Burden of diarrhea among children in Honduras, 2000-2004: estimates of the role of rotavirus.

OBJECTIVES: To estimate the annual burden of diarrhea and of diarrhea that is associated with rotavirus (RV) in children who are treated at public clinics and hospitals in Honduras. METHODS: Data were collected from computerized records of all children < 5 years old treated for diarrhea at clinics and hospitals operated by the Secretary of Health for the period of 2000 through 2004. A review of studies of RV in Honduras and neighboring countries provided estimates of detection rates of RV among children treated for acute diarrhea as outpatients or as inpatients. From these data, we estimated the annual number of cases of diarrhea and of rotavirus-related diarrhea in Honduras, the cumulative incidence of diarrhea and of rotavirus-related diarrhea for a child from birth to age 5 years, and the number of fatalities due to RV among children hospitalized for diarrhea. RESULTS: From 2000 through 2004, a mean of 222,000 clinic visits, 4,390 hospitalizations, and 162 in-hospital deaths due to diarrhea were recorded annually among children < 5 years of age in the public health facilities in Honduras. From our review of scientific literature on Honduras and neighboring countries, an estimated 30% of outpatients and 43% of inpatients who were treated for diarrhea would be expected to have RV. Consequently, we estimated that 66,600 outpatient visits, 1,888 hospitalizations, and 70 in-hospital deaths among children < 5 years in Honduras could be attributed to RV each year. Therefore, a child in the first five years of life has a respective risk for consultation, hospitalization, and in-hospital death of 1:1, 1:46, and 1:1,235 for diarrhea. For an episode associated with RV, the respective risks are 1:3, 1:106, and 1:2,857. These values likely underestimate the true burden of diarrhea in Honduras, since some 51% of children with acute diarrhea do not receive formal care for the illness, 70% do not receive oral rehydration solution, and 80% of diarrheal deaths occur outside of hospitals. CONCLUSIONS: Diarrhea is a major cause of illness among children < 5 years old in Honduras, and RV is likely the most common cause. Our preliminary estimates need to be refined so that health planners in Honduras can make decisions on the future use of rotavirus vaccines. A program of hospital-based surveillance for rotavirus in Honduras has been established to address this need.     

5岁以下儿童轮状病毒腹泻流行特征和经济负担评价分析

目的了解轮状病毒在5岁以下门诊和住院腹泻儿童中的流行特征,探索建立轮状病毒腹泻经济负担的评价方法,为轮状病毒疫苗的使用和成本效益评价提供背景资料。方法收集甘肃省2012年8月-2013年7月2个轮状病毒哨点医院门诊和住院的5岁以下腹泻就诊儿童的个案信息和粪便标本,进行轮状病毒腹泻流行特征分析,对所有标本统一使用酶联免疫吸附试验方法检测轮状病毒,资料采用SPSS17．0进行数据分析。结果共调查5岁以下腹泻就诊儿童734例．轮状病毒阳性率为41．69％,其中门诊病例的轮状病毒阳性率为30．99％,住院病例的轮状病毒阳性率为46．07％,门诊和住院轮状病毒腹泻儿童的发病年龄主要集中在2岁以下,分别占门诊和住院腹泻儿童的92．42％和97．92％,其中6月龄组的婴幼儿比例最高。分别占fq诊和住院腹泻儿童的54．55％和55．42％,粪便性状主要以水样便为主,占85．80％,其次为稀便,占81．27％。5岁以下轮状病毒腹泻儿童人次均门诊直接医疗费用375．42元,人次均住院直接医疗费用2053．91元．人次均门诊直接非医疗费用47．92元,人次均住院直接非医疗费用180．13元。人次均门诊间接费用270．45元,人次均住院间接费用721．20元。结论2岁以下婴幼儿是轮状病毒腹泻的高友人群,针对轮状病毒腹泻对儿童健康造成的危害和经济负担．需采取措施控制轮状病毒腹泻的发病水平。     

Epidemiology of rotavirus diarrhoea in Africa: a review to assess the need for rotavirus immunization.

