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. 2019 Nov 27;69(12):2059-2070.
doi: 10.1093/cid/ciz133.

Impact of Rotavirus Vaccine Introduction in Children Less Than 2 Years of Age Presenting for Medical Care With Diarrhea in Rural Matlab, Bangladesh

Lauren M Schwartz  1   2 , K Zaman  3 , Md Yunus  3 , Ahasan-Ul H Basunia  3 , Abu Syed Golam Faruque  3 , Tahmeed Ahmed  3 , Mustafizur Rahman  3 , Jonathan D Sugimoto  2 , M Elizabeth Halloran  1   2   4   5 , Ali Rowhani-Rahbar  1 , Kathleen M Neuzil  6 , John C Victor  7
Affiliations

Impact of Rotavirus Vaccine Introduction in Children Less Than 2 Years of Age Presenting for Medical Care With Diarrhea in Rural Matlab, Bangladesh

Lauren M Schwartz et al. Clin Infect Dis. .

Abstract

Background: Following the conclusion of a human rotavirus vaccine (HRV) cluster-randomized, controlled trial (CRT) in Matlab, Bangladesh, HRV was included in Matlab's routine immunization program. We describe the population-level impact of programmatic rotavirus vaccination in Bangladesh in children <2 years of age.

Methods: Interrupted time series were used to estimate the impact of HRV introduction. We used diarrheal surveillance collected between 2000 and 2014 within the 2 service delivery areas (International Centre for Diarrhoeal Disease Research, Bangladesh [icddr,b] service area [ISA] and government service area [GSA]) of the Matlab Health and Demographic Surveillance System, administered by icddr,b. Age group-specific incidence rates were calculated for both rotavirus-positive (RV+) and rotavirus-negative (RV-) diarrhea diagnoses of any severity presenting to the hospital. We used 2 models to assess the impact within each service area: Model 1 used the pre-vaccine time period in all villages (HRV- and control-only) and Model 2 combined the pre-vaccine time period and the CRT time period, using outcomes from control-only villages.

Results: Both models demonstrated a downward trend in RV+ diarrheal incidences in the ISA villages during 3.5 years of routine HRV use, though only Model 2 was statistically significant. Significant impacts of HRV on RV+ diarrhea incidences in GSA villages were not observed in either model. Differences in population-level impacts between the 2 delivery areas may be due to the varied rotavirus vaccine coverage and presentation rates to the hospital.

Conclusions: This study provides initial evidence of the population-level impact of rotavirus vaccines in children <2 years of age in Matlab, Bangladesh. Further studies are needed of the rotavirus vaccine impact after the nationwide introduction in Bangladesh.

Keywords: impact; rotavirus vaccine; time-series.

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Figures

Figure 1.
Figure 1.
Observed counts of rotavirus-positive (RV+) and rotavirus-negative (RV–) diarrhea of any severity, presenting to Matlab Hospital in (A) ISA and (B) GSA areas. Abbreviations: CRT, cluster-randomized controlled trial; GSA, government service area; ISA, International Centre for Diarrhoeal Disease Research, Bangladesh, service area; RCT, randomized, controlled trial; YR, year.
Figure 2.
Figure 2.
Timing of HRV coverage (dose 1) over time by ISA and GSA villages randomized to HRV or control only in <1-year-olds. Abbreviations: GSA, government service area; HRV, human rotavirus vaccine; ISA, International Centre for Diarrhoeal Disease Research, Bangladesh, service area. ISA, HRV: icddr, b service areas randomized to HRV during the CRT; ISA, Control: icddr, b service areas randomized as control-only villages during the CRT; GSA, HRV: Government service areas randomized to HRV during the CRT; GSA, Control: icddr, b service areas randomized as control-only villages during the CRT; *23 children were vaccinated in GSA Villages in September-October 2008 before the start of the cluster-randomized trial (CRT). This time period is still considered prevaccine due to the small number of children vaccinated.
Figure 3.
Figure 3.
Observed incidences and IRRs of RV+ and RV– diarrhea of any severity presenting to Matlab Hospital in ISA villages using Models 1 and 2 in (A) 0– to <12-month-old children and (B) 12 to <24-month-old children. Abbreviations: CI, confidence interval; CRT, cluster-randomized controlled trial; IRR, incidence rate ratio; ISA, International Centre for Diarrhoeal Disease Research, Bangladesh, service area; RV–, rotavirus negative; RV+, rotavirus positive; RCT, randomized, controlled trial; YR, year.
Figure 4.
Figure 4.
Observed incidence and IRRs of RV+ and RV– diarrhea of any severity presenting to Matlab Hospital in GSA villages using Models 1 and 2 in (A) 0 to <12-month-old children and (B) 12 to <24-month-old children. Abbreviations: CI, confidence interval; CRT, cluster-randomized controlled trial; GSA, government service area; IRR, incidence rate ratio; RV–, rotavirus negative; RV+, rotavirus positive; RCT, randomized, controlled trial; YR, year.
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