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Multicenter Study
. 2010 Jun 15:340:c2825.
doi: 10.1136/bmj.c2825.

Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study

Orbelina de Palma  1 , Lilian Cruz, Hector Ramos, Amada de Baires, Nora Villatoro, Desiree Pastor, Lucia Helena de Oliveira, Tara Kerin, Michael Bowen, Jon Gentsch, Douglas H Esposito, Umesh Parashar, Jacqueline Tate, Manish Patel
Affiliations
Multicenter Study

Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study

Orbelina de Palma et al. BMJ. .

Abstract

Objective: To evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America.

Design: Matched case-control study.

Setting: Seven hospitals in cities across El Salvador, January 2007 to June 2009.

Participants: 323 children aged less than 2 years admitted with laboratory confirmed rotavirus diarrhoea and 969 healthy controls matched for age and neighbourhood.

Main outcome measure: Effectiveness of rotavirus vaccination ((1-adjusted odds ratio of vaccination)x100) against rotavirus diarrhoea requiring hospital admission.

Results: Cases and controls were similar for breast feeding, premature birth, maternal education, and socioeconomic variables. G1P[8] strains were identified in 92% of rotavirus cases. Effectiveness of two doses of vaccination against diarrhoea requiring hospital admission was 76% (95% confidence interval 64% to 84%). Protection was significantly lower (P=0.046) among children aged 12 months or more (59%, 27% to 77%) compared with children aged 6-11 months (83%, 68% to 91%). One dose of vaccine was 51% (26% to 67%) effective. At the sentinel hospitals, all admissions for diarrhoea among children under 5 declined by 40% in 2008 and by 51% in 2009 from the prevaccine year 2006.

Conclusions: A monovalent rotavirus vaccine was highly effective against admissions for rotavirus diarrhoea in children aged less than 2 years in El Salvador and substantially reduced the number of such admissions in this low-middle income setting. The impact on disease epidemiology after vaccination, particularly among older children, warrants future attention.

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Conflict of interest statement

Competing interests: All authors have completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare (1) no financial support for the submitted work from anyone other than their employer; (2) no financial relationships with commercial entities that might have an interest in the submitted work; (3) no spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; and (4) no non-financial interests that may be relevant to the submitted work.

Figures

None
Diarrhoea and rotavirus related admissions among children aged less than 5 years at seven hospitals in El Salvador, January to June 2006-9
See this image and copyright information in PMC

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