to guide future research. Of studies identified, 59 studies from two databases were included in this analysis following a review by two reviewers. EXPERT OPINION RV is an understudied disease in older adults. We found that 0-62% of patients with AGE tested positive for RV, with results varying by setting, country, and patient age. Results also suggest that pediatric vaccination benefits older adults through herd protection. Several studies showed a reduction in RV incidence after vaccination. However, there was variety in results and lack of consistency in outcomes reported. Further studies targeting older adults are needed to better characterize RV burden.
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Affiliation(s)
| | | | | | - Nabi Kanibir
- Global Medical and Scientific Affairs, Msd International GmbH, Luzern, Switzerland
| | - Susanne Hartwig
- Biostatistical and Research Decision Sciences Epidemiology, MSD Vaccins, France
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Gower CM, Stowe J, Andrews NJ, Dunning J, Ramsay ME, Ladhani SN. Sustained declines in age group-specific rotavirus infection and acute gastroenteritis in vaccinated and unvaccinated individuals during the five years since Rotavirus vaccine introduction in England. Clin Infect Dis 2021; 74:437-445. [PMID: 34043765 DOI: 10.1093/cid/ciab460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The introduction of an oral live-attenuated monovalent rotavirus vaccine (Rotarix ®) into the UK infant immunisation programme in July 2013 was associated with large reductions in laboratory-confirmed rotavirus infections and hospitalisations due to acute gastroenteritis (AGE) within 12 months. Here we report the five-year impact of the programme in England. METHODS Individuals with laboratory-confirmed rotavirus infections during 2000-2018 and all-cause hospitalisations for AGE during 2007-2018 were identified using national electronic records. Age-specific incidence rate ratios (IRR) and estimated numbers of cases averted in each of the five post-vaccination years were calculated. RESULTS There were 206,389 laboratory-confirmed rotavirus infections and 3,657,651 hospitalisations for all-cause AGE. Reductions of 69-83% in laboratory-confirmed rotavirus infections in all age groups and 77-88% in infants aged <1 year in each of the five post-vaccine years are reported, with 11,386-11,633 cases averted annually. All-cause AGE hospitalisations were reduced by 12-35% across all age-groups and by 25-48% in <1 year-olds in the five post-vaccine years, with 24,474-49,278 hospitalisations averted annually. There was strong evidence of indirect (herd) protection, with at least 50% and up to 80% of the non-specific end point of all-cause gastroenteritis (AGE) hospitalisations averted being in unvaccinated age-groups, primarily older adults. Seasonal changes include a possible shift from annual to biennial peaks with lower peak incidence and longer seasons. CONCLUSIONS There were large and sustained declines in both laboratory-confirmed rotavirus infections and AGE hospitalisations across all age groups in each of the five years since the introduction of the UK rotavirus programme.
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Affiliation(s)
- Charlotte M Gower
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Julia Stowe
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jake Dunning
- Tuberculosis; Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections; and Travel and Migrant Health Division (TARGET), National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Mary E Ramsay
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Shamez N Ladhani
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.,Paediatric Infectious Disease Research Group St. George's University of London, Cranmer Terrace, London SW17 ORE, UK
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5
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Ye S, Whiley DM, Ware RS, Kirkwood CD, Lambert SB, Grimwood K. Multivalent Rotavirus Vaccine and Wild-type Rotavirus Strain Shedding in Australian Infants: A Birth Cohort Study. Clin Infect Dis 2019; 66:1411-1418. [PMID: 29149283 DOI: 10.1093/cid/cix1022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/13/2017] [Indexed: 01/25/2023] Open
Abstract
Background Rotavirus vaccines have reduced moderate-to-severe gastroenteritis episodes in infants and young children. Nevertheless, knowledge gaps exist concerning rotavirus vaccine shedding and vaccine impact upon mild and asymptomatic wild-type infections. Our primary objective was to investigate vaccine shedding in Australian infants where the multivalent human-bovine reassortant rotavirus vaccine, RotaTeq, was part of the routine vaccination schedule. Methods The Observational Research in Childhood Infectious Diseases (ORChID) birth cohort study was conducted in Brisbane, Australia, from September 2010 to October 2014. Newborn infants were enrolled progressively and followed until their second birthday. Parents recorded daily symptoms and mailed weekly stool swab samples from their infants to the laboratory where reverse-transcription polymerase chain reaction testing was performed, and rotavirus-positive samples underwent genotyping to distinguish between vaccine and wild-type strains. Results Rotavirus was detected in 1068 of 11139 (9.6%) stool swabs from 158 infants, and 994 (93.1%) were genotyped. RotaTeq vaccine strains accounted for 951 of 994 (95.7%) typed rotavirus-positive swabs. Proportions of infants shedding RotaTeq after the first, second, and third vaccine doses were 87.0%, 57.4%, and 47.3%, respectively, and median (interquartile range) shedding duration after vaccine doses 1-3 was 3 (1-8), 1.5 (1-3), and 1 (1-2), weeks, respectively. In contrast, the incidence rate of wild-type rotavirus episodes was 10.3 (95% confidence interval, 6.8-15.6) per 100 child-years of observation. Conclusions RotaTeq vaccine virus was detected in stool samples from 47%-87% of infants after each vaccine dose. Genotyping is an essential tool for differentiating between rotavirus vaccine and wild-type strains and monitoring vaccine impact in children. Clinical Trial Registration NCT01304914.
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Affiliation(s)
- Suifang Ye
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane.,Microbiology Division, Pathology Queensland Central Laboratory, Brisbane
| | - David M Whiley
- University of Queensland Centre for Clinical Research, University of Queensland, Brisbane.,Microbiology Division, Pathology Queensland Central Laboratory, Brisbane
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast.,UQ Child Health Research Centre, University of Queensland, Brisbane
| | - Carl D Kirkwood
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Stephen B Lambert
- UQ Child Health Research Centre, University of Queensland, Brisbane.,Communicable Diseases Branch, Queensland Health, Brisbane
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Queensland, Australia.,Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Queensland, Australia
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Roczo-Farkas S, Kirkwood CD, Cowley D, Barnes GL, Bishop RF, Bogdanovic-Sakran N, Boniface K, Donato CM, Bines JE. The Impact of Rotavirus Vaccines on Genotype Diversity: A Comprehensive Analysis of 2 Decades of Australian Surveillance Data. J Infect Dis 2019; 218:546-554. [PMID: 29790933 DOI: 10.1093/infdis/jiy197] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/03/2018] [Indexed: 12/28/2022] Open
Abstract
Background Introduction of rotavirus vaccines into national immunization programs (NIPs) could result in strain selection due to vaccine-induced selective pressure. This study describes the distribution and diversity of rotavirus genotypes before and after rotavirus vaccine introduction into the Australian NIP. State-based vaccine selection facilitated a unique comparison of diversity in RotaTeq and Rotarix vaccine states. Methods From 1995 to 2015, the Australian Rotavirus Surveillance Program conducted genotypic analysis on 13051 rotavirus-positive samples from children <5 years of age, hospitalized with acute gastroenteritis. Rotavirus G and P genotypes were determined using serological and heminested multiplex reverse-transcription polymerase chain reaction assays. Results G1P[8] was the dominant genotype nationally in the prevaccine era (1995-2006). Following vaccine introduction (2007-2015), greater genotype diversity was observed with fluctuating genotype dominance. Genotype distribution varied based on the vaccine implemented, with G12P[8] dominant in states using RotaTeq, and equine-like G3P[8] and G2P[4] dominant in states and territories using Rotarix. Conclusions The increased diversity and differences in genotype dominance observed in states using RotaTeq (G12P[8]), and in states and territories using Rotarix (equine-like G3P[8] and G2P[4]), suggest that these vaccines exert different immunological pressures that influence the diversity of rotavirus strains circulating in Australia.
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Affiliation(s)
- Susie Roczo-Farkas
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Carl D Kirkwood
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Daniel Cowley
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Graeme L Barnes
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville
| | - Ruth F Bishop
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Nada Bogdanovic-Sakran
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Karen Boniface
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Celeste M Donato
- Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - Julie E Bines
- Enteric Virus Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington
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7
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Ioannides S, Beard F, Larter N, Clark K, Wang H, Hendry A, Hull B, Dey A, Chiu C, Brotherton J, Jayasinghe S, Macartney K, McIntyre P. Vaccine Preventable Diseases and Vaccination Coverage in Aboriginal and Torres Strait Islander People, Australia, 2011–2015. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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8
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Fujii Y, Doan YH, Wahyuni RM, Lusida MI, Utsumi T, Shoji I, Katayama K. Improvement of Rotavirus Genotyping Method by Using the Semi-Nested Multiplex-PCR With New Primer Set. Front Microbiol 2019; 10:647. [PMID: 30984154 PMCID: PMC6449864 DOI: 10.3389/fmicb.2019.00647] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/14/2019] [Indexed: 12/24/2022] Open
Abstract
Rotavirus A (RVA) is a major cause of gastroenteritis in infants and young children. After vaccine introduction, RVA surveillance has become more important for monitoring changes in genotype distribution, and the semi-nested multiplex-PCR is a popular method for RVA genotyping. In particular, the VP7 primer set reported by Gouvea and colleagues in 1990 is still widely used worldwide as the recommended WHO primer set in regional and national reference RVA surveillance laboratories. However, this primer set yielded some mistakes with recent epidemic strains. The newly emerged equine-like G3 strains were mistyped as G1, G8 strains were mistyped as G3, the G9 lineage 3 strains showed very weak band, and the G9 lineage 6 strains showed a G9-specific band and a non-specific band. Gouvea’s standard protocol has become relatively unreliable for identifying genotypes correctly. To overcome this limitation, we redesigned the primer set to include recent epidemic strains. Our new primer set enabled us to correctly identify the VP7 genotypes of representative epidemic strains by agarose gel electrophoresis (G1, G2, human typical G3, equine-like G3, G4, G8, G9, and G12). We believe that the multiplex-PCR method with our new primer set is a useful and valuable tool for surveillance of RVA epidemics.
