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Published on: January 28, 2019
Sustained Decrease in Gastroenteritis-related Deaths and Hospitalizations in Children Less Than 5 Years of Age After
Iolanda Costa1, Alexandre C Linhares, Maria Helena Cunha
1From the *Secretaria de Saúde do Estado do Pará, Belém, Brazil; *Department of Epidemiology, Secretaria de Saúde do Estado do Pará, Belém, Brazil; †Virology Section, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministry of Health, Belém, Brazil; ‡GSK Vaccines, Rio de Janeiro, Brazil; §Epidemiology and Health Outcomes, GSK Vaccines, Regional Office, Panamá, Brazil; ¶Research & Development, GSK Pharmaceuticals, Bangalore, India; ‖VxR&D Medical, GSK Vaccines, Regional Office, Panamá, Brazil; and **VxR&D Medical & Clinical Latin America, GSK Vaccines, Rio de Janeiro, Brazil.
Insights
The Rotarix rotavirus (RV) vaccine significantly reduced gastroenteritis-related deaths and hospitalizations in Brazilian children under five. This demonstrates the vaccine
Area of Science:
- Pediatrics
- Vaccinology
- Public Health
Background:
- Rotavirus (RV) vaccine, Rotarix, was integrated into Brazil's national immunization program in 2006.
- The study aimed to assess the population-level impact of RV vaccination.
Purpose of the Study:
- To estimate the population-level effectiveness of the Rotarix vaccine.
- To analyze trends in gastroenteritis (GE)-related mortality and hospitalizations in children under five before and after vaccine introduction.
Main Methods:
- A time-trend analysis was performed on national data for GE-related death certificate-reported deaths (DCRDs), hospital deaths (HDs), and hospitalizations in children under five.
- Negative-binomial regression models were used to compare trends between the pre-vaccine (2001-2005) and post-vaccine (2007-2010) periods, adjusting for age, year, and region.
Main Results:
- A significant overall reduction in GE-related DCRDs (20.9%) was observed in children under five post-vaccination.
- GE-related hospital deaths (HDs) and hospitalizations showed substantial reductions of 57.1% and 26.6%, respectively, in children under five.
- Reductions in HDs were significant across all age groups (<1 year and 1 to <5 years).
Conclusions:
- The introduction of the Rotarix vaccine led to significant reductions in GE-related mortality and morbidity in Brazilian children.
- These findings provide evidence for the direct and indirect population-level impact of RV vaccination.
- RV vaccination is crucial for reducing the burden of gastroenteritis in young children.
Background:
Rotavirus (RV) vaccine, Rotarix, was introduced into the Brazil national immunization program in 2006. To estimate population-level vaccine effect, we conducted a time-trend analysis on all-cause gastroenteritis (GE)-related death certificate-reported deaths (DCRDs), hospital deaths (HDs) and hospitalizations trends in <5-year-olds before and after RV vaccine introduction.
Methods:
National level all-cause GE-related death certificate [Mortality Information System] and admission (Hospital Information System) data were aggregated and analyzed. Negative-binomial regression models (adjusting for age, year and region) compared DCRDs, HDs and hospitalization trends in <5-year-olds between baseline (2001-2005) and postvaccine introduction periods (Mortality Information System: 2007-2009 and Hospital Information System: 2007-2010). Negative-binomial regression models were fitted to data for each outcome before 2006, and the predicted annual frequencies of each outcome were plotted against corresponding observed annual frequencies.
Results:
During the postvaccine introduction period, there was an overall age-independent GE-related DCRDs reduction (20.9%, P = 0.04) observed in children <5 years of age; a reduction was also seen in infants <1 year of age (20.8%, P = 0.003). Age-independent GE-related HDs and hospitalizations reductions (57.1%, P < 0.0001 and 26.6%, P < 0.0001, respectively) were observed in <5-year-olds; HDs reductions were also observed for each age group (<1-year-olds: 55.0%, P < 0.0001 and 1- to <5-year-olds: 59.5%, P < 0.0001). Observed annual frequencies of GE-related DCRDs, HDs and hospitalizations were lower than the predicted value in each age group in all years after 2006.
Conclusions:
GE-related DCRDs, HDs and hospitalizations were significantly reduced in <1 and in 1- to <5-year-old Brazilian children after Rotarix introduction, which provides additional evidence of the direct and indirect population-level effect of RV vaccination on GE-related mortality and morbidity in children.
