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Acute Gastroenteritis Morbidity and Mortality Trends Following Universal Rotavirus Vaccination in Children in Peru:
Patricia Juliao1, Adriana Guzman-Holst2, Vinay Gupta3
1GSK, Ciudad del Saber Edificio 230, Panama City, Panama.
Insights
Rotavirus (RV) vaccination significantly reduced gastroenteritis (GE) cases, hospitalizations, and deaths in Peruvian children under five. This public health strategy demonstrates a positive impact on child mortality and healthcare burden.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Policy
- Vaccinology
Background:
- Rotavirus (RV) infection is a primary cause of severe diarrhea in children globally.
- In Peru, RV is linked to significant gastroenteritis (GE) cases, hospitalizations, and mortality in children under five.
- The World Health Organization recommends RV infant vaccination as a key public health strategy.
Purpose of the Study:
- To evaluate the impact of universal Rotavirus vaccination on gastroenteritis (GE) trends in Peruvian children.
- To analyze changes in GE ambulatory visits, hospitalizations, and deaths before and after RV vaccine introduction.
Main Methods:
- A time-trend analysis compared GE data in children under five from pre-vaccination (2004-2008) and post-vaccination (2010-2018) periods.
- Generalized linear regression models were used to assess vaccination impact nationwide and regionally.
- Data were adjusted for relevant variables to ensure robust analysis.
Main Results:
- Rotavirus vaccination coverage exceeded 80% in Peru between 2009 and 2011.
- Significant decreases were observed in GE ambulatory cases (40.3%), hospitalizations (46.2%), and deaths (55.5%) in infants under one year post-vaccination.
- Children under five experienced notable reductions: 34.4% fewer GE cases, 41.9% fewer hospitalizations, and 54.3% fewer deaths.
Conclusions:
- Nine years of Rotavirus vaccination in Peru show a statistically significant positive impact on reducing GE-related mortality, hospitalizations, and ambulatory visits in young children.
- The findings underscore the effectiveness of RV vaccination as a public health intervention.
- Enhanced surveillance is crucial for understanding regional variations and future vaccination planning.
Introduction:
Rotavirus (RV) infection is the leading cause of severe diarrhea in children worldwide. It is responsible for around 25% of gastroenteritis (GE) cases, 33% of hospitalized GE cases, and an annual mortality rate of 113.4/100,000 in children < 5 years of age in Peru. RV infant vaccination is recommended by the World Health Organization and provides the best public health strategy to manage the disease. Universal RV vaccination was introduced in Peru in 2009.
Methods:
Trends in GE ambulatory visits, hospitalizations, and deaths in children < 5 years of age are described in the pre-vaccination (2004-2008) versus post-vaccination (2010-2018) periods. Time-trend analysis was performed (using generalized linear regression models) to assess the impact of vaccination nationwide and by region after adjusting for variables.
Results:
Between 2009 and 2011, vaccination coverage increased to over 80% in Peru. In infants < 1 year of age, GE ambulatory cases, hospitalizations, and deaths decreased in the post-vaccination period by 40.3%, 46.2%, and 55.5%, respectively (and in children < 5 years of age, by 34.4%, 41.9%, and 54.3%, respectively) compared with the pre-vaccination period. Results of the multivariate time-trend analysis also found significant decreases in the post-vaccination period of 10.7% (GE ambulatory cases), 17.2% (GE hospitalizations), and 37.3% (GE mortality) in children < 5 years of age. Data analyzed by region varied, with Costa and Sierra regions generally in line with the national findings; however, some findings were less robust for Selva due to fewer available data.
Conclusion:
After 9 years of RV vaccination in Peru, there appears to be a statistically significant positive impact of vaccination, in terms of reducing GE-related mortality, hospitalizations, and ambulatory visits in infants and young children. For policymakers to understand regional differences and future vaccination needs, continued improvement in surveillance is needed.
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