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Affiliation(s)
- Yoshiki Fujii
- Laboratory of Viral Infection I, Department of Infection Control and Immunology, Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yen Hai Doan
- Laboratory of Viral Infection I, Department of Infection Control and Immunology, Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Rury Mega Wahyuni
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Maria Inge Lusida
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Takako Utsumi
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia.,Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ikuo Shoji
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiko Katayama
- Laboratory of Viral Infection I, Department of Infection Control and Immunology, Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan.,Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
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9
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Fujii Y, Doan YH, Suzuki Y, Nakagomi T, Nakagomi O, Katayama K. Study of Complete Genome Sequences of Rotavirus A Epidemics and Evolution in Japan in 2012-2014. Front Microbiol 2019; 10:38. [PMID: 30766516 PMCID: PMC6365416 DOI: 10.3389/fmicb.2019.00038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/10/2019] [Indexed: 11/13/2022] Open
Abstract
A comprehensive molecular epidemiological study using next-generation sequencing technology was conducted on 333 rotavirus A (RVA)-positive specimens collected from six sentinel hospitals across Japan over three consecutive seasons (2012–2014). The majority of the RVA isolates were grouped into five genotype constellations: Wa-like G1P[8], DS-1-like G1P[8], G2P[4], G3P[8] and G9P[8]. Phylogenetic analysis showed that the distribution of strains varied by geographical locations and epidemic seasons. The VP7 genes of different G types were estimated to evolve at 7.26 × 10-4–1.04 × 10-3 nucleotide substitutions per site per year. The Bayesian time-scaled tree of VP7 showed that the time to the most recent common ancestor of epidemic strains within a region was 1–3 years, whereas that of the epidemic strains across the country was 2–6 years. This study provided, for the first time, the timeframe during which an epidemic strain spread locally and within the country and baseline information needed to predict how rapidly RVAs spread.
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Affiliation(s)
- Yoshiki Fujii
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yen Hai Doan
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshiyuki Suzuki
- Graduate School of Natural Sciences, Nagoya City University, Nagoya, Japan
| | - Toyoko Nakagomi
- Department of Hygiene and Molecular Epidemiology, Nagasaki University, Nagasaki, Japan
| | - Osamu Nakagomi
- Department of Hygiene and Molecular Epidemiology, Nagasaki University, Nagasaki, Japan
| | - Kazuhiko Katayama
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan.,Laboratory of Viral Infection I, Kitasato University, Tokyo, Japan
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10
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Fu C, Dong Z, Shen J, Yang Z, Liao Y, Hu W, Pei S, Shaman J. Rotavirus Gastroenteritis Infection Among Children Vaccinated and Unvaccinated With Rotavirus Vaccine in Southern China: A Population-Based Assessment. JAMA Netw Open 2018; 1:e181382. [PMID: 30646128 PMCID: PMC6324266 DOI: 10.1001/jamanetworkopen.2018.1382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Since 2000, the Lanzhou lamb rotavirus vaccine has been exclusively licensed in China for voluntary rotavirus gastroenteritis (RV-GE) prevention. OBJECTIVE To evaluate the association of the Lanzhou lamb rotavirus vaccination with RV-GE among children in southern China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, ecological study was set in Guangzhou, China. Participants were infants possibly vaccinated (aged 2 months to 3 years) and the children ineligible for vaccination (aged ≥4 years). The study was conducted from May 1, 2007, to April 30, 2016, and the data analysis was conducted in July 2016. MAIN OUTCOMES AND MEASURES Annual median age at onset of RV-GE and seasonal distribution of incidence. Cases of RV-GE in Guangzhou, China, diagnosed from May 1, 2007, to April 30, 2016, and reported to the National Information System for Disease Control and Prevention were examined. Poisson regression models were fitted among 32 452 children younger than 4 years and among 450 children who had been ineligible for vaccination, while controlling for secular trends, socioeconomic status, and meteorological factors. Logistic regression was used to assess the indirect effects provided by the vaccinated infants from 2009 to 2011 on unvaccinated infants aged 2 to 35 months based on a separate case-control data set. RESULTS During 9 seasons, 119 705 patients with gastroenteritis were reported; 33 407 were confirmed for RV-GE (21 202 [63.5%] male, 32 022 [95.8%] aged <4 years, and 31 306 [93.8%] residing in urban districts). The median age at onset for all patients with RV-GE increased from 11 months during the 2007 season to 15 months during the 2015 season, and the onset, peak, and cessation of incidence were delayed. When citywide vaccination coverage in the prior 12 months was classified into high and low groups (≥8.36% vs <8.36%), the incidence rate ratio for the high coverage group decreased by 32.4% among children younger than 4 years (incidence rate ratio, 0.676; 95% CI, 0.659-0.693; P < .001). Among the children ineligible for vaccination, the incidence rate ratio in higher coverage periods was 0.790 (95% CI, 0.351-0.915; P < .001) compared with the lower coverage. Compared with districts with 14% or less vaccination coverage, the adjusted odds ratio for RV-GE among unvaccinated children younger than 3 years was 0.85 (95% CI, 0.73-0.99; P = .03) for districts with 15% to 19% of coverage, and 0.79 (95% CI, 0.67-0.93; P = .004) for districts with more than 20% of coverage. CONCLUSIONS AND RELEVANCE This study provides evidence of the population health benefits of the Lanzhou lamb rotavirus vaccination in preventing RV-GE among children in China younger than 4 years, including herd effects.
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Affiliation(s)
- Chuanxi Fu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiqiang Dong
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jichuan Shen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Ying Liao
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wensui Hu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Hungerford D, Vivancos R, Read JM, Iturriza-Gόmara M, French N, Cunliffe NA. Rotavirus vaccine impact and socioeconomic deprivation: an interrupted time-series analysis of gastrointestinal disease outcomes across primary and secondary care in the UK. BMC Med 2018; 16:10. [PMID: 29375036 PMCID: PMC5787923 DOI: 10.1186/s12916-017-0989-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Vaccination is free of charge to parents, with two doses delivered at 8 and 12 weeks of age. We evaluated vaccine impact across a health system in relation to socioeconomic deprivation. METHODS We used interrupted time-series analyses to assess changes in monthly health-care attendances in Merseyside, UK, for all ages, from July 2013 to June 2016, compared to predicted counterfactual attendances without vaccination spanning 3-11 years pre-vaccine. Outcome measures included laboratory-confirmed rotavirus gastroenteritis (RVGE) hospitalisations, acute gastroenteritis (AGE) hospitalisations, emergency department (ED) attendances for gastrointestinal conditions and consultations for infectious gastroenteritis at community walk-in centres (WIC) and general practices (GP). All analyses were stratified by age. Hospitalisations were additionally stratified by vaccine uptake and small-area-level socioeconomic deprivation. RESULTS The uptake of the first and second doses of rotavirus vaccine was 91.4% (29,108/31,836) and 86.7% (27,594/31,836), respectively. Among children aged < 5 years, the incidence of gastrointestinal disease decreased across all outcomes post-vaccine introduction: 80% (95% confidence interval [CI] 70-87%; p < 0.001) for RVGE hospitalisation, 44% (95% CI 35-53%; p < 0.001) for AGE hospitalisations, 23% (95% CI 11-33%; p < 0.001) for ED, 32% (95% CI 7-50%; p = 0.02) for WIC and 13% (95% CI -3-26%; p = 0.10) for GP. The impact was greatest during the rotavirus season and for vaccine-eligible age groups. In adults aged 65+ years, AGE hospitalisations fell by 25% (95% CI 19-30%; p < 0.001). The pre-vaccine risk of AGE hospitalisation was highest in the most socioeconomically deprived communities (adjusted incident rate ratio 1.57; 95% CI 1.51-1.64; p < 0.001), as was the risk for non-vaccination (adjusted risk ratio 1.54; 95% CI 1.34-1.75; p < 0.001). The rate of AGE hospitalisations averted per 1,000 first doses of vaccine was higher among infants in the most deprived communities compared to the least deprived in 2014/15 (28; 95% CI 25-31 vs. 15; 95% CI 12-17) and in 2015/16 (26; 95% CI 23-30 vs. 13; 95% CI 11-16). CONCLUSIONS Following the introduction of rotavirus vaccination, incidence of gastrointestinal disease reduced across the health-care system. Vaccine impact was greatest among the most deprived populations, despite lower vaccine uptake. Prioritising vaccine uptake in socioeconomically deprived communities should give the greatest health benefit in terms of population disease burden.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK. .,Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.,Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Miren Iturriza-Gόmara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, L12 2AP, Liverpool, UK
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12
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Rotavirus Infection in the Auckland Region After the Implementation of Universal Infant Rotavirus Vaccination: Impact on Hospitalizations and Laboratory Implications. Pediatr Infect Dis J 2018; 37:e1-e5. [PMID: 28746261 DOI: 10.1097/inf.0000000000001706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In July 2014, New Zealand introduced universal infant vaccination with RotaTeq (Merk & Co.) administered as 3 doses at 6 weeks, 3 and 5 months of age. We sought to assess the impact of rotavirus vaccination on gastroenteritis (GE) hospitalizations in the greater Auckland region and analyze changes in rotavirus testing in the period around vaccine introduction. METHODS Hospitalizations, laboratory testing rates and methods were compared between the pre-vaccine period (2009-2013), post-vaccine period (January 2015 to December 2015) and year of vaccine introduction (2014). RESULTS There was a 68% decline in rotavirus hospitalizations of children <5 years of age after vaccine introduction (from 258/100,000 to 83/100,000) and a 17% decline in all-cause gastroenteritis admissions (from 1815/100,000 to 1293/100,000). Reductions were also seen in pediatric groups too old to have received vaccine. Despite these changes, rotavirus testing rates in our region remained static in the year after vaccine introduction compared with the 2 prior years, and after vaccine introduction, we observed a high rate of false positives 19/58 (33%) in patients with reactive rotavirus tests. CONCLUSIONS Rotavirus vaccine has had a significant early impact on gastroenteritis hospitalizations for children in the Auckland region. However, continued rotavirus testing at pre-vaccine rates risks generating false positive results. Laboratories and clinicians should consider reviewing their testing algorithms before vaccine introduction.