Rapid progress towards the development of rotavirus vaccines has prompted a reassessment of the disease burden of rotavirus diarrhoea in developing countries and the possible impact of these vaccines in reducing diarrhoeal morbidity and mortality among infants and young children. We examined the epidemiology and disease burden of rotavirus diarrhoea among hospitalized and clinic patients in African countries through a review of 43 published studies of the etiology of diarrhoea. The studies were carried out from 1975 through 1992, and only those in which a sample of more than 100 patients with diarrhoea were specifically screened for rotavirus by using an established diagnostic test were included. Rotavirus was detected in a median of 24% of children hospitalized for diarrhoea and in 23% who were treated as outpatients; 38% of the hospitalized patients with rotavirus were < 6 months and 81% were < 1 year of age. Rotavirus was detected year-round in nearly every country and generally exhibited distinct seasonal peaks during the dry months. In 5 countries where rotavirus strains had been G-typed, 74% of strains were of one of the four common serotypes (G1 to G4), G1 was the predominant serotype, and 26% were non-typeable. This cumulative experience from 15 African countries suggests that rotavirus is the most important cause of severe diarrhoea in African children and that most strains in circulation today belong to common G types that are included in reassortant vaccines. Wherever large numbers of cases of rotavirus diarrhoea occur early in infancy, immunization at birth may protect the children before their first symptomatic infection.     

北京友谊医院1998～2001年轮状病毒哨点监测分析

目的 了解5岁以下儿童中以医院为基础的轮状病毒流行情况。方法 按WHO轮状病毒监测的通用方法(CID-98)进行，轮状病毒检测采用聚丙烯酰胺凝胶电泳／酶联免疫吸附试验(ELISA)。毒株分型用ELISA／逆转录聚合酶链反应。结果从1998年4月至2001年3月收集的484份腹泻患儿粪便标本中，检出阳性标本：123份，总的轮状病毒感染检出率为25．4％，住院和门诊患儿检出率分别是31．6％和27．3％，而在轮状病毒流行季节，则可以引起高达46．2％急性腹泻住院率。腹泻患儿发病呈现两个明显的季节高峰：一个由细菌性痢疾引起的夏季(6～9月)发病高峰，另一个是轮状病毒感染腹泻造成的秋冬季(10～12月)发病高峰。轮状病毒感染96．8％发生于3岁以下幼儿，主要在6～11月龄(38．2％)和1～2岁(28．5％)年龄组，轮状病毒感染率在6～35月龄年龄段最高。流行的轮状病毒G血清型依次为G1(55．3％)、G2(26．8％)、G3(9．8％)和G4(0．8％)，没有发现G9型，10份(8．1％)标本未能分型，混合感染(0．8％)罕见。结论 轮状病毒腹泻是北京市儿童的重要传染病，开发应用安全有效的轮状病毒疫苗将对减轻轮状病毒疾病负担有重要作用。     

Update on the disease burden and circulating strains of rotavirus in China: A systematic review and meta-analysis

Background

Rotavirus is the most common cause of severe diarrhea in children, and most associated deaths occur in developing countries. Two new internationally licensed vaccines are expected to be launched in the near future in China. We performed a systematic review and meta-analysis of rotavirus studies to update information on the burden of rotavirus disease in China.

Materials and methods

Eligible studies published before 2011 were identified using PubMed/Medline, Embase, Cochrane Library, LILACS, WHOLIS, and two Chinese literature databases, CNKI, and WANFANG. Arc-sine transformations and the DerSimonian–Laird random-effects or fixed-effects models were used for meta-analysis.

