Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis
Background:
In 2006, Brazil began routine immunization of infants <15 wk of age with a
single-strain rotavirus vaccine. We evaluated whether the rotavirus
vaccination program was associated with declines in childhood diarrhea
deaths and hospital admissions by monitoring disease trends before and after
vaccine introduction in all five regions of Brazil with varying disease
burden and distinct socioeconomic and health indicators.
Methods and Findings:
National data were analyzed with an interrupted time-series analysis that
used diarrhea-related mortality or hospitalization rates as the main
outcomes. Monthly mortality and admission rates estimated for the years
after rotavirus vaccination (2007–2009) were compared with expected
rates calculated from pre-vaccine years (2002–2005), adjusting for
secular and seasonal trends. During the three years following rotavirus
vaccination in Brazil, rates for diarrhea-related mortality and admissions
among children <5 y of age were 22% (95% confidence
interval 6%–44%) and 17% (95% confidence
interval 5%–27%) lower than expected, respectively. A
cumulative total of ∼1,500 fewer diarrhea deaths and 130,000 fewer
admissions were observed among children <5 y during the three years after
rotavirus vaccination. The largest reductions in deaths
(22%–28%) and admissions (21%–25%)
were among children younger than 2 y, who had the highest rates of
vaccination. In contrast, lower reductions in deaths (4%) and
admissions (7%) were noted among children two years of age and older,
who were not age-eligible for vaccination during the study period.
Conclusions:
After the introduction of rotavirus vaccination for infants, significant
declines for three full years were observed in under-5-y diarrhea-related
mortality and hospital admissions for diarrhea in Brazil. The largest
reductions in diarrhea-related mortality and hospital admissions for
diarrhea were among children younger than 2 y, who were eligible for
vaccination as infants, which suggests that the reduced diarrhea burden in
this age group was associated with introduction of the rotavirus vaccine.
These real-world data are consistent with evidence obtained from clinical
trials and strengthen the evidence base for the introduction of rotavirus
vaccination as an effective measure for controlling severe and fatal
childhood diarrhea.
:
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis. PLoS Med 8(4): e32767. doi:10.1371/journal.pmed.1001024
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001024
Souhrn
Background:
In 2006, Brazil began routine immunization of infants <15 wk of age with a
single-strain rotavirus vaccine. We evaluated whether the rotavirus
vaccination program was associated with declines in childhood diarrhea
deaths and hospital admissions by monitoring disease trends before and after
vaccine introduction in all five regions of Brazil with varying disease
burden and distinct socioeconomic and health indicators.
Methods and Findings:
National data were analyzed with an interrupted time-series analysis that
used diarrhea-related mortality or hospitalization rates as the main
outcomes. Monthly mortality and admission rates estimated for the years
after rotavirus vaccination (2007–2009) were compared with expected
rates calculated from pre-vaccine years (2002–2005), adjusting for
secular and seasonal trends. During the three years following rotavirus
vaccination in Brazil, rates for diarrhea-related mortality and admissions
among children <5 y of age were 22% (95% confidence
interval 6%–44%) and 17% (95% confidence
interval 5%–27%) lower than expected, respectively. A
cumulative total of ∼1,500 fewer diarrhea deaths and 130,000 fewer
admissions were observed among children <5 y during the three years after
rotavirus vaccination. The largest reductions in deaths
(22%–28%) and admissions (21%–25%)
were among children younger than 2 y, who had the highest rates of
vaccination. In contrast, lower reductions in deaths (4%) and
admissions (7%) were noted among children two years of age and older,
who were not age-eligible for vaccination during the study period.
Conclusions:
After the introduction of rotavirus vaccination for infants, significant
declines for three full years were observed in under-5-y diarrhea-related
mortality and hospital admissions for diarrhea in Brazil. The largest
reductions in diarrhea-related mortality and hospital admissions for
diarrhea were among children younger than 2 y, who were eligible for
vaccination as infants, which suggests that the reduced diarrhea burden in
this age group was associated with introduction of the rotavirus vaccine.
These real-world data are consistent with evidence obtained from clinical
trials and strengthen the evidence base for the introduction of rotavirus
vaccination as an effective measure for controlling severe and fatal
childhood diarrhea.
:
Please see later in the article for the Editors' Summary
Zdroje
1. BlackRECousensSJohnsonHLLawnJERudanI
2010
Global, regional, and national causes of child mortality in 2008:
a systematic analysis.
Lancet
375
1969
1987
2. ParasharUDBurtonALanataCBoschi-PintoCShibuyaK
2009
Global mortality associated with rotavirus disease among children
in 2004.
