Trends in diarrhea hospitalizations among infants at three hospitals in Tanzania before and after rotavirus vaccine introduction |
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| Affiliation: | 1. Dodoma Regional Referral Hospital, Dodoma, Tanzania;2. Mbeya Zonal Referral Hospital, Mbeya, Tanzania;3. World Health Organization, Country Office, Dar es Salaam, Tanzania;4. Mbalizi Hospital, Mbalizi, Tanzania;5. National Health Laboratory Quality Assurance Training Centre, Dar es Salaam, Tanzania;6. World Health Organization, AFRO Office, Brazzaville, Congo;7. Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Centers for Disease Control and Prevention, Atlanta, GA, USA;2. World Health Organization Regional Office for Africa (WHO/AFRO), Brazzaville, Congo;3. World Health Organization, Geneva, Switzerland;4. Centers for Disease Control and Prevention, Atlanta, GA, USA;1. Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India;1. Department of Medicine, Hutt Hospital, Hutt Valley District Health Board, High St, Lower Hutt 5010, New Zealand;2. Wellington SCL Microbiology Laboratory, Wellington Hospital, Riddiford St, Wellington 6010, New Zealand;3. Department of Infection Services, Wellington Hospital, Capital and Coast District Health Board, Riddiford St, Wellington 6010, New Zealand;1. Department of Paediatrics, Medical School of Lome, Togo;2. The World Health Organization, Regional Office for Africa, Brazzaville, Congo;3. Microbiology Departments, Medical School of Lome, Togo;4. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA;5. EPI Manager, Ministry of Health, Togo;6. WHO Country Office, Togo;1. Public Health Agency, 12-22 Linenhall Street, Belfast, Northern Ireland BT2 8BS, UK;2. Health Protection Surveillance Centre, 25-27 Middle Gardiner Street, Dublin 1 DO1 A4A3, Ireland;1. Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, PO Box 3021, Morogoro, Tanzania;2. SACIDS Africa Centre of Excellence for Infectious Diseases, SACIDS Foundation for One Health, Sokoine University of Agriculture, PO Box 3297, Morogoro, Tanzania;3. Food and Microbiology Laboratory, Tanzania Bureau of Standards, Ubungo Area, Morogoro Road/Sam Nujoma Road, PO Box 9524, Dar es Salaam, Tanzania;4. Department of Veterinary Microbiology, Parasitology and Biotechnology, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, PO Box 3019, Morogoro, Tanzania;5. Department of Animal, Aquaculture, and Range Sciences, College of Agriculture, Sokoine University of Agriculture, PO Box 3004, Morogoro, Tanzania;6. Muhimbili University of Health and Allied Sciences, Department of Biological and Pre-clinical Studies, PO Box 65001, Dar es Salaam, Tanzania |
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| Abstract: | 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. |
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| Keywords: | Rotavirus Diarrhea Gastroenteritis Rotavirus vaccine Infants Disease burden Tanzania Surveillance |
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