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13
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Reyes JF, Wood JG, Beutels P, Macartney K, McIntyre P, Menzies R, Mealing N, Newall AT. Beyond expectations: Post-implementation data shows rotavirus vaccination is likely cost-saving in Australia. Vaccine 2017; 35:345-352. [PMID: 27916411 DOI: 10.1016/j.vaccine.2016.11.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Universal vaccination against rotavirus was included in the funded Australian National Immunisation Program in July 2007. Predictive cost-effectiveness models assessed the program before introduction. METHODS We conducted a retrospective economic evaluation of the Australian rotavirus program using national level post-implementation data on vaccine uptake, before-after measures of program impact and published estimates of excess intussusception cases. These data were used as inputs into a multi-cohort compartmental model which assigned cost and quality of life estimates to relevant health states, adopting a healthcare payer perspective. The primary outcome was discounted cost per quality adjusted life year gained, including or excluding unspecified acute gastroenteritis (AGE) hospitalisations. RESULTS Relative to the baseline period (1997-2006), over the 6years (2007-2012) after implementation of the rotavirus program, we estimated that ∼77,000 hospitalisations (17,000 coded rotavirus and 60,000 unspecified AGE) and ∼3 deaths were prevented, compared with an estimated excess of 78 cases of intussusception. Approximately 90% of hospitalisations prevented were in children <5years, with evidence of herd protection in older age groups. The program was cost-saving when observed changes (declines) in both hospitalisations coded as rotavirus and as unspecified AGE were attributed to the rotavirus vaccine program. The adverse impact of estimated excess cases of intussusception was far outweighed by the benefits of the program. CONCLUSION The inclusion of herd impact and declines in unspecified AGE hospitalisations resulted in the value for money achieved by the Australian rotavirus immunisation program being substantially greater than predicted bypre-implementation models, despite the potential increased cases of intussusception. This Australian experience is likely to be relevant to high-income countries yet to implement rotavirus vaccination programs.
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Affiliation(s)
- J F Reyes
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J G Wood
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - P Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - K Macartney
- Discipline of Child and Adolescent Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - P McIntyre
- Discipline of Child and Adolescent Health and School of Public Health, University of Sydney, NSW, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Kids Research Institute, Children's Hospital at Westmead, NSW, Australia
| | - R Menzies
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - N Mealing
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A T Newall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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14
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de Deus N, Chilaúle JJ, Cassocera M, Bambo M, Langa JS, Sitoe E, Chissaque A, Anapakala E, Sambo J, Guimarães EL, Bero DM, João ED, Cossa-Moiane I, Mwenda JM, Weldegebriel GG, Parashar UD, Tate JE. Early impact of rotavirus vaccination in children less than five years of age in Mozambique. Vaccine 2017; 36:7205-7209. [PMID: 29128381 DOI: 10.1016/j.vaccine.2017.10.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mozambique introduced rotavirus vaccine (Rotarix, GSK Biologicals) in the National Immunization Program in September 2015 with the objective of reducing the burden of total diarrheal disease and specifically severe rotavirus disease. This study aimed to evaluate the early impact of rotavirus vaccine in reducing all-cause diarrhea and rotavirus-specific hospitalizations. METHODS We analysed stool specimens collected from children under five years old, between January 2014 and June 2017 within the National Surveillance for Acute Diarrhea. We compared annual changes in rotavirus positivity, median age of children hospitalized for rotavirus and the number of all-cause for diarrheal hospitalizations. Rotavirus detection was performed using enzyme immunoassay. RESULTS During this period, 1296 samples were collected and analyzed. Rotavirus positivity before vaccine introduction was 40.2% (39/97) in 2014 and 38.3% (225/588) in 2015, then after vaccine introduction reduced to 12.2% and 13.5% in 2016 and 2017, respectively. The median age of children hospitalized for rotavirus was 9 and 11 months in 2014 and 2015 and 10 months in 2016 and 2017. Rotavirus hospitalizations exhibited a seasonal peak prior to vaccine introduction, between June and September in 2014 and 2015, coinciding with winter period in Mozambique. After vaccine introduction, the peak was delayed until August to December in 2016 and was substantially diminished. There was a reduction in all-cause acute diarrhea hospitalizations in children aged 0-11 months after vaccine introduction. CONCLUSION We observed a reduction in rotavirus positivity and in the number of all-cause diarrhea hospitalizations after vaccine introduction. The data suggest rotavirus vaccine is having a positive impact on the control of rotavirus diarrheal disease in Mozambique.
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Affiliation(s)
- Nilsa de Deus
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
| | | | - Marta Cassocera
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Miguel Bambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Ezequias Sitoe
- Hospital Central de Nampula, Ministério da Saúde, Nampula, Mozambique
| | | | - Elda Anapakala
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | | | - Eva Dora João
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique; Institute of Hygiene and Tropical Medicine, New University of Lisbon, Lisbon, Portugal
| | | | - Jason M Mwenda
- World Health Organization (WHO), Regional Office for Africa, Brazzaville, People's Republic of Congo
| | | | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Rahajamanana VL, Raboba JL, Rakotozanany A, Razafindraibe NJ, Andriatahirintsoa EJPR, Razafindrakoto AC, Mioramalala SA, Razaiarimanga C, Weldegebriel GG, Burnett E, Mwenda JM, Seheri M, Mphahlele MJ, Robinson AL. Impact of rotavirus vaccine on all-cause diarrhea and rotavirus hospitalizations in Madagascar. Vaccine 2017; 36:7198-7204. [PMID: 28958809 DOI: 10.1016/j.vaccine.2017.08.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rotavirus vaccine was introduced into the Extended Program on Immunization in Madagascar in May 2014. We analyzed trends in prevalence of all cause diarrhea and rotavirus hospitalization in children <5years of age before and after vaccine introduction and assessed trend of circulating rotavirus genotypes at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET). METHODS From January 2010 to December 2016, we reviewed the admission logbook to observe the rate of hospitalization caused by gastroenteritis among 19619 children <5years of age admitted at the hospital. In June 2013-December 2016, active rotavirus surveillance was also conducted at CHUMET with support from WHO. Rotavirus antigen was detected by EIA from stool specimen of children who are eligible for rotavirus gastroenteritis surveillance at sentinel site laboratory and rotavirus positive specimens were further genotyped at Regional Reference Laboratory by RT-PCR. RESULTS Diarrhea hospitalizations decreased after rotavirus vaccine introduction. The median proportion of annual hospitalizations due to diarrhea was 26% (range: 31-22%) before vaccine introduction; the proportion was 25% the year of vaccine introduction, 17% in 2015 and 16% in 2016. Rotavirus positivity paralleled patterns observed in diarrhea. Before vaccine introduction, 56% of stool specimens tested positive for rotavirus; the percent positive was 13% in 2015, 12% in 2016. Diverse genotypes were detected in the pre-vaccine period; the most common were G3P[8] (n=53; 66%), G2P[4] (n=12; 15%), and G1P[8] (n=11; 14%). 6 distinct genotypes were found in 2015; the most common genotype was G2P[4] (n=10; 67%), the remaining, 5, G12[P8], G3[P8], G1G3[P4], G3G12[P4][P8] and G1G3[NT] had one positive specimen each. CONCLUSIONS Following rotavirus vaccine introduction all-cause diarrhea and rotavirus-specific hospitalizations declined dramatically. The most common genotypes detected in the pre-vaccine period were G3P[8] and G2P[4] in 2015, the post vaccine period.
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Affiliation(s)
- V L Rahajamanana
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar.
| | - J L Raboba
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - A Rakotozanany
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - N J Razafindraibe
- Teaching Hospital, Centre Hospitalier Universitaire Andohatapenaka, Antananarivo, Madagascar
| | | | - A C Razafindrakoto
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - S A Mioramalala
- National Malaria Country Program, Public Health Ministry, Antananarivo, Madagascar
| | | | - G G Weldegebriel
- WHO Inter-Country Support Team: East and Southern Africa (WHO IST/ESA), Harare, Zimbabwe
| | - E Burnett
- Foundation for the Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, USA
| | - J M Mwenda
- World Health Organization (WHO) Regional Office for Africa (WHO/AFRO), Brazzaville, Congo
| | - M Seheri
- Regional Rotavirus Reference Laboratory, SAMRC/Diarrheal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - M J Mphahlele
- Regional Rotavirus Reference Laboratory, SAMRC/Diarrheal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - A L Robinson
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
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16
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Kotirum S, Vutipongsatorn N, Kongpakwattana K, Hutubessy R, Chaiyakunapruk N. Global economic evaluations of rotavirus vaccines: A systematic review. Vaccine 2017; 35:3364-3386. [PMID: 28504193 DOI: 10.1016/j.vaccine.2017.04.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted. METHODS We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs. RESULTS 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings. CONCLUSION Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.
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Affiliation(s)
- Surachai Kotirum
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Social and Administrative Pharmacy Department, Faculty of Pharmacy, Rangsit University, Muang, Pathumthani, Thailand
| | - Naaon Vutipongsatorn
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | | | - Raymond Hutubessy
- World Health Organization, Initiative for Vaccine Research, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, USA; Health and Well-being Cluster, Global Asia in the 21(st) Centuary (GA21) Platform, Monash University Malaysia, Selangor, Malaysia.
