Impact analysis of rotavirus vaccination in various geographic regions in Western Europe

BACKGROUND

Universal mass vaccination (UMV) against rotavirus has been implemented in many but not all European countries. This study investigated the impact of UMV on rotavirus incidence trends by comparing European countries with UMV: Belgium, England/Wales and Germany versus countries without UMV: Denmark and the Netherlands.

METHODS

For this observational retrospective cohort study, time series data (2001-2016) on rotavirus detections, meteorological factors and population demographics were collected. For each country, several meteorological and population factors were investigated as possible predictors of rotavirus incidence. The final set of predictors were incorporated in negative binomial models accounting for seasonality and serial autocorrelation, and time-varying incidence rate ratios (IRR) were calculated for each age group and country separately. The overall vaccination impact two years after vaccine implementation was estimated by pooling the results using a random effects meta-analyses. Independent t-tests were used to compare annual epidemics in the pre-vaccination and post-vaccination era to explore any changes in the timing of rotavirus epidemics.

RESULTS

The population size and several meteorological factors were predictors for the rotavirus epidemiology. Overall, we estimated a 42% (95%-CI 23;56%) reduction in rotavirus incidence attributable to UMV. Strongest reductions were observed for age-groups 0-, 1- and 2-years (IRR 0.47, 0.48 and 0.63, respectively). No herd effect induced by UMV in neighbouring countries was observed. In all UMV countries, the start and/or stop and corresponding peak of the rotavirus season was delayed by 4-7 weeks.

CONCLUSIONS

The introduction of rotavirus UMV resulted in an overall reduction of 42% in rotavirus incidence in Western European countries two years after vaccine introduction and caused a change in seasonal pattern. No herd effect induced by UMV neighbouring countries was observed for Denmark and the Netherlands.

How do diagnostic self-tests change healthcare relationships? A qualitative study

Background

Diagnostic self-tests in Belgian pharmacies are a recent phenomenon. While considered a way to empower patients to take informed decisions, self-tests also challenge the relationship between patients and health professionals and between pharmacists and general practitioners. This study explored how the introduction of diagnostic self-tests in pharmacies influences the health care relationships.

Methods

A qualitative study, part of the Care-test research program, was conducted using semi-structured interviews with 18 patients, 25 doctors, and 16 pharmacists from Brussels. Data collection ended after data saturation. Reflexive thematic analysis was performed.

Results

Mutual partnership approaches were not mainstreamed and mainly intuitive when existing, with patients being often more in demand for a partnership with their doctors than what their doctors offered. This perceived lack of dialogue led some patients to autonomous behaviours, qualified as “non-adherence” by professionals (self-medication with medicinal herbs, unilateral adaptation of therapies including those for HIV-infection and for orphan disease, etc.). Not all the patients, however, were in demand for a more active role. Some deferred to the doctor's choice, but they did not experience another kind of relationship. The doctor-pharmacist collaboration mainly entailed factual information exchange, although more collaborative relationships exist. Current collaborations related to self-tests were limited due to their novelty and controversial nature. While patients were generally in favour of diagnostic self-tests, professionals had divided opinions about them.

Conclusions

The study reveals divergent views between patients and health professionals and amongst professionals, about self-tests and the need for a partnership between patients and professionals. This suggests a need for health professionals to be better skilled in dealing with participative approaches.

Key messages

Mutual partnership and Interprofessional collaboration are not mainstreamed in health care. Patients, doctors and pharmacists had divergent views about diagnostic self-tests and about the need for partnership.

Rotavirus vaccination coverage and adherence to recommended age among infants in Flanders (Belgium) in 2012

In Belgium, rotavirus vaccination has been recommended and partially reimbursed since October 2006. Through a retrospective survey in 2012, we estimated the coverage rate of the rotavirus vaccination in Flanders among infants born in 2010. Using a standardised questionnaire, 874 families were interviewed at home, collecting information on demographic characteristics, socio-economic background and documented vaccination history (updated from medical files and vaccination database, if needed). Adherence to the recommended age for vaccination (8, 12 and 16 weeks) was also assessed. The coverage rate for two doses of rotavirus vaccination was 92.2% (95% confidence interval: 90.2-93.8). Respectively 31.7% and 10.1% of the children received their first and second dose at the recommended age. Incomplete vaccination was often a deliberate choice of the parents. Only eight children (1%) were vaccinated after the maximum age of 26 weeks. Factors identified by multiple logistic regression as related to incomplete vaccination were: living in the province of Antwerp, unemployed mother, and three or more older siblings in the household. Four years after introduction, the coverage rates were surprisingly high for a vaccine that is not fully reimbursed and not readily available in the vaccinator's fridge, which is the case for the other recommended infant vaccines.