Early impact of rotavirus vaccine in under 5 year old children hospitalized due to diarrhea,Swaziland

BackgroundSwaziland introduced rotavirus vaccine in the National Immunization Program, in May 2015, with the objective of reducing the burden of rotavirus diarrheal disease. We monitored the early impact of the vaccine in reducing rotavirus diarrhea.MethodsWe conducted sentinel rotavirus surveillance from January 2013 to December 2016 in children under five years of age admitted due to diarrhea attending Mbabane Government Referral Hospital in the Hhohho Region and Raleigh Fitkin Memorial Hospital in the Manzini Region. All cases had stool samples collected and tested for rotavirus antigen by enzyme immunoassay.ResultsBetween 2013 and 2016, 596 samples were collected and tested. Rotavirus positivity reduced from average of 50.8% (172/338) (in 2013–2014 (pre vaccine period)) to 29% (24/82) in 2016, post-vaccine introduction. The median age of children with rotavirus infection increased from average of 10 months in 2013–2014 to 13.7 months in 2016. The peak season for all-cause diarrhea and rotavirus-specific hospitalizations among children under five years of age was June–August in all years with a blunting of the peak season in 2016. Rotavirus positivity among children 0–11 months reduced from an average of 49% in 2013–2014 (116/236) to 33% (15/45) in 2016, a 33% reduction following rotavirus vaccine introduction.ConclusionThere has been a rapid reduction of all-cause diarrhea and rotavirus hospitalizations in Swaziland, particularly in young children and during the rotavirus season, after the introduction rotavirus vaccine. Continued surveillance is needed to monitor the long-term impact of rotavirus vaccine introduction.     

嘉兴地区5岁以下儿童轮状病毒腹泻的疾病负担

目的:了解嘉兴地区5岁以下儿童轮状病毒腹泻疾病负担情况。方法:采用系统抽样法,抽取2018—2019年嘉兴市秀洲区各乡镇/街道报告的300例5岁以下轮状病毒腹泻病例作为调查对象。采用自行设计的调查表,获取调查对象基本情况和治疗情况,以及生病期间亲属陪护情况和生命质量等情况,综合评估疾病负担。结果:300例患儿的调查问卷...     

Reduction of hospitalizations with diarrhea among children aged 0–5 years in Nouakchott,Mauritania, following the introduction of rotavirus vaccine

Introduction

Rotavirus vaccine was introduced in Mauritania in December 2014. We investigated hospitalizations with diarrhea during pre and post-vaccination periods among children aged 0–5?years in Nouakchott, the capital of Mauritania.

Trends in diarrhea hospitalizations among infants at three hospitals in Tanzania before and after rotavirus vaccine introduction

BackgroundThe Tanzania Ministry of Health introduced monovalent human rotavirus vaccine in January 2013, to be administered at ages 6 and 10 weeks. Data suggest there was high vaccine uptake. We used hospital ward registers from 3 hospitals to examine trends in diarrhea hospitalizations among infants before and after vaccine introduction.MethodsWard registers from Dodoma Regional Referral Hospital (Central Tanzania), and two hospitals in Mbeya (Southwest area), Mbeya Zonal Referral Hospital and Mbalizi Hospital, were used to tally admissions for diarrhea among children by age group, month and year. Rotavirus surveillance had started at these hospitals in early 2013; the proportion of infants enrolled and rotavirus-EIA positive were examined by month to determine peak periods of rotavirus disease post-vaccine introduction.ResultsRegisters were available for 2–4 prevaccine years and 2–3 post introduction years. At Dodoma Regional Referral Hospital, compared with the mean of 2011 and 2012, diarrhea hospitalizations among infants were 26% lower in 2015 and 58% lower in 2016. The diarrhea peak shifted later in the year first by 1 and then by 2–3 months from prevaccine. At the Mbeya hospitals, the number of diarrhea admissions in prevaccine period varied substantially by year. At Mbeya Referral Hospital, diarrhea hospitalizations among infants were lower by 25–37% in 2014 and 11–26% in 2015, while at Mbalizi Hospital, these hospitalizations were 4% lower in 2014 and 14% higher in 2015. Rotavirus testing data demonstrated a lowering of the prevaccine peak, a shift in timing of the peak months and indicated that other diarrheal peaks in post-introduction years were not due to rotavirus.ConclusionsIn this ecological evaluation, total diarrhea hospitalizations among infants were lower (≥25% lower in ≥1 year) following introduction in 2 of 3 hospitals. There are challenges in using ward registers to ascertain possible impact of rotavirus vaccine introduction on trends in hospitalizations for treatment of all diarrheal illness.     

云南省富宁县一起婴幼儿轮状病毒腹泻暴发调查

对2004年12月28习云南省富宁县板轮乡龙洋村发生多例婴幼儿不明原因腹泻病例进行调查及处理. 1.对象与方法:采用流行病学现场调查[1];调查对象为富宁县板轮乡龙洋村所有儿童.     

