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Has Rotavirus Vaccination Decreased the Prevalence of Biliary Atresia?
Elizabeth Danial1, Shannon Fleck-Derderian2, Philip Rosenthal2
1University of California, Berkeley.
Insights
Rotavirus vaccination in the US did not significantly impact the prevalence of biliary atresia (BA), a rare liver disease in infants. Despite a decrease in rotavirus infections after vaccination, BA diagnoses and liver transplants remained largely unchanged.
Area of Science:
- Neonatal liver disease
- Pediatric gastroenterology
- Virology
Background:
- Biliary atresia (BA) is a rare neonatal liver disease causing cholestasis and is the primary indication for pediatric liver transplantation.
- While the exact cause of BA is unknown, murine models suggest a link to rotavirus infection.
- Universal rotavirus vaccination was introduced in the United States in 2006.
Purpose of the Study:
- To investigate the correlation between the prevalence of biliary atresia (BA) and the number of annual rotavirus infections in the United States.
- To assess the impact of rotavirus vaccination on BA incidence.
Main Methods:
- Utilized data from the Kids' Inpatient Database (1997-2012) for BA discharges and the Organ Procurement and Transplantation Network (1988-2015) for liver transplants.
- Obtained annual rotavirus infection data from the National Respiratory and Enteric Virus Surveillance System.
- Analyzed trends between rotavirus infections, BA diagnoses, and liver transplants over time.
Main Results:
- Rotavirus infections significantly decreased after 2006, coinciding with widespread vaccination.
- The number of BA discharges doubled between 1997 and 2003, and further increased from 2006 to 2012.
- Liver transplants for BA showed minimal change during the study period.
Conclusions:
- The widespread implementation of rotavirus vaccination in the US has not demonstrably influenced the prevalence of biliary atresia.
- Further research may be needed to explore other potential etiologies or contributing factors for BA.
Objectives:
Biliary atresia (BA) is a rare neonatal liver disease that causes cholestasis and is the leading indication for pediatric liver transplantation. Although the exact etiology of BA remains unknown, evidence from murine models supports the role of rotavirus infection in the development of BA. In 2006, universal rotavirus vaccination was implemented in the United States. The goal of this study was to determine if the prevalence of BA correlated with the number of annual rotavirus infections.
Methods:
We utilized data from the 1997 to 2012 Kids' Inpatient Database and the 1988 to 2015 Organ Procurement and Transplantation Network to determine the annual number of infant discharges with a primary diagnosis of BA and the number of infants with BA who received a liver transplant, respectively. We obtained the number of annual rotavirus infections from the National Respiratory and Enteric Virus Surveillance System and examined whether trends existed between the data from these 3 sources over time.
Results:
From 1997 to 2006, the number of positive rotavirus antigen tests remained steady, however a rapid decrease was observed from 2006 to 2012 (8774 to 1277), coinciding with the uptake of rotavirus immunizations nationwide. The number of BA discharges doubled from 1997 to 2003 and again increased from 2006 to 2012 (67 to 137 and 117 to 156), while the number of liver transplants for BA changed very little from 1997 to 2012.
Conclusions:
The recent implementation of rotavirus vaccination has not had any substantial influence on the prevalence of BA in the United States.
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