Childhood mortality from acute diarrheal disease in Paraguay and vaccination impact: a 31-year ecological study

Area of Science:

• Pediatric Public Health
• Vaccinology
• Epidemiology

Background:

• Acute diarrheal disease (ADD) is a major global cause of death in children under five.
• Paraguay introduced the rotavirus vaccine (Rotarix) in 2010 to combat ADD.
• Long-term data analysis is crucial to assess the vaccine's impact on child mortality trends.

Purpose of the Study:

• To analyze 31 years of public data on ADD morbidity and mortality in Paraguayan children under five.
• To evaluate the impact of rotavirus vaccination on ADD-related mortality.
• To assess trends in pediatric mortality and ADD incidence post-vaccination.

Main Methods:

• Utilized public health databases for annual ADD incidence, total deaths, and mortality rates (1993-2023).
• Calculated proportionate mortality, cause-specific mortality rates, and risk reductions using EPIDAT and Joinpoint software.
• Stratified data by age group and vaccination periods, employing joinpoint regression for trend analysis.

Main Results:

• Pediatric mortality in Paraguay showed a steady decline across all age groups between 1993 and 2021.
• Infant mortality decreased by 81.4% (ARR 0.83) after Rotarix introduction in 2010.
• Under-five mortality declined significantly between 2009-2012, with ADD incidence decreasing post-2019 as vaccine coverage surpassed 70%.

Conclusions:

• Paraguay achieved sustained reductions in infant and child mortality over three decades, driven by healthcare and immunization programs.
• Rotarix introduction in 2010 was associated with a substantial reduction in infant mortality (43 deaths per 100,000 live births).
• Vaccination and health system strengthening are key, but ongoing monitoring for emerging health threats is essential.