J Infect Dis
200
Suppl 1
S9
S15
3. World Health Organization
2009
Meeting of the Immunization Strategic Advisory Group of Experts,
April 2009—conclusions and recommendations.
Wkly Epidemiol Rec
84
220
236
4. [Anonymous]
2010
Evaluation: the top priority for global health.
Lancet
375
526
5. OxmanADBjorndalABecerra-PosadaFGibsonMBlockMA
2010
A framework for mandatory impact evaluation to ensure well
informed public policy decisions.
Lancet
375
427
431
6. ReidpathDDMorelCMMecaskeyJWAlloteyP
2009
The Millennium Development Goals fail poor children: the case for
equity-adjusted measures.
PLoS Med
6
e1000062
doi:10.1371/journal.pmed.1000062
7. PatelMShaneALParasharUDJiangBGentschJR
2009
Oral rotavirus vaccines: how well will they work where they are
needed most?
J Infect Dis
200
Suppl 1
S39
S48
8. PatelMMParasharUD
2009
Assessing the effectiveness and public health impact of rotavirus
vaccines after introduction in immunization programs.
J Infect Dis
200
Suppl 1
S291
S299
9. LinharesACVelazquezFRPerez-SchaelISaez-LlorensXAbateH
2008
Efficacy and safety of an oral live attenuated human rotavirus
vaccine against rotavirus gastroenteritis during the first 2 years of life
in Latin American infants: a randomised, double-blind, placebo-controlled
phase III study.
Lancet
371
1181
1189
10. Ruiz-PalaciosGMPerez-SchaelIVelazquezFRAbateHBreuerT
2006
Safety and efficacy of an attenuated vaccine against severe
rotavirus gastroenteritis.
N Engl J Med
354
11
22
11. MadhiSACunliffeNASteeleDWitteDKirstenM
2010
Effect of human rotavirus vaccine on severe diarrhea in African
infants.
N Engl J Med
362
289
298
12. de PalmaOCruzLRamosHde BairesAVillatoroN
2010
Effectiveness of rotavirus vaccination against childhood
diarrhoea in El Salvador: case-control study.
BMJ
340
c2825
13. ZamanKDangDAVictorJCShinSYunusM
2010
Efficacy of pentavalent rotavirus vaccine against severe
rotavirus gastroenteritis in infants in developing countries in Asia: a
randomised, double-blind, placebo-controlled trial.
Lancet
376
615
623
14. VesikariTMatsonDODennehyPVan DammePSantoshamM
2006
Safety and efficacy of a pentavalent human-bovine (WC3)
reassortant rotavirus vaccine.
N Engl J Med
354
23
33
15. ArmahGESowSOBreimanRFDallasMJTapiaMD
2010
Efficacy of pentavalent rotavirus vaccine against severe
rotavirus gastroenteritis in infants in developing countries in sub-Saharan
Africa: a randomised, double-blind, placebo-controlled
trial.
Lancet
376
606
614
16. BoomJATateJESahniLCRenchMAHullJJ
2010
Effectiveness of pentavalent rotavirus vaccine in a large urban
population in the United States.
Pediatrics
125
e199
e207
17. BoomJATateJESahniLCRenchMAQuayeO
2010
Sustained protection from pentavalent rotavirus vaccination
during the second year of life at a large, urban United States pediatric
hospital.
Pediatr Infect Dis J
29
1133
1135
18. PatelMPedreiraCDe OliveiraLHTateJOrozcoM
2009
Association between pentavalent rotavirus vaccine and severe
rotavirus diarrhea among children in Nicaragua.
JAMA
301
2243
2251
19. CurnsATSteinerCABarrettMHunterKWilsonE
2010
Reduction in acute gastroenteritis hospitalizations among US
children after introduction of rotavirus vaccine: analysis of hospital
discharge data from 18 US states.
J Infect Dis
201
1617
1624
20. LambertSBFauxCEHallLBirrellFAPetersonKV
2009
Early evidence for direct and indirect effects of the infant
rotavirus vaccine program in Queensland.
Med J Aust
191
157
160
21. TateJEPanozzoCAPayneDCPatelMMCorteseMM
2009
Decline and change in seasonality of US rotavirus activity after
the introduction of rotavirus vaccine.
Pediatrics
124
465
471
22. ZellerMRahmanMHeylenEDe CosterSDe VosS
2010
Rotavirus incidence and genotype distribution before and after
national rotavirus vaccine introduction in Belgium.