Results

A total of 211 studies were included in this review, of which 63 (29.9%) were inpatient studies, 26 (12.3%) were outpatient, 122 (57.8%) were combined. Community subjects were investigated in two combined studies. Rates of gastroenteritis caused by rotavirus in inpatients, outpatients, and community children were 42.6%, 32.5% and 9.3%, respectively. The most common G type was G3 (39.3%), followed by G1 (30.3%), G2 (7.2%), and G9 (3.3%). The most common P types were P[8] (50.2%), P[4] (18.2%), and P[6] (7.2%). The most prevalent G-P combinations were G3P[8] (32.1%), G1P[8] (23.0%), and G2P[4] (7.9%).

Conclusion

Rotavirus is an important cause of both severe and mild diarrheal disease in children <5 years of age in China; G3P[8] is the most prevalent strain. The introduction of an effective rotavirus vaccine to Chinese pediatric immunization programs is necessary.     

Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Ghana

Background

Globally, rotavirus gastroenteritis is the most common identifiable cause of severe diarrhea in children under 5. Recently introduced rotavirus vaccines from Merck &; Co. and GlaxoSmithKline have the potential to save hundreds of thousands of lives. Efficacy results in Ghana suggest Merck &; Co.’s live oral pentavalent rotavirus vaccine (RotaTeq^®) prevents 65.0% of severe gastroenteritis due to rotavirus infection in children under 5. The announcement by Merck and GSK to make their rotavirus vaccines available for developing nations at reduced prices provides Ghana with the opportunity to introduce rotavirus vaccines into the national immunization program after investigation of the medical, economic and political implications.

Methods

We estimated the average costs of treating children with diarrhea in the Ashanti region of Ghana as inpatients and outpatients. Using these results, data from rotavirus surveillance studies, and recent rotavirus vaccine efficacy evaluation, we estimated the cost-effectiveness of introducing RotaTeq in Ghana.

Results

Based on our prospective calculations, we estimated an average inpatient and outpatient costs of $233.97 and $17.09, respectively, for treating childhood diarrhea. Using the 2003 birth cohort, RotaTeq introduction could save 1554 lives and avert 93,109 disability-adjusted life-years (DALYs) annually. At a market price of $5 per dose, introducing RotaTeq would have a base-case cost of $62.26 per DALY averted, at a market price of $3.50 per dose, a base-case cost of $39.59 per DALY averted and at market cost of $1 per dose, a base-case cost of $1.81 per DALY averted. All three values are below the 2009 Ghana per capita GDP. Thus, RotaTeq introduction into Ghana will be very cost-effective. Sensitivity analyses suggest these results are robust.

Conclusions

RotaTeq vaccination for children under five in Ghana would be a highly cost-effective public health intervention. Ghanaian health officials should seek GAVI funding and evaluate how to maximize RotaTeq access.     

Hospital-based study of the economic burden associated with rotavirus diarrhea in eastern China

Rotavirus infection is one of the most common causes of severe diarrhea in China. To evaluate the economic burden associated with rotavirus infection of children in China, we combined data on the disease burden of rotavirus-associated costs for samples comprising 832 outpatients and 604 inpatients from five seaside cities. The average social costs and direct medical costs for rotavirus-associated admissions were calculated to be US $61.64 and US $40.73 for outpatients, and US $684.15 and US $559.48 for inpatients, respectively, from October 1, 2006 to December 1, 2007. On average, the private cost ranged from US $54.64 for outpatients to US $454.24 for inpatients when children suffered from rotavirus infection. Accordingly, this cost accounted for 35.19-293% of the monthly income of an unskilled or service worker. We estimated that the annual number of children with rotavirus diarrhea was 12.10 million. Consequently, the total annual direct cost, total annual social cost, and total annual private cost were US $271.4 million, US $365.0 million, and US $290.0 million, respectively. Furthermore, rotavirus diarrhea affected children's behavior and emotions, which had a great influence on the caretakers’ quality of life. These data indicate the potential requirement for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.     

