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Aliabadi N, Antoni S, Mwenda JM, Weldegebriel G, Biey JNM, Cheikh D, Fahmy K, Teleb N, Ashmony HA, Ahmed H, Daniels DS, Videbaek D, Wasley A, Singh S, de Oliveira LH, Rey-Benito G, Sanwogou NJ, Wijesinghe PR, Liyanage JBL, Nyambat B, Grabovac V, Heffelfinger JD, Fox K, Paladin FJ, Nakamura T, Agócs M, Murray J, Cherian T, Yen C, Parashar UD, Serhan F, Tate JE, Cohen AL. Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008-16: findings from the Global Rotavirus Surveillance Network. Lancet Glob Health 2020; 7:e893-e903. [PMID: 31200889 PMCID: PMC7336990 DOI: 10.1016/s2214-109x(19)30207-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/27/2022]
Abstract
Summary Background Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). Methods Between Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction. Findings 403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32.9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38.0% (95% CI 4.8–73.4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23.0% (0.7–57.7) of admissions for acute gastroenteritis, showing a 39.6% (35.4–43.8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26.4% (15.0–37.8) in the Eastern Mediterranean Region to 55.2% (43.0–67.4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6–10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction. Interpretation A significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance.
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Affiliation(s)
- Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sébastien Antoni
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jason M Mwenda
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Goitom Weldegebriel
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Joseph N M Biey
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Dah Cheikh
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Kamal Fahmy
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Nadia Teleb
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | | | - Hinda Ahmed
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Danni S Daniels
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Dovile Videbaek
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Annemarie Wasley
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Simarjit Singh
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | | | - Gloria Rey-Benito
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | - N Jennifer Sanwogou
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | | | | | - Batmunkh Nyambat
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Varja Grabovac
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - James D Heffelfinger
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Kimberley Fox
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Fem Julia Paladin
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Tomoka Nakamura
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Mary Agócs
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jillian Murray
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Thomas Cherian
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Catherine Yen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatima Serhan
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jacqueline E Tate
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L Cohen
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
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