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17
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Ngabo F, Tate JE, Gatera M, Rugambwa C, Donnen P, Lepage P, Mwenda JM, Binagwaho A, Parashar UD. Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis. LANCET GLOBAL HEALTH 2016; 4:e129-36. [PMID: 26823214 DOI: 10.1016/s2214-109x(15)00270-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/22/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings. METHODS We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals. FINDINGS Compared with the 2009-11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17-29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48-49%, and admissions specific to rotavirus captured by active surveillance fell by 61-70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group. INTERPRETATION The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings. FUNDING Gavi, the Vaccine Alliance and the Government of Rwanda.
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Affiliation(s)
- Fidele Ngabo
- Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium.
| | | | | | - Celse Rugambwa
- World Health Organization, Rwanda Office, Kigali, Rwanda
| | - Philippe Donnen
- Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium
| | - Philippe Lepage
- Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Jason M Mwenda
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Agnes Binagwaho
- Ministry of Health, Kigali, Rwanda; Harvard Medical School, Boston, MA, USA; Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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18
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Burnett E, Yen C, Tate JE, Parashar UD. Rotavirus vaccines: current global impact and future perspectives. Future Virol 2016; 11:699-708. [PMID: 27840654 PMCID: PMC5102270 DOI: 10.2217/fvl-2016-0082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 11/21/2022]
Abstract
As of May 2016, 81 countries have introduced Rotarix or RotaTeq rotavirus vaccines into their national immunization program. Despite initially slow uptake in some countries and differences in vaccine effectiveness (VE) between high-, low- and middle-income countries, impact of the vaccines has been swift and striking in all settings, with good VE against vaccine-type and nonvaccine-type strains. Newly published research indicates poor nutrition is associated with decreased VE and breastfeeding at the time of vaccination does not affect vaccine response. Vaccines in development and proposed alternate schedules also promise to address limitations of the current vaccines and optimize rotavirus disease prevention.
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Affiliation(s)
- Eleanor Burnett
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Catherine Yen
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Jacqueline E Tate
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Umesh D Parashar
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
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Wilson SE, Rosella LC, Wang J, Le Saux N, Crowcroft NS, Harris T, Bolotin S, Deeks SL. Population-Level Impact of Ontario's Infant Rotavirus Immunization Program: Evidence of Direct and Indirect Effects. PLoS One 2016; 11:e0154340. [PMID: 27168335 PMCID: PMC4864308 DOI: 10.1371/journal.pone.0154340] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/11/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the direct and indirect population impact of rotavirus (RV) immunization on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) in Ontario before and after the publicly-funded RV immunization program. METHODS Administrative data was used to identify ED visits and hospitalizations for all Ontarians using ICD-10 codes. We used two outcome definitions: RV-specific AGE (RV-AGE) and codes representing RV-, other viral and cause unspecified AGE ("overall AGE"). The pre-program and public program periods were August 1, 2005 to July 31, 2011; and August 1, 2011 to March 31, 2013, respectively. A negative binominal regression model that included the effect of time was used to calculate rates and rate ratios (RRs) and 95% confidence intervals (CIs) for RV-AGE and overall AGE between periods, after adjusting for age, seasonality and secular trends. Analyses were conducted for all ages combined and age stratified. RESULTS Relative to the pre-program period, the adjusted RRs for RV-AGE and overall AGE hospitalizations in the public program period were 0.29 (95%CI: 0.22-0.39) and 0.68 (95%CI: 0.62-0.75), respectively. Significant reductions in RV-AGE hospitalizations were noted overall and for the following age bands: < 12 months, 12-23 months, 24-35 months, 3-4 years, and 5-19 years. Significant declines in overall AGE hospitalizations were observed across all age bands, including older adults > = 65 years (RR 0.80, 95%CI: 0.72-0.90). The program was associated with adjusted RRs of 0.32 (95% CI: 0.20-0.52) for RV-AGE ED visits and 0.90 (95% CI: 0.85-0.96) for overall AGE ED visits. CONCLUSIONS This large, population-based study provides evidence of the impact of RV vaccine in preventing hospitalizations and ED visits for RV-AGE and overall AGE, including herd effects.
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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
| | - Nicole Le Saux
- Division of Infectious Disease, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Natasha S. Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, 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
| | - 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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Mealing N, Hayen A, Newall AT. Assessing the impact of vaccination programmes on burden of disease: Underlying complexities and statistical methods. Vaccine 2016; 34:3022-3029. [PMID: 27156635 DOI: 10.1016/j.vaccine.2016.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Abstract
It is important to assess the impact a vaccination programme has on the burden of disease after it is implemented. For example, this may reveal herd immunity effects or vaccine-induced shifts in the incidence of disease or in circulating strains or serotypes of the pathogen. In this article we summarise the key features of infectious diseases that need to be considered when trying to detect any changes in the burden of diseases at a population level as a result of vaccination efforts. We outline the challenges of using routine surveillance databases to monitor infectious diseases, such as the identification of diseased cases and the availability of vaccination status for cases. We highlight the complexities in modelling the underlying patterns in infectious disease rates (e.g. presence of autocorrelation) and discuss the main statistical methods that can be used to control for periodicity (e.g. seasonality) and autocorrelation when assessing the impact of vaccination programmes on burden of disease (e.g. cosinor terms, generalised additive models, autoregressive processes and moving averages). For some analyses, there may be multiple methods that can be used, but it is important for authors to justify the method chosen and discuss any limitations. We present a case study review of the statistical methods used in the literature to assess the rotavirus vaccination programme impact in Australia. The methods used varied and included generalised linear models and descriptive statistics. Not all studies accounted for autocorrelation and seasonality, which can have a major influence on results. We recommend that future analyses consider the strength and weakness of alternative statistical methods and justify their choice.
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Affiliation(s)
- Nicole Mealing
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Andrew Hayen
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
| | - Anthony T Newall
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, Australia.
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Mpabalwani EM, Simwaka CJ, Mwenda JM, Mubanga CP, Monze M, Matapo B, Parashar UD, Tate JE. Impact of Rotavirus Vaccination on Diarrheal Hospitalizations in Children Aged <5 Years in Lusaka, Zambia. Clin Infect Dis 2016; 62 Suppl 2:S183-7. [DOI: 10.1093/cid/civ1027] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sartori AMC, Nascimento ADF, Yuba TY, Soárez PCD, Novaes HMD. Methods and challenges for the health impact assessment of vaccination programs in Latin America. Rev Saude Publica 2016; 49:S0034-89102015000100410. [PMID: 26759964 PMCID: PMC4687821 DOI: 10.1590/s0034-8910.2015049006058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/12/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms “rotavirus”, “pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and “impact” in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.
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Affiliation(s)
- Ana Marli Christovam Sartori
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Tânia Yuka Yuba
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Comeau JL, Gagneur A, Quach C. Impact of a publicly funded monovalent rotavirus vaccination program in the Province of Quebec (Canada). Vaccine 2016; 34:893-8. [PMID: 26795368 DOI: 10.1016/j.vaccine.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED In November 2011, the province of Quebec, Canada implemented a publicly funded rotavirus (RV) vaccination program using the monovalent RV vaccine (RV1). To assess its impact, trends in passive RV laboratory detection and Emergency Department (ED) visits for gastroenteritis (GE) at two pediatric centers were evaluated. METHODS RV tests performed were extracted from the virology laboratory databases and ED visits for GE between July 1, 2006 and June 30, 2013, from the ED databases of The Montreal Children's Hospital (MCH) and Centre Hospitalier Universitaire de Sherbrooke (CHUS). The percent positive RV tests over time and season duration were assessed using 5-week moving averages. We defined season start and end as the first two and the last two consecutive weeks where the percent positive RV tests were ≥ 10%, respectively. RESULTS Comparing the pre- and post-vaccination program periods, a decrease in the proportion of positive RV tests was seen: 15.9% vs. 5.1% (p<0.001). Pre-vaccination program, RV seasons started between December and February, peaked in March or April and ended in May. In 2011-2012, the season started in March, peaked in April, and ended in May. In 2012-2013, the season lasted 3 weeks in May. ED visits for GE decreased post-introduction of the RV1 program: from 4.8% to 3.4% in 2011-2012, and 4.2% in 2012-13 (p<0.001). In children <2 years of age, ED GE visits decreased from 7.5% to 4.8% in 2011-2012, and 5.2% in 2012-2013 (p<0.001). Admissions for GE also decreased significantly from 0.41% of all ED visits to 0.14% in 2011-2012 and 0.22% in 2012-2013 (p<0.005). CONCLUSION Implementation of a publicly funded RV vaccination program had a major impact on the epidemiology of RV infections in Quebec: RV seasons have started later and been of shorter duration, peak positives were fewer, and ED visits for GE decreased.
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Affiliation(s)
- Jeannette L Comeau
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada.
| | - Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke (QC) J1H 5N4, Canada.
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada; Division des risques biologiques et de la santé au travail - Institut national de santé publique du Québec, 190 Crémazie Blvd E., Montreal (QC) H2P 1E2, Canada; Department of Epidemiology, Biostatistics, and Occupational Health - McGill University, 1020 Pine Avenue W, Montreal (QC) H3A 1A2, Canada; MUHC Vaccine Study Centre, 14770 Pierrefonds Blvd, Suite 204, Montreal (QC) H9H 4Y6, Canada.
