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Published on: January 28, 2019
Impact and Effectiveness of Monovalent Rotavirus Vaccine Against Severe Rotavirus Diarrhea in Ghana
George Armah1, Kimberly Pringle2, Christabel C Enweronu-Laryea3
1Noguchi Memorial Institute for Medical Research, University of Ghana, Accra.
Insights
Ghana
Area of Science:
- Public Health
- Vaccinology
- Epidemiology
Background:
- Ghana introduced the monovalent rotavirus vaccine (RV1) in April 2012.
- Rotavirus is a leading cause of severe acute gastroenteritis (AGE) in children globally.
Purpose of the Study:
- Assess the impact of RV1 introduction on rotavirus and AGE hospitalizations in Ghana.
- Estimate the vaccine effectiveness (VE) of RV1 against rotavirus hospitalizations.
Main Methods:
- Interrupted time-series analysis of hospital admission data from 2 teaching hospitals (40 months pre- and 31 months post-vaccine introduction).
- Prospective enrollment of children under 2 years eligible for RV1 across 7 sentinel sites.
- Unconditional logistic regression models to estimate VE, controlling for confounders.
Main Results:
- Rotavirus hospitalizations decreased by 49% (95% CI, 32%-63%) among children under 5 years in the first 3 years post-RV1 introduction.
- Vaccine coverage reached 93%-100% for the recommended doses.
- Any-dose VE against rotavirus hospitalization was estimated at 60% (95% CI, -2% to 84%).
Conclusions:
- RV1 introduction in Ghana led to substantial reductions in pediatric diarrheal disease.
- The estimated VE is consistent with observed rotavirus decrease and efficacy data from sub-Saharan Africa.
Background:
Ghana was among the first African nations to introduce monovalent rotavirus vaccine (RV1) into its childhood immunization schedule in April 2012. We aimed to assess the impact of vaccine introduction on rotavirus and acute gastroenteritis (AGE) hospitalizations and to estimate vaccine effectiveness (VE).
Methods:
Using data from 2 teaching hospitals, monthly AGE and rotavirus admissions by age were examined 40 months before and 31 months after RV1 introduction using interrupted time-series analyses. From January 2013, we enrolled children <2 years of age who were eligible for RV1 from a total of 7 sentinel sites across the country. To estimate VE, we fit unconditional logistic regression models to calculate odds ratios of vaccination by rotavirus case-patient status, controlling for potential confounders.
Results:
Vaccine coverage ranged from 95% to 100% for dose 1 and 93% to 100% for dose 2. In the first 3 years after vaccine introduction, the percentage of hospital admissions positive for rotavirus fell from 48% in the prevaccine period to 28% (49% adjusted rate reduction; 95% confidence interval [CI], 32%-63%) postvaccination among <5-year-olds. With high vaccine coverage, it was not possible to arrive at robust VE estimates; any-dose VE against rotavirus hospitalization was estimated at 60% (95% CI, -2% to 84%;P= .056).
Conclusions:
Results from the first 3 years following RV1 introduction suggest substantial reductions of pediatric diarrheal disease as a result of vaccination. Our VE estimate is consistent with the observed rotavirus decrease and with efficacy estimates from elsewhere in sub-Saharan Africa.