Detection of rotavirus before and after monovalent rotavirus vaccine introduction and vaccine effectiveness among children in mainland Tanzania

BackgroundMonovalent rotavirus vaccine (RV1) was introduced in Tanzania in January 2013 under the Reach Every Child initiative, to be given at ages 6 and 10 weeks. We used the sentinel hospital rotavirus surveillance system to examine the rotavirus detection rate before and after vaccine introduction and estimate vaccine effectiveness.MethodsBefore vaccine introduction, rotavirus surveillance was established at two mainland hospitals; children admitted for acute diarrhea were eligible for enrollment and stools were tested for rotavirus antigen. We compared the rotavirus positivity rate in the pre-vaccine period (Tanga Hospital, 2009 and 2011; Bugando Medical Centre, 2012) to that from post-introduction years, 2014–2015. In 2013, surveillance was established at 9 additional hospitals. We examined rotavirus positivity among infants at these sites for 2014–2015. We obtained vaccine records and calculated vaccine effectiveness at 3 sites using case-test-negative control design.ResultsAt Tanga Hospital, the rotavirus positivity rate among infants was 41% (102/251) pre-vaccine and 14% (28/197) in post-vaccine years (rate ratio: 0.35 [95% CI 0.22–0.54]). At Bugando, the positivity rate was 58% (83/143) pre-vaccine, and 18% (49/277) post-introduction (rate ratio 0.30 [95% CI 0.210.44]). Results were similar among children <5 years. At the new sites, the median site rotavirus positivity rate among infants was 26% in 2014 (range 19–44%) and 18% in 2015 (range 16–33%). The effectiveness of ≥1 RV1 dose against rotavirus hospitalization among children 5–23 months was 53% (95% CI: −14, 81), and 66% (95% CI: 9–87) against hospitalization with intravenous rehydration. Following introduction, peak rotavirus activity occurred later in the year and appeared more concentrated in time.ConclusionRotavirus surveillance data from Tanzania indicate that the rotavirus positivity rate among children hospitalized with diarrhea that were enrolled was substantially reduced after vaccine introduction. Low positivity rates among infants were detected at hospitals across the country. Overall, the data support that rotavirus vaccine has been successfully introduced and is effective in Tanzanian children.     

中国婴幼儿轮状病毒腹泻流行病学研究

目的 了解中国婴幼儿轮状病毒(RV)腹泻流行特点和分子流行病学特征,为RV疫苗的研制提供动态信息.方法 对中国2003-2010年监测年限≥1年的涵盖19个省、4个自治区、4个直辖市(共33个市、6个县)的74篇关于RV腹泻流行病学研究的文献进行系统综述,并结合新疆乌鲁木齐婴幼儿RV腹泻研究状况作相应分析.结果 根据74篇文献统计,住院腹泻患儿RV中位检出率为47.4％(19.7％ ～64.9％);门诊腹泻患儿中位检出率为34.1％(23.3％～38.9％);部分报道门诊和住院中腹泻患儿的中位检出率为37.6％(9.6％～65.6％).人群中,6月～2岁的婴幼儿依然是RV感染的主要人群,流行高峰从每年9月～次年2月,不同年份不同地区略有差异.2003-2010年中国流行的RV优势株为G3P [8],其次为G1P[8].结论 RV流行株具有多样性且动态变化,新基因型偶有检出,表明长期监测RV的流行情况是必要的.     

Diarrhea among hospitalized children under five: A call for inclusion of rotavirus vaccine to the national immunization program in Indonesia

ContextRotavirus diarrhea is a common disease worldwide which mostly affects children under five years old. Rotavirus infection causes severe diarrhea and leads to substantial health care costs. In Indonesia the rotavirus vaccine has been available since 2011, however it has not been included into the National Immunization Program. This study aims to describe the proportion of rotavirus in children under 5 in Indonesia, the clinical characteristics of rotavirus infections, and the rotavirus strains circulating in the country during 2010–2015.MethodsChildren under five years of age with acute watery diarrhea were prospectively identified and enrolled through the active diarrhea surveillance system in 5 sites in four provinces in Indonesia during 2010–2015. The rotavirus specimens were tested using Enzyme Immunoassay. Bivariate logistic regression tests were performed to compare rotavirus positive and negative results with respect to the collected demographic and clinical variables.ResultsFrom January 2010 to December 2015, the average annual rotavirus prevalence among children hospitalized with acute watery diarrhea in four provinces in Indonesia was 47.5%. Rotavirus diarrhea occurred mostly in children under 2 years of age. Of all age groups, children aged 6–11 and 12–23 months had the highest prevalence of rotavirus diarrhea in all years (54.2% and 50.6%, respectively). This study found that the most prevalent of G and P genotypes were G1P8 in 2010 (63.2%), 2011 (64.1%) and 2012 (74.6%) and G3P8 in 2013 (49.7%), 2014 (82.5%) and 2015 (84.4%)ConclusionsThis study demonstrates that rotavirus is a major cause of diarrhea in hospitalized children in Indonesia. These findings highlight the need for inclusion of the rotavirus vaccine to the National Immunization Program in Indonesia.     

