Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years

Abstract

Importance: Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years.

Objectives: To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine.

Design, setting, and participants: This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations.

Exposure: Diarrhea due to rotavirus infection.

Main outcomes and measures: Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country.

Results: Rotavirus infection was responsible for an estimated 128 500 deaths (95% uncertainty interval [UI], 104 500-155 600) among children younger than 5 years throughout the world in 2016, with 104 733 deaths occurring in sub-Saharan Africa (95% UI, 83 406-128 842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28 000 deaths (95% UI, 14 600-46 700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years.

Conclusions and relevance: Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.

Figure 1.. Geographic Distribution of Rotavirus-Associated Mortality Rates Among Children Younger Than 5 Years in 2016

ATG indicates Antigua; BRB, Barbados; COM, Comoros; DMA, Dominica; E Med, East Mediterranean; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; TLS, Timor Leste; TON, Tongo; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samoa.

Figure 2.. Distribution of the Fraction of Diarrhea-Associated Mortality Attributable to Rotavirus Among Children Younger Than 5 Years in 2016

ATG indicates Antigua; BRB, Barbados; COM, Comoros; DMA, Dominica; E Med, East Mediterranean; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; TLS, Timor Leste; TON, Tongo; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samoa.

Figure 3.. Sociodemographic and Spatial-Temporal Patterns in Rotavirus-Associated Mortality

A, Rotavirus-associated mortality rate by sociodemographic index in 195 countries, estimated for 2016. B, Rotavirus mortality rate over time, globally and by superregion.

Figure 4.. Number of Deaths Averted Because of Rotavirus Vaccine Coverage by Global Burden of Disease, Injuries, and Risk Factors Study Region

Plots show the number of deaths among children younger than 5 years that were averted because of the rotavirus vaccine in 2016, the number of deaths that are potentially avertable given full coverage of the rotavirus vaccine, and the number of deaths that are not preventable given the current vaccine efficacy.