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Value of Post-Licensure Data on Benefits and Risks of Vaccination to Inform Vaccine Policy: The Example of Rotavirus Vaccines. Am J Prev Med 2015; 49:S377-82. [PMID: 26590437 DOI: 10.1016/j.amepre.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 1999, the first rhesus-human reassortant rotavirus vaccine licensed in the U.S. was withdrawn within a year of its introduction after it was linked with intussusception at a rate of ~1 excess case per 10,000 vaccinated infants. While clinical trials of 60,000-70,000 infants of each of the two current live oral rotavirus vaccines, RotaTeq (RV5) and Rotarix (RV1), did not find an association with intussusception, post-licensure studies have documented a risk in several high and middle income countries, at a rate of ~1-6 excess cases per 100,000 vaccinated infants. However, considering this low risk against the large health benefits of vaccination that have been observed in many countries, including in countries with a documented vaccine-associated intussusception risk, policy makers and health organizations around the world continue to support the routine use of RV1 and RV5 in national infant immunization programs. Because the risk and benefit data from affluent settings may not be directly applicable to developing countries, further characterization of any associated intussusception risk following rotavirus vaccination as well as the health benefits of vaccination is desirable for low income settings.
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Value of post-licensure data on benefits and risks of vaccination to inform vaccine policy: The example of rotavirus vaccines. Vaccine 2015; 33 Suppl 4:D55-9. [DOI: 10.1016/j.vaccine.2015.05.094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/19/2022]
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Wilson SE, Deeks SL, Rosella LC. Importance of ICD-10 coding directive change for acute gastroenteritis (unspecified) for rotavirus vaccine impact studies: illustration from a population-based cohort study from Ontario, Canada. BMC Res Notes 2015; 8:439. [PMID: 26374397 PMCID: PMC4570676 DOI: 10.1186/s13104-015-1412-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ontario, Canada, we conducted an evaluation of rotavirus (RV) vaccine on hospitalizations and Emergency Department (ED) visitations for acute gastroenteritis (AGE). In our original analysis, any one of the International Classification of Disease, Version 10 (ICD-10) codes was used for outcome ascertainment: RV-specific- (A08.0), viral- (A08.3, A08. 4, A08.5), and unspecified infectious- gastroenteritis (A09). Annual age-specific rates per 10,000 population were calculated. FINDINGS The average monthly rate of AGE hospitalization for children under age two increased from 0.82 per 10,000 from January 2003 to March 2009, to 2.35 over the period of April 2009 to March 31, 2013. Similar trends were found for ED consultations and in other age groups. A rise in events corresponding to the A09 code was found when the outcome definition was disaggregated by ICD-10 code. Documentation obtained from the World Health Organization confirmed that a change in directive for the classification of unspecified gastroenteritis occurred with the release of ICD-10 in April 2009. AGE events previously classified under the code K52.9, are now classified under code A09.9. CONCLUSIONS Based on change in the classification of unspecified gastroenteritis we modified our outcome definition to also include unspecified non-infectious-gastroenteritis (K52.9). We recommend other investigators consider using both A09.9 and K52.9 ICD-10 codes for outcome ascertainment in future rotavirus vaccine impact studies to ensure that all unspecified cases of AGE are captured, especially if the study period spans 2009.
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Affiliation(s)
- Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Laura C Rosella
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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Zeller M, Donato C, Trovão NS, Cowley D, Heylen E, Donker NC, McAllen JK, Akopov A, Kirkness EF, Lemey P, Van Ranst M, Matthijnssens J, Kirkwood CD. Genome-Wide Evolutionary Analyses of G1P[8] Strains Isolated Before and After Rotavirus Vaccine Introduction. Genome Biol Evol 2015; 7:2473-83. [PMID: 26254487 PMCID: PMC4607516 DOI: 10.1093/gbe/evv157] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rotaviruses are the most important etiological agent of acute gastroenteritis in young children worldwide. Among the first countries to introduce rotavirus vaccines into their national immunization programs were Belgium (November 2006) and Australia (July 2007). Surveillance programs in Belgium (since 1999) and Australia (since 1989) offer the opportunity to perform a detailed comparison of rotavirus strains circulating pre- and postvaccine introduction. G1P[8] rotaviruses are the most prominent genotype in humans, and a total of 157 G1P[8] rotaviruses isolated between 1999 and 2011 were selected from Belgium and Australia and their complete genomes were sequenced. Phylogenetic analysis showed evidence of frequent reassortment among Belgian and Australian G1P[8] rotaviruses. Although many different phylogenetic subclusters were present before and after vaccine introduction, some unique clusters were only identified after vaccine introduction, which could be due to natural fluctuation or the first signs of vaccine-driven evolution. The times to the most recent common ancestors for the Belgian and Australian G1P[8] rotaviruses ranged from 1846 to 1955 depending on the gene segment, with VP7 and NSP4 resulting in the most recent estimates. We found no evidence that rotavirus population size was affected after vaccine introduction and only six amino acid sites in VP2, VP3, VP7, and NSP1 were identified to be under positive selective pressure. Continued surveillance of G1P[8] strains is needed to determine long-term effects of vaccine introductions, particularly now rotavirus vaccines are implemented in the national immunization programs of an increasing number of countries worldwide.
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Affiliation(s)
- Mark Zeller
- Laboratory of Clinical Virology, University of Leuven, Leuven, Belgium
| | - Celeste Donato
- Enteric Virus Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia Department of Microbiology, La Trobe University, Bundoora, VIC, Australia
| | - Nídia Sequeira Trovão
- Laboratory Evolutionary and Computational Virology, University of Leuven, Leuven, Belgium
| | - Daniel Cowley
- Enteric Virus Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Elisabeth Heylen
- Laboratory of Clinical Virology, University of Leuven, Leuven, Belgium
| | - Nicole C Donker
- Enteric Virus Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | | | - Asmik Akopov
- Laboratory Evolutionary and Computational Virology, University of Leuven, Leuven, Belgium
| | | | - Philippe Lemey
- Laboratory Evolutionary and Computational Virology, University of Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Laboratory of Clinical Virology, University of Leuven, Leuven, Belgium
| | | | - Carl D Kirkwood
- Enteric Virus Research Group, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia Department of Microbiology, La Trobe University, Bundoora, VIC, Australia
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Davey HM, Muscatello DJ, Wood JG, Snelling TL, Ferson MJ, Macartney KK. Impact of high coverage of monovalent human rotavirus vaccine on Emergency Department presentations for rotavirus gastroenteritis. Vaccine 2015; 33:1726-30. [DOI: 10.1016/j.vaccine.2015.01.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/15/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
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Alam MM, Khurshid A, Shaukat S, Rana MS, Sharif S, Angez M, Nisar N, Aamir UB, Naeem M, Zaidi SSZ. Viral etiologies of acute dehydrating gastroenteritis in pakistani children: confounding role of parechoviruses. Viruses 2015; 7:378-93. [PMID: 25609308 PMCID: PMC4306844 DOI: 10.3390/v7010378] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/16/2015] [Indexed: 11/22/2022] Open
Abstract
Despite substantial interventions in the understanding and case management of acute gastroenteritis, diarrheal diseases are still responsible for a notable amount of childhood deaths. Although the rotavirus is known to cause a considerable burden of pediatric diarrheal cases, the roles of other viruses remain undefined for the Pakistani population. This study was based on tertiary care hospital surveillance, from January 2009 to December 2010, including the detection of rotavirus, norovirus, astrovirus, and human parechovirus in children under the age of five using serological or molecular assays. Rotavirus, human parechovirus, norovirus, and astrovirus were detected in 66%, 21%, 19.5%, and 8.5% subjects, respectively. Human parechovirus genotypes, determined through analysis of VP1 gene sequences, showed a great diversity among co-circulating strains. Eighty percent of hospitalized children had dual or multiple viral infections, while 98% parechovirus positive cases were co-infected with rotavirus. The remarkable diversity of viruses associated with the childhood diarrhea in Pakistan calls for large-scale epidemiological surveys, coupled with case control studies, to ascertain their role in clinical manifestations. In addition, these findings also highlight the need for the implementation of up-to-date health interventions, such as the inclusion of a rotavirus vaccine in routine immunization programs for the improvement of quality in child health care.
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Affiliation(s)
| | - Adnan Khurshid
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Shahzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Muhammad Suleman Rana
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Mehar Angez
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Nadia Nisar
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Uzma Bashir Aamir
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
| | - Muhammad Naeem
- Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan.
| | - Syed Sohail Zahoor Zaidi
- Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan.
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Comparison of test specificities of commercial antigen-based assays and in-house PCR methods for detection of rotavirus in stool specimens. J Clin Microbiol 2014; 53:295-7. [PMID: 25339400 DOI: 10.1128/jcm.02251-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Seven commercial rotavirus antigen assays were compared with in-house PCR methods for detecting rotavirus in stool specimens. The assay sensitivities were 80% to 100%, while the specificities were 54.3% for one commercial immunochromatographic (ICT) method and 99.4% to 100% for other assays. Thus, except for one commercial ICT, all the assays were generally reliable for rotavirus detection.
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Disease burden of selected gastrointestinal pathogens in Australia, 2010. Int J Infect Dis 2014; 28:176-85. [PMID: 25281904 DOI: 10.1016/j.ijid.2014.08.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/07/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To estimate and compare disease burden attributable to six gastrointestinal pathogens (norovirus, rotavirus, Campylobacter, non-typhoidal Salmonella, Giardia, and Cryptosporidium) in Australia, 2010. METHODS We estimated the number of acute gastroenteritis (AGE) cases and deaths, disability-adjusted life years (DALYs), and DALY/case for each pathogen. We included AGE cases that did not require medical care. Sequelae were included for Campylobacter (Guillain-Barré syndrome, reactive arthritis (ReA), irritable bowel syndrome (IBS)) and Salmonella (ReA, IBS). RESULTS We estimated 16626069 AGE cases in Australia in 2010 (population 22 million). Of the pathogens studied, most AGE cases were attributed to norovirus (2180145), Campylobacter (774003), and Giardia (614740). Salmonella caused the fewest AGE cases (71255) but the most AGE deaths (90). The DALY burden was greatest for Campylobacter (18222 DALYs) and Salmonella (3856 DALYs), followed by the viral and protozoal pathogens. The average DALY/case was greatest for Salmonella (54.1 DALY/1000 cases), followed by Campylobacter (23.5 DALY/1000 cases). CONCLUSIONS The pathogen causing the greatest disease burden varied according to the metric used, however DALYs are considered most useful given the incorporation of morbidity, mortality, and sequelae. These results can be used to prioritize public health interventions toward Salmonella and Campylobacter infections and to measure the impact of these interventions.
