Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May 1;62 Suppl 2(Suppl 2):S188-95.
doi: 10.1093/cid/civ1204.

Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa

Michelle J Groome  1 , Elizabeth R Zell  2 , Fatima Solomon  3 , Susan Nzenze  3 , Umesh D Parashar  4 , Alane Izu  3 , Shabir A Madhi  5
Affiliations

Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa

Michelle J Groome et al. Clin Infect Dis. .

Abstract

Background: The public health impact of rotavirus vaccination in African settings with a high human immunodeficiency virus (HIV) infection prevalence is yet to be established. We evaluated trends in all-cause diarrheal hospitalizations in Soweto, Johannesburg, before and after the introduction of rotavirus vaccine into South Africa's national immunization program in August 2009.

Methods: Hospitalizations in children <5 years of age with a diagnosis of diarrhea, defined byInternational Classification of Diseases, Tenth Revisioncodes A00-A05, A06.0-A06.3, A06.9, A07.0-A07.2, A07.9, and A08-A09, were identified at the Chris Hani Baragwanath Academic Hospital from 1 January 2006 to 31 December 2014. The median annual prevaccine (2006-2008) hospitalization incidence was compared to that of the vaccine era (2010-2014), and stratified by age group and HIV infection status.

Results: Incidence reductions (per 1000 population) were greatest in children aged <12 months: 54.4 in the prevaccine era vs 30.0, 23.6, 20.0, 18.8, and 18.9 in the postvaccine years 2010-2014, respectively (a 44.9%-65.4% reduction). Lower incidence reductions (39.8%-49.4%) were observed among children aged 12-24 months from the second year post-vaccine introduction onward. Reductions were observed in both HIV-infected and HIV-uninfected children. There was a change in the seasonal pattern of diarrheal hospitalizations post-vaccine introduction, with flattening of the autumn-winter peaks seen in the prevaccine years.

Conclusions: An accelerated and sustained decline in all-cause diarrheal hospitalizations, temporally associated with rotavirus vaccine introduction, was observed in children <2 years of age. However, the impact of other interventions such as improved sanitation and changes in HIV management cannot be discounted.

Keywords: HIV; children; diarrhea; rotavirus vaccine.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. M. J. G. has received grants from Gavi and personal fees from GlaxoSmithKline and Sanofi Pasteur. F. S. and S. N. have received grants from Gavi. S. A. M. has received grants from Gavi (Accelerated Vaccine Introduction Special Studies), GlaxoSmithKline, Novartis, and BMGF; and personal fees from GlaxoSmithKline, Pfizer, and Medimmune. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Monthly count of all-cause diarrheal hospitalizations in children <5 years of age at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa, 2006–2014. Vertical line represents introduction of rotavirus vaccine into the national immunization program in August 2009.
Figure 2.
Figure 2.
Annual incidence per 1000 population (95% confidence interval) of diarrheal hospitalizations among human immunodeficiency virus (HIV)–uninfected children <5 years of age in Soweto, 2006–2014. Values are incidence difference = incidence in vaccine-era years 2010, 2011, 2012, 2013, and 2014, respectively, minus median incidence in the prevaccine years 2006–2008 (percentage change). A negative value indicates a reduction in incidence; a positive value indicates an increase in incidence. *P < .05. The 95% confidence intervals and P values are provided in Supplementary Table 1.
Figure 3.
Figure 3.
Annual incidence per 1000 population (95% confidence interval) of diarrheal hospitalizations among human immunodeficiency virus (HIV)–infected children <5 years of age in Soweto, 2006–2014. Values are incidence difference = incidence in vaccine-era years 2010, 2011, 2012, 2013, and 2014, respectively, minus median incidence in the prevaccine years 2006–2008 (percentage change). A negative value indicates a reduction in incidence; a positive value indicates an increase in incidence. *P < .05. The 95% confidence intervals and P values are provided in Supplementary Table 2.
See this image and copyright information in PMC

References

    1. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD. 2008. estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12:136–41. - PubMed
    1. Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381:1405–16. - PMC - PubMed
    1. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med 2006; 354:11–22. - PubMed
    1. Vesikari T, Matson DO, Dennehy P, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 2006; 354:23–33. - PubMed
    1. Vesikari T, Karvonen A, Prymula R, et al. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet 2007; 370:1757–63. - PubMed

Publication types

MeSH terms