中国婴幼儿轮状病毒腹泻的流行病学和疾病负担研究进展

目的为全面了解中国轮状病毒(Rotavirus,RV)腹泻的流行情况、疾病负担以及流行毒株特征,促进RV疫苗的开发和应用,对1979~2005年公开发表的关于RV研究的文献进行检索和综述。结果显示,在全年开展RV腹泻监测的医院中,住院腹泻患儿RV检出率中位数是46%,门诊腹泻患儿RV检出率中位数是29%,而社区腹泻患儿RV检出率只占10%。中国RV腹泻以秋冬季为流行高峰,主要流行时间从10月~次年2月。总体上流行株以G1血清型为主,2001年以后则以G3型为主。P基因型则是以P[8]型为优势株。中国RV毒株G-P组合型呈现出多样性的特征,提示了长期开展RV监测的必要性。     

The epidemiology and burden of rotavirus in China: a review of the literature from 1983 to 2005

We reviewed studies of rotavirus in MEDLINE and the Chinese literature to get a preliminary estimate of the burden of rotavirus gastroenteritis in China and the epidemiology of the disease. Studies were selected if they were conducted for a period 1 year or more, had more than 100 patients enrolled, and used an accepted diagnostic test. Overall, in 27 reports of children hospitalized for diarrhea in urban areas and 3 in rural areas, 44 and 33%, respectively, had rotavirus identified as the etiologic agent. Rotavirus was less commonly detected in children with milder illness seen in clinics (26% in urban and 28% in rural areas) and those cared for in the community (9%). The four main strains of rotavirus in circulation worldwide were also found in China and while G1 was the predominant strain overall, G3 emerged to be the most common strain in 9 of the 12 most recent studies. The disease has a distinct winter seasonal pattern and affects most children in their first 2 years of life. Although further studies are required to fully assess the burden of rotavirus diarrhea before decisions can be made about vaccine use, this review suggests that development and implementation of rotavirus vaccines should be a national priority.     

杭州地区腹泻患儿轮状病毒感染流行病学特征分析

【目的】 探讨杭州地区腹泻儿童感染A组轮状病毒的流行病学特征,指导临床防治。 【方法】 对2007-2011年门诊和住院的急性腹泻儿童的大便进行轮状病毒抗原检测,并采用统计方法分析流行病学特征。 【结果】 杭州地区2007-2011年腹泻儿童A组轮状病毒平均阳性率为29.25%。阳性率从2007年的39.42%下降到2011年的19.61%,其中每年11-12月份为儿童轮状病毒感染高峰期;且以6~18月的患儿感染率最高。腹泻儿童中门诊轮状病毒阳性率为32.28%,住院儿童的阳性率为20.70%。 【结论】 杭州地区儿童A组轮状病毒感染率低于全国平均水平,而且有逐年下降趋势。在今后应加快安全高效的轮状病毒疫苗的开发,从根本上解决儿童轮状病毒的危害。     

Epidemiological aspects of rotavirus infection in Ahwaz, Iran

Rotavirus is the major cause of diarrhoea in children worldwide. In this study, conducted in the city of Ahwaz, Iran, during November 2001-March 2002, stool samples from 200 inpatient (n=63) and outpatient (n=137) children aged 1-24 month(s) were analyzed. Polyacrylamide gel electrophoresis was used for isolating rotavirus. Rotavirus was isolated from 36 (26.3%) of the 137 stool samples of outpatients and from 23 (36.5%) of the 63 stool samples of inpatients. The overall frequency of rotavirus in this population was 29.5%. The highest detection of rotavirus was made in children aged 7-12 months, which demonstrated that the relationship between age and rate of rotaviral infection was statistically significant (p < 0.05). The predominant electrophoretic pattern detected was the long (L) electrophoretype (46 of 59; 78%), followed by the short (S) electrophoretype (12 of 59; 20.3%). One strain had a mixed pattern. Such analysis throughout Iran would assist in developing sound guidelines for the prevention of rotavirus infections.     