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Weil-Olivier C, Millier A, Toumi M, Trichard M. Population access to rotavirus vaccination in industrialized countries: lessons learnt from current experience. Expert Rev Vaccines 2014; 13:1405-17. [PMID: 25142637 DOI: 10.1586/14760584.2014.943194] [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: 11/08/2022]
Abstract
BACKGROUND Four steps are usually necessary before population access to vaccination programmes. Marketing authorization, appropriation by national agencies of the data, recommendation and policy-decision steps on funding and implementation. Using rotavirus vaccination as an illustrative case, this study aims at better understanding picture of population access, and identifying lessons learnt from current experience. METHODS Systematic review of national vaccination policies in 20 countries. RESULTS 12 countries have included rotavirus vaccination in their childhood national vaccination programme, two decided not to include it, decision is pending in three countries, while it has not started in the three remaining countries. Published evaluations and/or advice were available in 16 countries. Many differences in content and outcomes were identified. CONCLUSION Rotavirus vaccination implementation across industrialized countries was disparate, leading to unequal population access over time. Comparative analyses of the decision-making process suggest different interpretations of available evidence, raising the need for a similar decision integrated framework, using a structured and systematic approach.
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Impact of rotavirus vaccine on premature infants. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1404-9. [PMID: 25080553 DOI: 10.1128/cvi.00265-14] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infants born preterm are at a higher risk of complications and hospitalization in cases of rotavirus diarrhea than children born at term. We evaluated the impact of a rotavirus vaccination campaign (May 2007 to May 2010) on hospitalizations for rotavirus gastroenteritis in a population of children under 3 years old born prematurely (before 37 weeks of gestation) in the Brest University Hospital birth zone. Active surveillance from 2002 to 2006 and a prospective collection of hospitalizations for rotavirus diarrhea were initiated in the pediatric units of Brest University Hospital until May 2010. Numbers of hospitalizations for rotavirus diarrhea among the population of children born prematurely, before and after the start of the vaccination program, were compared using a Poisson regression model controlling for epidemic-to-epidemic variation. A total of 217 premature infants were vaccinated from 2007 to 2010. Vaccine coverage for a complete course of three doses was 41.9%. The vaccine safety in premature infants was similar to that in term infants. The vaccination program led to a division by a factor of 2.6 (95% confidence interval [CI], 1.3 to 5.2) in the number of hospitalizations for rotavirus diarrhea during the first two epidemic seasons following vaccine introduction and by a factor of 11 (95% CI, 3.5 to 34.8) during the third season. We observed significant effectiveness of the pentavalent rotavirus vaccine on the number of hospitalizations in a population of prematurely born infants younger than 3 years of age. A multicenter national study would provide better assessment of this impact. (This study [Impact of Systematic Infants Vaccination Against Rotavirus on Gastroenteritis Hospitalization: a Prospective Study in Brest District, France (IVANHOE)] has been registered at ClinicalTrials.gov under registration no. NCT00740935.).
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Abstract
Vaccines are now available to combat rotavirus, the most common cause of severe diarrhea among children worldwide. We review clinical trial data for available rotavirus vaccines and summarize postlicensure data on effectiveness, impact, and safety from countries routinely using these vaccines in national programs. In these countries, rotavirus vaccines have reduced all-cause diarrhea and rotavirus hospitalizations by 17%-55% and 49%-92%, respectively, and all-cause diarrhea deaths by 22%-50% in some settings. Indirect protection of children who are age-ineligible for rotavirus vaccine has also been observed in some high and upper middle income countries. Experience with routine use of rotavirus vaccines in lower middle income countries has been limited to date, but vaccine introductions in such countries have been increasing in recent years. The risk-benefit analysis of rotavirus vaccines is extremely favorable but other strategies to improve the effectiveness of the vaccine, particularly in lower middle income settings, should be considered.
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Affiliation(s)
- Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Anca IA, Furtunescu FL, Pleşca D, Streinu-Cercel A, Rugină S, Holl K. Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children below five years of age in Romania. Germs 2014; 4:30-40. [PMID: 24967217 DOI: 10.11599/germs.2014.1053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/19/2014] [Accepted: 04/28/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Rotavirus (RV) is a leading cause of acute gastroenteritis (AGE), affecting 95% of children below five years of age. METHODS In this prospective, multi-center study, children below five years of age who were hospitalized or those who visited the emergency room (ER) due to AGE or who developed AGE at least 48 hours after hospitalization (nosocomial infection) and had a RV-positive stool sample were included (n=1,222). RV-positive samples were genotyped by reverse-transcriptase polymerase chain reaction. RESULTS RV test results were available for 1,212 children (hospitalizations [n=677], ER visits [n=398] and nosocomial AGE cases [n=137]). Proportions of rotavirus gastroenteritis (RVGE) hospitalizations and ER visits were 51.70% (350/677; 95%CI: 47.86-55.52) and 36.18% (144/398; 95%CI: 31.45-41.12), respectively. Overall, 45.95% (494/1075) of all community-acquired AGE cases were due to RV. High numbers of RVGE cases were recorded between January and March. Most common genotypes were G9P[8] (34.27%) followed by G4P[8] (25.83%) and G1P[8] (23.02%). Of all community-acquired RVGE cases, the highest number of cases was observed in children aged 12-23 months. Median duration of hospitalization among RV-positive subjects was six days (range: 2-31 days). Incidence of nosocomial RVGE was 0.52 (95%CI: 0.45-0.60) cases per 1,000 child-days hospitalization. Median duration for additional hospitalization due to nosocomial RVGE was five days (range: 1-10). The highest burden of nosocomial RVGE was observed in children aged 12-23 months (42.34%, 58/137). Our findings confirm a high burden of acute RVGE disease in Romania and provide useful data to support the implementation of RV vaccination in Romania. TRIAL REGISTRATION NCT01253967.
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Affiliation(s)
- Ioana Alina Anca
- MD, PhD, Carol Davila University of Medicine and Pharmacy; Institute For Mother and Child Care, Bucharest 020395, Romania
| | - Florentina Ligia Furtunescu
- MD, PhD, Department of Complementary Sciences, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 050463, Romania
| | - Doina Pleşca
- MD, PhD, Carol Davila University of Medicine and Pharmacy; Children's Clinical Hospital "Dr. Victor Gomoiu", Bucharest 022102, Romania
| | - Adrian Streinu-Cercel
- MD, PhD, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; National Institute for Infectious Diseases "Prof. Dr. Matei Balş", Bucharest 021105, Romania
| | - Sorin Rugină
- MD, PhD, Ovidius University, Faculty of Medicine, Infectious Diseases Clinic, Constanţa 900709, Romania
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Characterization of G2P[4] rotavirus strains associated with increased detection in Australian states using the RotaTeq® vaccine during the 2010-2011 surveillance period. INFECTION GENETICS AND EVOLUTION 2014; 28:398-412. [PMID: 24861815 DOI: 10.1016/j.meegid.2014.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/15/2014] [Accepted: 05/17/2014] [Indexed: 11/20/2022]
Abstract
The introduction of rotavirus vaccines Rotarix® and RotaTeq® into the Australian National Immunisation Program in July 2007 has resulted in a dramatic decrease in the burden of rotavirus disease. G2P[4] strains became the dominant genotype Australia-wide during the 2010-2011 surveillance period and for the first time since vaccine introduction, a higher proportion were isolated in jurisdictions using RotaTeq® vaccine compared to locations using Rotarix®. Phylogenetic analysis of the VP7 gene of 32 G2P[4] strains identified six genetic clusters, these distinct clusters were also observed in the VP4 gene for a subset of 12 strains. The whole genome was determined for a representative strain of clusters; A (RVA/Human-wt/AUS/SA066/2010/G2P[4]), B (RVA/Human-wt/AUS/WAPC703/2010/G2P[4]), C (RVA/Human-wt/AUS/MON008/2010/G2P[4]) and E (RVA/Human-wt/AUS/RCH041/2010/G2P[4]). All of the strains possessed the archetypal DS-1 like genome constellation G2-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Three of the strains, SA066, MON008 and WAPC703 clustered together and were distinct to RCH041 for all 11 genes. The VP7 genes of 31/32 of the strains characterized in this study possessed five conserved amino acid substitutions when compared to the G2 VP7 gene present in the RotaTeq® vaccine. Three of the substitutions were in the VP7 antigenic regions A and C, the substitutions A87T, D96N and S213D have been reported in the majority of G2P[4] strains circulating globally over the previous decade. These changes may have improved the ability of strains to circulate in settings of high vaccine use.
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Yen C, Tate JE, Hyde TB, Cortese MM, Lopman BA, Jiang B, Glass RI, Parashar UD. Rotavirus vaccines: current status and future considerations. Hum Vaccin Immunother 2014; 10:1436-48. [PMID: 24755452 DOI: 10.4161/hv.28857] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rotavirus is the leading cause of severe diarrhea among children<5 years worldwide. Currently licensed rotavirus vaccines have been efficacious and effective, with many countries reporting substantial declines in diarrheal and rotavirus-specific morbidity and mortality. However, the full public health impact of these vaccines has not been realized. Most countries, including those with the highest disease burden, have not yet introduced rotavirus vaccines into their national immunization programs. Research activities that may help inform vaccine introduction decisions include (1) establishing effectiveness, impact, and safety for rotavirus vaccines in low-income settings; (2) identifying potential strategies to improve performance of oral rotavirus vaccines in developing countries, such as zinc supplementation; and (3) pursuing alternate approaches to oral vaccines, such as parenteral immunization. Policy- and program-level barriers, such as financial implications of new vaccine introductions, should be addressed to ensure that countries are able to make informed decisions regarding rotavirus vaccine introduction.