Vaccine
28
7507
7513
23. de OliveiraLHDanovaro-HollidayMCMatusCRAndrusJK
2008
Rotavirus vaccine introduction in the Americas: progress and
lessons learned.
Expert Rev Vaccines
7
345
353
24. RichardsonVHernandez-PichardoJQuintanar-SolaresMEsparza-AguilarMJohnsonB
2010
Effect of rotavirus vaccination on death from childhood diarrhea
in Mexico.
N Engl J Med
362
299
305
25. GurgelRGBohlandAKVieiraSCOliveiraDMFontesPB
2009
Incidence of rotavirus and all-cause diarrhea in northeast Brazil
following the introduction of a national vaccination
program.
Gastroenterology
137
1970
1975
26. CorreiaJBPatelMMNakagomiOMontenegroFMGermanoEM
2010
Effectiveness of monovalent rotavirus vaccine (Rotarix) against
severe diarrhea caused by serotypically unrelated G2P[4] strains
in Brazil.
J Infect Dis
201
363
369
27. LanzieriTMCostaIShafiFACunhaMHOrtega-BarriaE
2010
Trends in hospitalizations from all-cause gastroenteritis in
children younger than 5 years of age in Brazil before and after human
rotavirus vaccine introduction, 1998-2007.
Pediatr Infect Dis J
29
673
675
28. BarrosFCMatijasevichARequejoJHGiuglianiEMaranhaoAG
2010
Recent trends in maternal, newborn, and child health in Brazil:
progress toward Millennium Development Goals 4 and 5.
Am J Public Health
100
1877
1889
29. United Nations Development Programme
2010
Human development report 2010. Available: http://hdr.undp.org/en/reports/global/hdr2010/. Accessed 19
March 2010
30. TemporaoJG
2003
[The private vaccines market in Brazil: privatization of
public health.] Cad Saude Publica
19
1323
1339
31. Brazilian Ministry of Health
2011
Sistema de Informação do Programa Nacional de
Imunizações. Brasilia: Brazilian Ministry of Health. Available
at: http://pni.datasus.gov.br/inf_estatistica_cobertura.asp.
Accessed 19 March 2011
32. REDE Interagencial de Informação para a
Saúde
2008
Basic health indicators in Brazil: concepts and application,
2nd edition. Brasilia, Brazil: Pan American Health Organization. Available:
http://www.ripsa.org.br/php/index.php Accessed 19 March
2011
33. Brazilian Institute of Geography and Statistics
2010
Population estimates. Available at: http://www.ibge.com.br/english/estatistica/populacao/estimativa2009/default.shtm
[Last accessed March 19, 2011]
34. McCullaghPNelderJ
1989
Generalized linear models.
London
Chapman and Hall
35. MunfordVGilioAEde SouzaECCardosoDMCardosoDD
2009
Rotavirus gastroenteritis in children in 4 regions in Brazil: a
hospital-based surveillance study.
J Infect Dis
200
Suppl 1
S106
S113
36. LuzCRMascarenhasJDGabbayYBMottaARLimaTV
2005
Rotavirus serotypes and electropherotypes identified among
hospitalised children in Sao Luis, Maranhao, Brazil.
Rev Inst Med Trop Sao Paulo
47
287
293
37. LinharesACGabbayYBFreitasRBda RosaESMascarenhasJD
1989
Longitudinal study of rotavirus infections among children from
Belem, Brazil.
Epidemiol Infect
102
129
145
38. GurgelRQCuevasLEVieiraSCBarrosVCFontesPB
2007
Predominance of rotavirus P[4]G2 in a vaccinated
population, Brazil.
Emerg Infect Dis
13
1571
1573
39. NakagomiTCuevasLEGurgelRGElrokhsiSHBelkhirYA
2008
Apparent extinction of non-G2 rotavirus strains from circulation
in Recife, Brazil, after the introduction of rotavirus
vaccine.
Arch Virol
153
591
593
40. PatelMMde OliveiraLHBispoAMGentschJParasharUD
2008
Rotavirus P[4]G2 in a vaccinated population,
Brazil.
Emerg Infect Dis
14
863
865
41. United States Centers for Disease Control and Prevention
2009
Reduction in rotavirus after vaccine introduction—United
States, 2000-2009.
MMWR Morb Mortal Wkly Rep
58
1146
1149
42. World Health Organization
2008
Generic protocol for monitoring impact of rotavirus vaccination on
rotavirus disease burden and viral strains. Document WHO/IVB/08.16
Available: http://whqlibdoc.who.int/hq/2008/WHO_IVB_08.16_eng.pdf.
Accessed 16 March 2011. Geneva: World Health Organization
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