31例婴幼儿轻度轮状病毒腹泻合并惊厥分析

目的:探讨轮状病毒性腹泻与惊厥的关系。方法:对2003年10月~2004年3月我科确诊的31例轮状病毒腹泻合并惊厥患儿的临床及实验室检查资料进行回顾性分析。结果:31例患儿均伴有无热惊厥,神经系统检查和血液生化均正常;多数惊厥时间不超过4 m in;发作形式包括强直痉挛性发作(21例)、失神发作(2例)和部分性发作(8例);11例脑电图异常患儿均于7~10 d恢复正常;随诊1年后无1名患儿诊断癫痫。结论:轮状病毒感染可能引起肠道外神经系统并发症,但预后良好,不必进行抗癫痫治疗。     

2005—2018年中国5岁以下轮状病毒腹泻报告病例流行特征分析

目的分析2005—2018年中国(不含中国香港、澳门和台湾数据,下同)5岁以下轮状病毒腹泻病例的流行特征及变化趋势。方法从传染病报告信息管理系统中下载2005—2018年中国其他感染性腹泻报告病例数据,提取、建立5岁以下轮状病毒腹泻报告病例数据库,用描述性流行病学方法分析其流行特征及变化趋势。结果2005—2018年共报告5岁以下儿童轮状病毒腹泻报告病例820588例,男性为500944例;年均报告发病率为63.7/10万,报告发病率从2005年的8.4/10万波动上升至2018年的178.1/10万;报告省份由17个增加到30个;发病高峰季节为11月至次年2月;<5月龄的儿童占13.1%(107845例),6月龄至2岁占70.3%(576874例),报告发病数高峰为11~13月龄儿童(163947例)。年均报告发病率前3位的省份分别为(535.2/10万)、广东(334.3/10万)和北京(317.3/10万);除西藏地区无报告外,报告发病率最低3个省份分别为山西(0.9/10万)、黑龙江(1.6/10万)和辽宁(2.5/10万);南方地区报告发病数(745526例)是北方(74935例)的9.9倍。检出轮状病毒与其他腹泻病原两种及以上同时感染的病例占1.8%(15030例),其中90.1%(13544例)是轮状病毒与腺病毒同时感染。结论我国5岁以下儿童自6月龄起轮状病毒感染率迅速上升,84.4%的报告病例为<2岁婴幼儿。     

2010年婴幼儿腹泻轮状病毒监测分析

目的了解乌鲁木齐地区婴幼儿轮状病毒(RV)腹泻流行情况。方法 2010年1~12月,采集门诊或住院≤5岁婴幼儿腹泻样本503份,用胶体金法和ELISA检测RV抗原,阳性样本用逆转录-聚合酶链反应(RT-PCR)进行G、P基因型分型。结果 503份腹泻样本,RV阳性率为24.25%(122/503)。RV感染对象主要为35月以内婴幼儿(95.08%)。对102份RV阳性样本进行G/P分型,G3型是主要优势株,占46.08%,其次为G1型(34.31%)、G9型(11.76%)和G2型(2.94%),混合G型感染占4.90%;P基因型以P[8]为主导,占67.65%,其次为P型混合感染(19.61%)、P[4](6.86%)和P[6](4.90%),1例(0.98%)未能分型。最常见的G/P组合为G3P[8](35.29%)和G1P[8](27.45%)。结论 RV是乌鲁木齐地区婴幼儿腹泻的主要病原,2010年G3P[8]和G1P[8]为主要流行基因型。     

Reduction in hospitalizations for diarrhea and rotavirus infections in New York state following introduction of rotavirus vaccine

Objectives

To monitor trends and costs of diarrhea and rotavirus-associated hospitalizations in New York before and after rotavirus vaccine implementation in 2006. To examine rotavirus test results from sentinel hospital-associated laboratories.

Methods

Hospital discharge data and laboratory rotavirus testing data were analyzed for children 1 month up to 18 years of age for 10 sentinel and all statewide hospitals from January 1, 2003 through December 31, 2008.

Results

Among children 1–23 months of age, a 40% reduction in diarrhea-associated hospitalizations and 85% decrease in rotavirus-coded hospitalizations at the 10 sentinel hospitals was observed in 2008 compared with the average of pre-vaccine seasons from 2003 through 2006. For both sentinel and statewide hospitals, the percent of diarrhea admissions due to rotavirus was reduced at least 83% among children 1–23 months (vaccine eligible) and 70% for older unimmunized children. Statewide hospital costs for rotavirus hospitalizations in children <2 years of age were reduced $10 million. Sentinel hospital laboratory data validated the declining trends seen in hospitalizations.