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Affiliation(s)
- Catherine Yen
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA; Global Immunization Division; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Jacqueline E Tate
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Terri B Hyde
- Global Immunization Division; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Margaret M Cortese
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Benjamin A Lopman
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Baoming Jiang
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
| | - Roger I Glass
- Fogarty International Center; National Institutes of Health; Bethesda, MD USA
| | - Umesh D Parashar
- Division of Viral Diseases; Centers for Disease Control and Prevention; Atlanta, GA USA
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Group A rotaviruses in children with gastroenteritis in a Canadian pediatric hospital: The prevaccine era. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:e1-6. [PMID: 24421793 DOI: 10.1155/2013/982385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A publicly funded, group A rotavirus (RVA) vaccination program was implemented in Quebec in November 2011. OBJECTIVES To evaluate trends in RVA infections and describe circulating genotypes before the implementation of a publicly funded vaccination program. METHODS The Montreal Children's Hospital (Montreal, Quebec) virology laboratory database was reviewed for RVA ELISA performed between July 2006 and June 2011. A five-week moving average was used to follow the proportion of positive RVA ELISA test results. A season was defined as starting with the first two and ending with the final two consecutive weeks in which the percentage of specimens testing positive for RVA was ≥10%. Duplicate tests were excluded. A random sample of 39 RVA-positive fecal samples from the final season (2010/2011) was genetically characterized: VP4, VP6, VP7 and NSP4 gene segments were genotyped using sequence analysis. RESULTS Of the 3403 nonduplicate tests, 433 were RVA positive: 15.1% (2006/2007) to 9.3% (2010/2011) of the samples were positive during the study period, with a proportionally larger decrease in the percentage of positive tests compared with the decrease in the number of tests performed. The most common RVA strain types detected were G9P[8]I1 (n=19) and G1P[8]I1 (n=14), followed by G2P[4]I2 (n=4), G3P[6]I1 (n=1) and G4P[8]I2 (n=1). Mixed RVA infection was observed in two samples. CONCLUSION Before the implementation of the vaccination program, the proportion of positive RVA tests had already begun to steadily decline. The present study was the first to report the genetic makeup of human RVA collected from a Canadian hospital based on the genotyping of four gene segments. The present study provided a baseline with which to monitor the impact of the universal vaccination program.
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A hospital-based surveillance of rotavirus gastroenteritis in children <5 years of age in Singapore. Pediatr Infect Dis J 2013; 32:e426-31. [PMID: 23958814 DOI: 10.1097/inf.0b013e31829f2cb0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In Singapore, 2 rotavirus vaccines were licensed in October 2005 and July 2007, respectively, for vaccinating infants aged ≥ 6 weeks against rotavirus gastroenteritis. These vaccines are optional and are not included in the National Childhood Immunization Program. This study aimed to determine the incidence of rotavirus gastroenteritis-associated hospitalizations among children <5 years of age. METHODS Children <5 years, who were hospitalized for acute gastro enteritis, were enrolled between September 2005 and April 2008. Stool samples were tested for the presence and serotyping of rotavirus. Incidence and proportion of gastroenteritis and rotavirus gastroenteritis cases were calculated with 95% confidence intervals. RESULTS Among 1976 children included in the according-to-protocol cohort, 781 were rotavirus positive with a median age of 24 months (range: 0-59 months). The overall incidence of rotavirus gastroenteritis hospitalizations during the entire study period in children <5 years of age was 4.6 (95% confidence interval: 4.3-4.9) per 1000 person-years with the highest number of cases observed in children 13-24 months of age (26.5%). G1P[8] (18.3%) and G9P[8] (9.9%) were the most common rotavirus types. Rotavirus gastroenteritis hospitalizations peaked between January and March. CONCLUSION Rotavirus infection was the primary cause of acute gastro enteritis hospitalizations among children <5 years of age, constituting nearly one-third of gastroenteritis hospitalizations in Singapore. The predominant strain observed in Singapore was G1P[8]. Results of this study suggest the need for implementation of rotavirus vaccination into National Childhood Immunization Program in Singapore.
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Abstract
The most common cause of severe diarrhea in infants and young children is rotavirus gastroenteritis (RVGE), which is associated with significant morbidity, healthcare resource use, and direct and indirect costs in industrialized nations. The monovalent rotavirus vaccine RIX4414 (Rotarix™) is administered as a two-dose oral series in infants and has demonstrated protective efficacy against RVGE in clinical trials conducted in developed countries. In addition, various naturalistic studies have demonstrated ‘real-world’ effectiveness after the introduction of widespread rotavirus vaccination programs in the community setting. Numerous cost-effectiveness analyses have been conducted in developed countries in which a universal rotavirus vaccination program using RIX4414 was compared with no universal rotavirus vaccination program. There was a high degree of variability in base-case results across studies even when the studies were conducted in the same country, often reflecting differences in the selection of data sources or assumptions used to populate the models. In addition, results were sensitive to plausible changes in a number of key input parameters. As such, it is not possible to definitively state whether a universal rotavirus vaccination program with RIX4414 is cost effective in developed countries, although results of some analyses in some countries suggest this is the case. In addition, international guidelines advocate universal vaccination of infants and children against rotavirus. It is also difficult to draw conclusions regarding the cost effectiveness of rotavirus vaccine RIX4414 relative to that of the pentavalent rotavirus vaccine, which is administered as a three-dose oral series. Although indirect comparisons in cost-effectiveness analyses indicate that RIX4414 provided more favorable incremental cost-effectiveness ratios when each vaccine was compared with no universal rotavirus vaccination program, results were generally sensitive to vaccine costs. Actual tender prices of a full vaccination course for each vaccine were not known at the time of the analyses and therefore had to be estimated.
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Pendleton A, Galic M, Clarke C, Ng SP, Ledesma E, Ramakrishnan G, Liu Y. Impact of rotavirus vaccination in Australian children below 5 years of age: a database study. Hum Vaccin Immunother 2013; 9:1617-25. [PMID: 23733041 PMCID: PMC3906257 DOI: 10.4161/hv.24831] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study was conducted to assess the impact of administration of two-dose rotavirus (RV) vaccine (RIX4414; GlaxoSmithKline Vaccines) among children aged less than 5 y in three states/territories of Australia. Aggregated and de-identified data on rotavirus gastroenteritis (RVGE) and all-cause gastroenteritis (AGE) from July 1998–June 2009 were obtained from the Australian Institute of Health and Welfare database. The baseline incidence (July 1998–June 2006) of RVGE hospitalizations before RV vaccine introduction in New South Wales (NSW), the Australian Capital Territory (ACT) and the Northern Territory (NT) were 33.75, 42.93 and 288.67 per 10 000 child-years, respectively among children aged 0–11 mo. Following RV vaccine introduction in NSW, the ACT and the NT, incidence of RVGE hospitalizations reduced to 13.06, 17.35 and 47.52 per 10 000 child-years, respectively, during July 2007–June 2008 and 3.87, 8.40 and 122.79 per 10,000 child-years, respectively, during July 2008–June 2009 among children aged 0–11 mo. Reductions in RVGE and AGE were also observed in all children below 5 y of age in NSW and the ACT. Overall reduction in hospitalizations due to RVGE and AGE was observed following RV vaccine introduction into the NIP in Australia.
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Hull BP, Menzies R, Macartney K, McIntyre PB. Impact of the introduction of rotavirus vaccine on the timeliness of other scheduled vaccines: the Australian experience. Vaccine 2013; 31:1964-9. [PMID: 23422140 DOI: 10.1016/j.vaccine.2013.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/15/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
Strict age limits for receipt of rotavirus vaccines and simultaneous use of vaccines requiring two (Rotarix(®)) and three (RotaTeq(®)) doses in Australia may impact on coverage and timeliness of other vaccines in the infant schedule. Using data from the Australian Childhood Immunisation Register (ACIR), coverage and timeliness of rotavirus vaccines and changes in timeliness of other infant vaccines following rotavirus vaccine introduction was examined, with particular emphasis on Indigenous infants in whom coverage is less optimal. Final dose rotavirus coverage reached 83% within 21 months of program commencement but remained 7% lower than other vaccines due in infancy. Coverage was 11-17% lower in Indigenous infants. Adherence to the first dose upper age limits for rotavirus vaccine was high with >97% of children vaccinated by the recommended age, but for subsequent rotavirus doses, receipt beyond the upper age limits was more common, especially in Indigenous children. Following rotavirus vaccine introduction, there were improvements in timeliness of receipt of all doses of DTPa-containing and 7-valent pneumococcal conjugate vaccines. High population coverage can be attained with rotavirus vaccines, even with adherence to strict upper age restrictions for vaccine dose administration. Rotavirus vaccine introduction appears to have impacted upon the timeliness of other concomitantly scheduled vaccines. These factors should be considered when rotavirus programs are introduced.
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Affiliation(s)
- Brynley P Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, New South Wales, Australia.
