With increasing numbers of countries implementing the use of the rotavirus vaccine, rotavirus and acute gastroenteritis hospitalizations and mortalities continue to show a sustained reduction, according to a review published in Infectious Diseases.
In 2013, the rotavirus was responsible for >200,000 deaths and represented 37% of deaths resulting from diarrhea among children aged <5 years. Since the licensure of the 2 current vaccines in 2006 and the recommendation from the World Health Organization in 2009 to implement vaccination in all countries, the rotavirus vaccine has been included in the routine infant immunization schedule in >100 countries and has had a notable effect on rotavirus disease and acute gastroenteritis by reducing the number of rotavirus-positive specimens in children aged <5 years by 40% and reducing rotavirus hospitalizations in children aged <1 year by a median of 80%.
Since the authors’ last review on the effects of the rotavirus vaccine, an additional 20 countries have introduced the rotavirus vaccine and >50 articles on the effects of this vaccine have been published. Therefore, this study reviewed published data on relative reductions of rotavirus hospitalizations, acute gastroenteritis-related hospitalizations, and mortality among children aged <5 years.
In total, 1827 records from 2006 to 2019 with at least 12 months of data before and after rotavirus vaccine introduction were reviewed from the PubMed database; among the records included were 105 articles from 49 countries. Search criteria included the terms “rotavirus” and either “vaccin*” or “immuni*”. Relative reductions were abstracted into a standardized form.
Results showed a sustained positive effect after the introduction of the rotavirus vaccine. In children <1 year old, compared with before the vaccine was introduced, there was a median reduction of 70% in rotavirus-related hospitalizations, as well as a 34% and 31% decrease in acute gastroenteritis-related hospitalizations and mortality, respectively.
In children aged <5 years, there was a median reduction of 59% in rotavirus-related hospitalizations, and a 36% decrease in both acute gastroenteritis-related hospitalizations and mortality.
In addition, the rates of reduction in acute gastroenteritis and rotavirus hospitalizations showed an upward trend over time after the introduction of the vaccine and were highest in settings that had the highest vaccine coverage. Among children <1 year old, there was a median rate reduction of 30% in acute gastroenteritis-related hospitalizations in areas that had a rotavirus vaccine coverage of <65%. This increased to a reduction of 37% in areas with 65% to 84% coverage, and of 47% in areas with ³85% coverage. Similarly, there was a median rate reduction of 43% in rotavirus hospitalizations in areas with <65% coverage, a reduction of 79% in areas with 65% to 84% coverage, and a reduction of 85% in areas with ³85% coverage.
Overall, the review authors concluded that, “These results should encourage countries still considering routine rotavirus vaccine implementation.”
Burnett E, Parashar UD, Tate JE. Global impact of rotavirus vaccination on diarrhea hospitalizations and deaths among children <5 years old: 2006-2019 [published online February 25, 2020]. Infect Dis. doi:10.1093/infd/jiaa081/5755890