Monitoring of rotavirus vaccination in Morocco: Establishing the baseline burden of rotavirus disease

Background

Rotavirus is a leading cause of childhood morbidity and mortality worldwide. Clinical trials for two rotavirus vaccines recommended by the WHO for global use since 2009 have successfully demonstrated the safety and efficacy of these vaccines in a wide range of countries. To control the burden of severe and fatal diarrheal disease, the Ministry of Health of Morocco introduced the single strain rotavirus vaccine into their national immunization program in 2010.

Methods

We employed a standard WHO case definition to identify children under 5 hospitalized with AGE at four hospitals from June 2006 to May 2010 to establish baseline burden of rotavirus disease before introduction of vaccine. Stool samples were collected and tested for rotavirus using a standard enzyme immunoassay.

Results

Overall, 40% (741 of 1841) of the children hospitalized with AGE tested positive for rotavirus, making it the single most common cause of severe gastroenteritis among children in Morocco. Applying this prevalence to the estimates of diarrheal hospitalizations and deaths in Morocco, we estimate that rotavirus annually causes 19,646 hospitalizations and 1604 deaths in children under 5 years of age.

Discussion

On the basis of these surveillance data, we estimate that 1 in 389 Moroccan children died and 1 in 32 was hospitalized due to rotavirus before their fifth birthday. A considerable proportion of these deaths and hospitalizations should be preventable through vaccination, and the 4 years of stable prevaccine surveillance in Morocco will be a tremendously useful platform for assessing potential changes in the epidemiology of rotavirus disease and measuring impact of the new rotavirus vaccine program in Morocco.     

Impact of routine rotavirus vaccination on all-cause and rotavirus hospitalizations during the first four years following vaccine introduction in Rwanda

BackgroundRwanda introduced pentavalent rotavirus vaccine into its national immunization program in 2012. To determine the long-term impact of rotavirus vaccine on disease burden in a high burden setting, we examined trends in rotavirus and all-cause diarrhea hospitalizations in the first four years following rotavirus vaccine introduction.MethodsWe used data from an active surveillance system, from a review of pediatric ward registries, and from the Health Management Information System to describe trends in rotavirus and all-cause diarrhea hospitalizations from January 2009 through December 2016. Percent reductions were calculated to compare the number of all-cause and rotavirus diarrhea hospitalizations pre- and post-rotavirus vaccine introduction.ResultsThe proportion of diarrhea hospitalizations due to rotavirus declined by 25–44% among all children <5 years of age during 2013–2015 with a shift in rotavirus hospitalizations to older age groups. The proportion of total hospitalizations due to diarrhea among children <5 years of age decreased from 19% pre-vaccine introduction to 12–13% post-vaccine introduction. In the national hospital discharge data, substantial decreases were observed in all-cause diarrhea hospitalizations among children <5 years of age in 2013 and 2014 but these gains lessened in 2015–2016.DiscussionContinued monitoring of long-term trends in all-cause diarrhea and rotavirus hospitalizations is important to ensure that the impact of the vaccination program is sustained over time and to better understand the changing age dynamics of diarrhea and rotavirus hospitalizations in the post-vaccine introduction era.     

Rotavirus surveillance --- worldwide, 2009

Rotavirus is the leading cause of severe diarrhea worldwide among children aged <5 years (1). An estimated 527,000 children in this age group died from rotavirus in 2004, and approximately 85% of those deaths occurred in South Asia and sub-Saharan Africa (2). In 2009, the World Health Organization (WHO) recommended inclusion of rotavirus vaccination in all national immunization programs (3). Disease burden data generated from surveillance are important for making decisions regarding whether to introduce rotavirus vaccine into a country, and establishing surveillance platforms is essential to enable monitoring of vaccine impact. WHO coordinates a global surveillance network for rotavirus that uses standardized case definitions and laboratory methods at sentinel hospitals to identify cases of rotavirus in children with diarrhea. This report summarizes an assessment of data from the global surveillance network for 2009, which found that, among 43 participating countries that tested ≥ 100 stool specimens and reported results for all 12 months in 2009, a median of 36% of enrolled and tested children aged < 5 years hospitalized with diarrhea (range: 25%-47% among the six WHO regions) tested positive for rotavirus. These data illustrate the important etiologic role of rotavirus in hospitalizations for diarrhea in children worldwide, which can be prevented by rotavirus vaccination.     