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Dey A, Wang H, Menzies R, Macartney K. Changes in hospitalisations for acute gastroenteritis in Australia after the national rotavirus vaccination program. Med J Aust 2013; 197:453-7. [PMID: 23072242 DOI: 10.5694/mja12.10062] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the impact of the Australian rotavirus vaccination program on both rotavirus and all-cause acute gastroenteritis (AGE) hospitalisations and to compare outcomes in Indigenous and non-Indigenous people. DESIGN AND SETTING Retrospective analysis of the Australian Institute of Health and Welfare National Hospital Morbidity database for hospitalisations coded as rotavirus and all-cause AGE, between 1 July 2001 and 30 June 2010. MAIN OUTCOME MEASURES Age-specific hospitalisation rates in Indigenous and non-Indigenous people, before and after the introduction of the vaccine program in July 2007. RESULTS There was a 71% decline in rotavirus-coded hospitalisations of children aged < 5 years between periods before and after rotavirus vaccination (from 261 per 100,000 to 75 per 100,000). There was also a 38% decline in non-rotavirus coded AGE hospitalisations (from 1419 per 100,000 to 880 per 100,000). This represented more than 7700 hospitalisations of children aged < 5 years being averted in the financial year 2009-10. Reductions were also observed in the 5-19-years age group, suggesting that transmission of virus was reduced at a population level. Decreases in hospitalisations of Indigenous children were smaller than those for the general population, and fluctuated by location and year. CONCLUSIONS These data show a sustained and substantial decline in severe rotavirus disease and all-cause AGE since the introduction of rotavirus vaccination, most pronounced in the target age group, but with evidence of herd immunity. The impact of rotavirus vaccination in Indigenous children in hyperendemic settings was less remarkable.
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Affiliation(s)
- Aditi Dey
- National Centre for Immunisation Research & Surveillance, Sydney, NSW, Australia.
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Akikusa JD, Hopper SM, Kelly JJ, Kirkwood CD, Buttery JP. Changes in the epidemiology of gastroenteritis in a paediatric short stay unit following the introduction of rotavirus immunisation. J Paediatr Child Health 2013; 49:120-4. [PMID: 23336756 DOI: 10.1111/jpc.12098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2012] [Indexed: 11/29/2022]
Abstract
AIM Acute gastroenteritis (AGE) has been a significant component of the clinical load in the short stay unit (SSU) at the Royal Children's Hospital (RCH) since its establishment in 2004. Since the introduction of routine rotavirus immunisation in Australia in 2007 there has been a clinical impression of a substantial reduction in AGE managed in the SSU. This study aimed to examine changes in the epidemiology of AGE in the SSU, and RCH overall, between 2005 and 2009 and explore whether this reflects a change specifically in AGE due to rotavirus. METHODS Discharge coding data for AGE from all inpatient wards, the SSU and emergency department (ED) at the RCH were examined. Stool virology results for the same period were analysed. RESULTS Since 2007 there has been a 58% reduction in AGE admissions to the SSU. The median age of patients admitted to the RCH with rotaviral enteritis has increased from 1.3 years to 3.8 years. Presentations to the ED for AGE have fallen from 53 to 34 cases per 1000 attendances between 2004 and 2009, and admission rates from the ED have fallen from 23 to 13% of AGE presentations. Detection rates of rotavirus fell from 13.1 to 6.7% between 2005 and 2009. CONCLUSION A marked decrease in AGE-related clinical activity and reduction in rotavirus detection at the RCH has occurred since the introduction of routine rotavirus immunisation in Australia. This has significant resource planning implications for units based on short stay models of care.
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Affiliation(s)
- Jonathan D Akikusa
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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Tu HAT, Rozenbaum MH, de Boer PT, Noort AC, Postma MJ. An update of "Cost-effectiveness of rotavirus vaccination in the Netherlands: the results of a Consensus Rotavirus Vaccine model". BMC Infect Dis 2013; 13:54. [PMID: 23363553 PMCID: PMC3568412 DOI: 10.1186/1471-2334-13-54] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To update a cost-effectiveness analysis of rotavirus vaccination in the Netherlands previously published in 2011. METHODS The rotavirus burden of disease and the indirect protection of older children and young adults (herd protection) were updated. RESULTS When updated data was used, routine infant rotavirus vaccination in the Netherlands would potentially become an even more cost-effective strategy than previously estimated with the incremental cost per QALY at only €3,000-4,000. Break-even total vaccination costs were indicated at €92-122, depending on the applied threshold. CONCLUSIONS We concluded that the results on potentially favourable cost-effectiveness in the previous study remained valid, however, the new data suggested that previous results might represent an underestimation of the economic attractiveness of rotavirus vaccination.
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Affiliation(s)
- Hong Anh T Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.
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Estimating rotavirus gastroenteritis hospitalisations by using hospital episode statistics before and after the introduction of rotavirus vaccine in Australia. Vaccine 2012; 31:967-72. [PMID: 23246261 DOI: 10.1016/j.vaccine.2012.11.099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/20/2012] [Accepted: 11/30/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hospital discharge records and laboratory data have shown a substantial early impact from the rotavirus vaccination program that commenced in 2007 in Australia. However, these assessments are affected by the validity and reliability of hospital discharge coding and stool testing to measure the true incidence of hospitalised disease. The aim of this study was to assess the validity of these data sources for disease estimation, both before and after, vaccine introduction. METHODS All hospitalisations at a major paediatric centre in children aged <5 years from 2000 to 2009 containing acute gastroenteritis (AGE) ICD 10 AM diagnosis codes were linked to hospital laboratory stool testing data. The validity of the rotavirus-specific diagnosis code (A08.0) and the incidence of hospitalisations attributable to rotavirus by both direct estimation and with adjustments for non-testing and miscoding were calculated for pre- and post-vaccination periods. RESULTS A laboratory record of stool testing was available for 36% of all AGE hospitalisations (n=4948) the rotavirus code had high specificity (98.4%; 95% CI, 97.5-99.1%) and positive predictive value (96.8%; 94.8-98.3%), and modest sensitivity (61.6%; 58-65.1%). Of all rotavirus test positive hospitalisations only a third had a rotavirus code. The estimated annual average number of rotavirus hospitalisations, following adjustment for non-testing and miscoding was 5- and 6-fold higher than identified, respectively, from testing and coding alone. Direct and adjusted estimates yielded similar percentage reductions in annual average rotavirus hospitalisations of over 65%. CONCLUSION Due to the limited use of stool testing and poor sensitivity of the rotavirus-specific diagnosis code routine hospital discharge and laboratory data substantially underestimate the true incidence of rotavirus hospitalisations and absolute vaccine impact. However, this data can still be used to monitor vaccine impact as the effects of miscoding and under-testing appear to be comparable between pre and post vaccination periods.
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Rodrigues F, Iturriza-Gómara M, Marlow R, Gray J, Nawaz S, Januário L, Finn A. The evolving epidemiology of rotavirus gastroenteritis in central Portugal with modest vaccine coverage. J Clin Virol 2012; 56:129-34. [PMID: 23238239 DOI: 10.1016/j.jcv.2012.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/22/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rotavirus (RV) vaccines have been available on the private market in Portugal since 2006, with an estimated coverage rising from 16 to 42% between 2007 and 2010. OBJECTIVES To assess trends, surveillance of children presenting with acute gastroenteritis (AG) to a large paediatric emergency service (ES) in the central region of Portugal was conducted yearly during the winter-spring seasons. STUDY DESIGN Stool samples, collected throughout five epidemic seasons (January-June, 2006 to 2010) from children ≤ 36 months of age attending the ES with AG, were tested for RV by immunochromatographic rapid test and positive samples were genotyped. RESULTS A total of 6145 AG cases were identified: 1956 (32%) provided a stool sample (range: 28% in 2008-37% in 2009). The proportion of AG subjects who tested positive for RV fluctuated over the five surveillance seasons (49%, 39%, 25%, 26% and 39%, respectively) as did the distribution of co-circulating RV genotypes. There were no consistent changes in seasonality or age distribution and the proportion of admitted AG subjects who tested RV-positive did not show progressive trends over time. CONCLUSIONS Our results demonstrate fluctuations in RVAG incidence with no clear progressive trends or seasonal RV shifts among our surveillance subjects over five years, in the context of limited rotavirus vaccine coverage. Significant annual changes in genotype distributions were detected. Higher vaccine coverage may be necessary than at present for consistent impact on disease.
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Affiliation(s)
- Fernanda Rodrigues
- Emergency Service and Infectious Diseases Unit, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, Alto da Baleia, 3000-602 Coimbra, Portugal.
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Liu N, Yen C, Fang ZY, Tate JE, Jiang B, Parashar UD, Zeng G, Duan ZJ. Projected health impact and cost-effectiveness of rotavirus vaccination among children <5 years of age in China. Vaccine 2012; 30:6940-5. [DOI: 10.1016/j.vaccine.2012.05.084] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 05/30/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
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Lepage P, Vergison A. Impact of rotavirus vaccines on rotavirus disease. Expert Rev Anti Infect Ther 2012; 10:547-61. [PMID: 22702319 DOI: 10.1586/eri.12.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rotaviruses are the most common cause of acute gastroenteritis in young children worldwide. Both licensed rotavirus vaccines (Rotarix™ [RV1] and RotaTeq™ [RV5]) are effective and safe. Studies from countries that have included RV1 or RV5 in the national immunization programs have demonstrated their safety and sustained efficacy under real-life circumstances. A significant decline in acute gastroenteritis-related deaths among Latin American children was observed after the introduction of RV1 and RV5 vaccines. Both vaccines were able to decrease the number of cases of rotavirus acute gastroenteritis and of severe rotavirus diseases. Vaccination was also associated with a dramatic reduction in hospitalizations and outpatient visits for all-cause acute gastroenteritis. Indirect protection after infant mass vaccination has been strongly suggested. Moreover, postlicensure safety studies assessed rare adverse events (rates <1 in 50,000), such as intussusception.
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Affiliation(s)
- Philippe Lepage
- Université Libre de Bruxelles and Infectious Diseases Unit, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
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