Impact of Rotavirus Vaccination on Hospitalizations and Deaths From Childhood Gastroenteritis in Botswana

Abstract

Background: A monovalent human rotavirus vaccine (RV1) was introduced in Botswana in July 2012. We assessed the impact of RV1 vaccination on childhood gastroenteritis-related hospitalizations and deaths in 2013 and 2014.

Methods: We obtained data from registers of 4 hospitals in Botswana on hospitalizations and deaths from gastroenteritis, regardless of cause, among children <5 years of age. Gastroenteritis hospitalizations and deaths during the prevaccine period (January 2009-December 2012) were compared to the postvaccine period (January 2013-December 2014). Vaccine coverage was estimated from data collected through a concurrent vaccine effectiveness study at the same hospitals.

Results: By December 2014, coverage with ≥1 dose of RV1 was an estimated 90% among infants <1 year of age and 76% among children 12-23 months of age. In the prevaccine period, the annual median number of gastroenteritis-related hospitalizations in children <5 years of age was 1212, and of gastroenteritis-related deaths in children <2 years of age was 77. In the postvaccine period, gastroenteritis-related hospitalizations decreased by 23% (95% confidence interval [CI], 16%-29%) to 937, and gastroenteritis-related deaths decreased by 22% (95% CI, -9% to 44%) to 60. Declines were most prominent during the rotavirus season (May-October) and among infants <1 year of age, with reductions of 43% (95% CI, 34%-51%) in gastroenteritis hospitalizations and 48% (95% CI, 11%-69%) in gastroenteritis deaths.

Conclusions: Following introduction of RV1 into the national immunization program, significant declines in hospitalizations and deaths from gastroenteritis were observed among children in Botswana, suggestive of the beneficial public health impact of rotavirus vaccination.

Keywords: morbidity; mortality; rotavirus vaccine.

Figure 1.

Infant all-cause gastroenteritis-related deaths during the 2013 and 2014 rotavirus seasons compared with the 2009–2012 prevaccine baseline rotavirus seasons, as a sum of monthly medians and with percentage reductions from baseline, from 4 hospitals in Botswana.

Figure 2.

Seasonal variation in gastroenteritis-related deaths (A) and hospitalizations (B) among children 0–23 months of age, with comparison of 2013–2014 totals to prevaccine medians, from 4 hospitals in Botswana.

Figure 3.

All-cause gastroenteritis-related hospitalizations among infants and children aged 12–23 months during the 2013 and 2014 rotavirus seasons compared with the 2009–2012 prevaccine baseline rotavirus seasons, as a sum of monthly medians and with percentage reductions from baseline, from 4 hospitals in Botswana.