Dynamic model of rotavirus transmission and the impact of rotavirus vaccination in Kyrgyzstan

New rotavirus vaccines show promise to reduce the burden of severe diarrhea among children in developing countries. We present an age-specific dynamic rotavirus model to assess the effect of rotavirus vaccination in Kyrgyzstan, a country in Central Asia that is eligible for funds from the GAVI Alliance. A routine rotavirus vaccination program at 95% coverage and 54% effectiveness against severe infection is estimated to lead to a 56% reduction in rotavirus-associated deaths and a 50% reduction in hospital admissions, while outpatient visits and homecare episodes would decrease by 52% compared to baseline levels after 5 years of intervention. A 10% reduction in vaccine efficacy due to incomplete 3-dose regimen is estimated to increase the numbers of severe cases by 6-8%. Herd immunity was found to account for 1% or less of averted cases of severe gastroenteritis, while an extra 7-8% of all rotavirus infections would be avoided due to reduced transmission. Conclusion: Rotavirus vaccines would reduce the burden of rotavirus disease substantially, but the results are sensitive to delay in age-appropriate vaccination.     

Estimating the herd immunity effect of rotavirus vaccine

IntroductionDiarrhea is one of the leading causes of death in children under 5, and an estimated 39% of these deaths are attributable to rotavirus. Currently two live, oral rotavirus vaccines have been introduced on the market; however, the herd immunity effect associated with rotavirus vaccine has not yet been quantified. The purpose of this meta-analysis was to estimate the herd immunity effects associated with rotavirus vaccines.MethodsWe performed a systematic literature review of articles published between 2008 and 2014 that measured the impact of rotavirus vaccine on severe gastroenteritis (GE) morbidity or mortality. We assessed the quality of published studies using a standard protocol and conducted meta-analyses to estimate the herd immunity effect in children less than one year of age across all years presented in the studies. We conducted these analyses separately for studies reporting a rotavirus-specific GE outcome and those reporting an all-cause GE outcome.ResultsIn studies reporting a rotavirus-specific GE outcome, four of five of which were conducted in the United States, the median herd effect across all study years was 22% [19–25%]. In studies reporting an all-cause GE outcome, all of which were conducted in Latin America, the median herd effect was 24.9% [11–30%].ConclusionsThere is evidence that rotavirus vaccination confers a herd immunity effect in children under one year of age in the United States and Latin American countries. Given the high variability in vaccine efficacy across regions, more studies are needed to better examine herd immunity effects in high mortality regions.     

Pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children: Seven years of active surveillance, 2010–2016

BackgroundEach year, approximately 1,066 Cambodian children under five years old die of diarrhea, and 51% of these deaths are due to rotavirus gastroenteritis. Quantifying childhood hospitalizations caused by severe rotavirus infections is also important in demonstrating disease burden caused by this virus. The objective of this study is to update and confirm the current burden of pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children using seven years of continuous active, prospective surveillance from 2010 to 2016. We also characterize the circulating rotavirus genotypic strains during this period.MethodsActive surveillance for rotavirus gastroenteritis was conducted from January 2010 through December 2016 at a national hospital in Phnom Penh, Cambodia. Children <60 months of age who were hospitalized for acute gastroenteritis (AGE) were consented and enrolled. Information on gender, age, clinical characteristics, and month of onset were collected. Stool specimens were collected and tested by enzyme immunoassay for the presence of rotavirus antigen, and genotyping was performed on rotavirus test-positive specimens to characterize predominant rotavirus strains during the surveillance period.ResultsOf 7007 children enrolled with AGE and having specimens collected, 3473 (50%) were attributed to rotavirus gastroenteritis. The majority of rotavirus hospitalizations occurred in children younger than two years old (92%). Year-round rotavirus transmission was observed, with seasonal peaks during the cooler, dry months between November and May. Genotypic trends in rotavirus were observed over the surveillance period; the predominant rotavirus strains changed from G1P[8] (2010–2012), to G2P[4] (2013–2014), the emergence of genotype G8P[8] in 2015, and G3P[8] in 2016.ConclusionsRotavirus is the leading cause of severe acute gastroenteritis hospitalizations in Cambodian children under five years old, with 50% of such hospitalizations attributable to rotavirus. Over 90% of rotavirus hospitalizations occurred in children under 2 years of age. Changes in the predominant rotavirus strains occurred over time among these unvaccinated children. This information is important to understand and prioritize the current potential impacts upon child health that could be achieved through the introduction of rotavirus vaccines in Cambodia.     

