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Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series
Greice Madeleine Ikeda do Carmo1, Catherine Yen, Jennifer Cortes
1Secretariat for Health Surveillance (Secretaria de Vigilância em Saúde), Ministry of Health, Brasilia, Brazil.
Insights
Brazil
Area of Science:
- Public Health
- Vaccinology
- Pediatrics
Background:
- Brazil introduced a single-strain rotavirus vaccine for infants in 2006.
- The study assessed the vaccine's impact on childhood diarrhea mortality and hospitalizations across Brazil's diverse regions.
Purpose of the Study:
- To evaluate the association between rotavirus vaccination and reductions in childhood diarrhea deaths.
- To assess the impact on childhood diarrhea hospital admissions post-vaccine introduction.
Main Methods:
- Interrupted time-series analysis of national data (2002-2009).
- Compared diarrhea-related mortality and hospitalization rates before and after vaccine introduction.
- Adjusted for secular and seasonal trends.
Main Results:
- Rotavirus vaccination was associated with a 22% decrease in diarrhea deaths and a 17% decrease in hospital admissions in children under 5.
- Approximately 1,500 fewer deaths and 130,000 fewer admissions were observed in the three years post-vaccination.
- The greatest reductions were seen in children under 2 years old, who had higher vaccination rates.
Conclusions:
- Rotavirus vaccination in infants led to significant, sustained declines in diarrhea mortality and hospitalizations in Brazilian children under 5.
- The observed reductions, particularly in younger children, strongly suggest the vaccine's effectiveness in controlling childhood diarrhea.
- These findings support rotavirus vaccination as a key public health intervention for preventing severe childhood diarrhea.
Background:
In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. We evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators.
Methods And Findings:
National data were analyzed with an interrupted time-series analysis that used diarrhea-related mortality or hospitalization rates as the main outcomes. Monthly mortality and admission rates estimated for the years after rotavirus vaccination (2007-2009) were compared with expected rates calculated from pre-vaccine years (2002-2005), adjusting for secular and seasonal trends. During the three years following rotavirus vaccination in Brazil, rates for diarrhea-related mortality and admissions among children <5 y of age were 22% (95% confidence interval 6%-44%) and 17% (95% confidence interval 5%-27%) lower than expected, respectively. A cumulative total of ~1,500 fewer diarrhea deaths and 130,000 fewer admissions were observed among children <5 y during the three years after rotavirus vaccination. The largest reductions in deaths (22%-28%) and admissions (21%-25%) were among children younger than 2 y, who had the highest rates of vaccination. In contrast, lower reductions in deaths (4%) and admissions (7%) were noted among children two years of age and older, who were not age-eligible for vaccination during the study period.
Conclusions:
After the introduction of rotavirus vaccination for infants, significant declines for three full years were observed in under-5-y diarrhea-related mortality and hospital admissions for diarrhea in Brazil. The largest reductions in diarrhea-related mortality and hospital admissions for diarrhea were among children younger than 2 y, who were eligible for vaccination as infants, which suggests that the reduced diarrhea burden in this age group was associated with introduction of the rotavirus vaccine. These real-world data are consistent with evidence obtained from clinical trials and strengthen the evidence base for the introduction of rotavirus vaccination as an effective measure for controlling severe and fatal childhood diarrhea.
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