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Multicenter Study
. 2020 May 23;70(11):2306-2313.
doi: 10.1093/cid/ciz912.

Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis

Grieven P Otieno  1 , Christian Bottomley  2 , Sammy Khagayi  3 , Ifedayo Adetifa  1   2   4 , Mwanajuma Ngama  1 , Richard Omore  3 , Billy Ogwel  3 , Betty E Owor  1 , Godfrey Bigogo  3 , John B Ochieng  3 , Clayton Onyango  5 , Jane Juma  3 , Jason Mwenda  6 , Collins Tabu  7 , Jacqueline E Tate  8 , Yaw Addo  9 , Tuck Britton  9 , Umesh D Parashar  8 , Robert F Breiman  9 , Jennifer R Verani  5 , D James Nokes  1   10
Affiliations
Multicenter Study

Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis

Grieven P Otieno et al. Clin Infect Dis. .

Abstract

Background: Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs).

Methods: Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre- and post-vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post-vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes).

Results: Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8-80%) reduction in RVHs observed in the first year post-vaccine introduction in Kilifi and a 59% (95% CI, 20-79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46-93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61-92%); this reduction was sustained at both sites into the third year.

Conclusions: A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.

Keywords: control; interrupted time series; rotavirus vaccine; vaccine impact.

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Figures

Figure 1.
Figure 1.
Proportion of children aged less than 5 years who had received 1 or 2 doses of rotavirus vaccine between 2014 and 2017 in Kilifi and Siaya demographic surveillance sites. Abbreviation: HDSS, Health and Demographic Surveillance System; n, number of children vaccinated.
Figure 2.
Figure 2.
Monthly counts of diarrhea and rotavirus-positive cases in Kilifi (A) and Siaya (B) from January 2010 to June 2017. Strikes by health workers are indicated by gray shading, and the start of rotavirus vaccination in Kenya (July 2014) is indicated by an arrow.
Figure 3.
Figure 3.
Monthly counts of rotavirus-positive cases (solid lines) and the number of cases (dashed lines) predicted by the model assuming no vaccine introduction. The vertical line indicates the time of vaccine introduction in Kenya (July 2014).
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