Conclusions

In 2008, New York hospital data showed significant reductions in rotavirus hospitalizations and costs among children aged 1–23 months who were eligible for vaccine. Reductions also occurred among unimmunized older children suggesting the importance of continue monitoring in future seasons to fully assess vaccine impact.     

三个监测点医院2001-2004年婴幼儿轮状病毒腹泻监测

目的 了解3个监测点医院2001年8月至2004年7月住院的5岁以下婴幼儿轮状病毒腹泻流行状况。方法 以医院为基础的哨点监测,监测对象为5岁以下腹泻住院患儿。收集患儿的临床资料和粪便标本并进行轮状病毒检测和分型。结果 共检测3121份腹泻患儿的粪便标本,轮状病毒检出率为51%。94%的轮状病毒腹泻发生在2岁以下儿童。G3型为流行优势株,占69．9%,其次为G1型6．6%、G2型2．9%、G9型2．2%、G4型0．3%。P[8]型为最常见的P基因型。最常见的P-G组合型是P[8]G3,占64．0%,还有其他7种不常见的P-G组合的毒株类型。结论 轮状病毒是3个监测点医院住院腹泻患儿的主要病原,P[8]G3型为主要流行株。     

安徽省婴幼儿腹泻轮状病毒G/P分型分析

目的了解安徽省婴幼儿腹泻轮状病毒的基因型别分布特点。方法对2011年1～12月收集的5岁以下住院婴幼儿腹泻粪便标本307份,采用酶联免疫吸附试验(ELISA)检测轮状病毒抗原,阳性标本运用逆转录聚合酶链式反应(RT-PCR)进行G型和P型分型。结果 307份粪便标本中轮状病毒阳性率为15.64%(48/307);G3型为优势株,占47.91%(23/48),G9型占27.08%(13/48),G1型占16.67%(8/48),混合G型感染占14.58%(7/48),G2型占6.25%(3/48),G4型占2.08%(1/48);P基因型中最常见为P[8],占62.67%(32/48),P[4]占8.33%(4/48);G3P[8]优势组合占47.91%。结论引起安徽地区婴幼儿腹泻的轮状病毒G3P[8]是主要优势流行株,G9型为次之的优势株且存在混合G型感染。     

Impact of rotavirus vaccine on all-cause diarrhea and rotavirus hospitalizations in Madagascar

BackgroundRotavirus 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 <5 years of age before and after vaccine introduction and assessed trend of circulating rotavirus genotypes at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET).MethodsFrom January 2010 to December 2016, we reviewed the admission logbook to observe the rate of hospitalization caused by gastroenteritis among 19619 children <5 years 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.ResultsDiarrhea 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.ConclusionsFollowing 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.     

Impact of rotavirus vaccination on diarrheal hospitalizations in children younger than 5 years of age in a rural southern Mozambique

BackgroundRotavirus vaccine (Rotarix®) was introduced in Mozambique through its Expanded Program of Immunization in September 2015. We assessed the impact of rotavirus vaccination on childhood gastroenteritis-associated hospitalizations post-vaccine introduction in a high HIV prevalence rural setting of southern Mozambique.MethodsWe reviewed and compared the trend of hospitalizations (prevalence) and incidence rates of acute gastroenteritis (AGE), and rotavirus associated-diarrhea (laboratory confirmed rotavirus) in pre- (January 2008–August 2015) and post-rotavirus vaccine introduction periods (September 2015–December 2020), among children <5 years of age admitted to Manhiça District Hospital.ResultsFrom January 2008 to December 2020, rotavirus vaccination was found to contribute to the decline of the prevalence of AGE from 19% (95% CI: 18.14–20.44) prior to the vaccine introduction to 10% (95% CI: 8.89–11.48) in the post-introduction period, preventing 40% (95 % IE: 38–42) and 84% (95 % IE: 80–87) of the expected AGE and laboratory confirmed rotavirus cases, respectively, among infants. Similarly, the overall incidence of rotavirus was 11.8-fold lower in the post-vaccine introduction period (0.4/1000 child-years-at-risk [CYAR]; 95% CI: 0.3–0.6) compared with the pre-vaccination period (4.7/1000 CYAR; 95% CI: 4.2–5.1) with the highest reduction being observed among infants (16.8-fold lower from the 15.1/1000 CYAR in the pre-vaccine to 0.9/1000 CYAR in the post-vaccine eras).ConclusionsWe documented a significant reduction in all-cause diarrhea hospitalizations and rotavirus positivity after vaccine introduction demonstrating the beneficial impact of rotavirus vaccination in a highly vulnerable population.