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Published on: January 28, 2019
Effectiveness of monovalent rotavirus vaccine in a high-income, predominant-use setting
Margaret K Doll1, David L Buckeridge1, Kathryn T Morrison1
1McGill University, Montreal, QC, Canada.
Insights
The monovalent rotavirus (RV1) vaccine demonstrated high effectiveness in preventing pediatric rotavirus hospitalizations in a high-income country. Increased RV1 vaccine coverage significantly reduced rotavirus prevalence and hospitalizations.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health
Background:
- Rotavirus is a leading cause of severe gastroenteritis in infants and young children globally.
- The introduction of rotavirus vaccines has significantly reduced disease burden in many countries.
- Assessing vaccine effectiveness in settings with predominant use of a specific vaccine type is crucial for understanding its real-world impact.
Purpose of the Study:
- To evaluate the effectiveness of the monovalent rotavirus (RV1) vaccine in a high-income setting.
- To examine the impact of RV1 vaccine implementation on the burden of pediatric rotavirus gastroenteritis.
- To compare RV1 vaccine effectiveness with findings from settings using multiple rotavirus vaccine types.
Main Methods:
- Active surveillance for rotavirus gastroenteritis in children aged 8 weeks to <3 years across three hospitals.
- Collection of vaccination histories and clinical data through interviews and medical records.
- Genotyping of rotavirus strains and analysis of prevalence trends using binomial regression.
- Test-negative case-control design to determine RV1 vaccine effectiveness against hospitalization or emergency visits.
Main Results:
- A significant decrease in rotavirus prevalence was observed following increased RV1 vaccine coverage.
- Each 1% increase in 2-dose RV1 coverage was associated with a 3.8% relative decrease in rotavirus prevalence.
- Adjusted 2-dose RV1 vaccine effectiveness against hospitalization or emergency visits was 91.2% (95% CI: 61.6%, 98.0%).
- Prevalence of homotypic rotavirus strains significantly decreased post-vaccination.
Conclusions:
- The RV1 vaccine is highly effective in preventing rotavirus-related hospitalizations and emergency visits in children under 3 years old.
- These findings are comparable to those from high-income settings utilizing both RV1 and pentavalent vaccines.
- The study highlights the substantial public health impact of RV1 vaccine in reducing pediatric rotavirus disease burden.
Background And Objectives:
We assessed monovalent rotavirus (RV1) vaccine effectiveness (VE) in a high-income setting with RV1 predominant use, and examined the burden of pediatric rotavirus gastroenteritis following the implementation of an RV1-only vaccination program.
Methods:
We conducted active rotavirus gastroenteritis surveillance among children 8 weeks to <3 years of age at three hospitals. Participant information and vaccination histories were collected via parent/guardian interview and medical records. Stool specimens were tested for rotavirus; positive specimens were genotyped. The effect of increasing RV1 coverage on rotavirus prevalence was examined as a weekly time series via binomial regression with a log link function, using either categorical season or mean 2-dose rotavirus seasonal vaccine coverage as the exposure variable. As compared with RV1 vaccine formulation, rotavirus genotypes were classified as homotypic, partly-heterotypic, or heterotypic; prevalence of each was compared by season. A test-negative case-control design was used to examine RV1 VE against hospitalization or emergency visits.
Results:
We enrolled 866 participants in active surveillance; of these, 384 (44.3%) were eligible for VE analyses. After adjustment for season, we detected a 70.1% (95% CI: 21.9%, 88.6%) relative decrease in rotavirus prevalence in the 2013-14 season compared with 2012-13 season. On average, a 1% increase in ≥2-dose rotavirus coverage among children 1 year of age was associated with a 3.8% (95% CI: 1.8%, 5.8%) relative decrease in rotavirus prevalence. Rotavirus homotypic strain prevalence decreased, with 77% (95% CI: 68%, 89%) versus 8% (95% CI: 0%, 36%) prevalence during the 2011-12 and 2013-14 seasons, respectively. Adjusted 2-dose RV1 VE was 91.2% (95% CI: 61.6%, 98.0%).
Conclusions:
RV1 vaccine was highly effective to prevent rotavirus hospitalizations and emergency visits among children <3 years of age in a high-income setting with its predominant use. Our estimates were similar to high-income settings with concurrent RV1 and pentavalent vaccine use.