Progress in the introduction of rotavirus vaccine--Latin America and the Caribbean, 2006-2010

Rotavirus disease is the leading cause of childhood morbidity and mortality related to diarrhea in Latin America and the Caribbean (LAC), where an estimated 8,000 deaths related to rotavirus diarrhea occur annually among children aged <5 years. After two safe and effective rotavirus vaccines became available, the World Health Organization (WHO) in 2007 recommended inclusion of rotavirus vaccine in the immunization programs of Europe and the Americas, and in 2009 expanded the recommendation to all infants aged <32 weeks worldwide. This report describes progress in the introduction of rotavirus vaccine in LAC, where it was first introduced in 2006 in Brazil, El Salvador, Mexico, Nicaragua, Panama, and Venezuela; by January 2011, it was included in the national immunization schedules of 14 countries in LAC. Estimated national rotavirus vaccine coverage (2 doses of the monovalent vaccine or 3 doses of the pentavalent vaccine) among children aged <1 year in 2010 ranged from 49% to 98% (median: 89%) in the 11 LAC countries with vaccine introduction before 2010. Of the 14 countries that had introduced rotavirus vaccine into their national immunization programs, 13 participate in a hospital-based rotavirus surveillance network. Data from some countries in this network and from other monitoring efforts in LAC countries have shown declines in hospitalizations and deaths related to severe diarrhea after rotavirus vaccine introduction. The rapid introduction of rotavirus vaccine in LAC demonstrates the benefits of the early commitment of national decision makers to introduce these vaccines in low-income and middle-income countries at the same time as in high-income countries.     

Evaluating the first introduction of rotavirus vaccine in Thailand: Moving from evidence to policy

BackgroundWe assessed the effectiveness and possible impact of introducing rotavirus vaccine into the routine immunization program.MethodsTwo provinces were selected for an observational study, one where vaccine was introduced and another where vaccine was not available. In these areas, two sub-studies were linked. The prospective cohort study enrolled children 2 month old and followed them to the age of 18 months to detect all diarrhea episodes. The hospital surveillance study enrolled all children up to age 5 hospitalized with diarrhea whose fecal samples were tested for rotavirus. Rates of rotavirus hospitalizations in older children who had not been vaccinated in both settings provided data to determine whether immunization had an indirect herd effect. The key endpoints for the study were both vaccine effectiveness (VE) based upon hospitalized rotavirus diarrhea and herd protection.FindingsFrom the cohort study, the overall VE for hospitalized rotavirus diarrhea was 88% (95%CI 76–94). Data from hospital surveillance indicated that for 2 consecutive years, the seasonal peak of rotavirus admissions was no longer present in the vaccinated area. Herd protection was observed among older children born before the rotavirus vaccine program was introduced, who experienced a 40–69% reduction in admission for rotavirus.ConclusionsRotavirus vaccine was highly effective in preventing diarrheal hospitalizations and in conferring herd protection among older children who had not been vaccinated.