Global Impact of Rotavirus Vaccination on Diarrhea Hospitalizations and Deaths Among Children <5 Years Old: 2006-2019

Abstract

Background: Since 2006, more than 100 countries have introduced rotavirus vaccine into their immunization programs. We reviewed published data on relative reductions of rotavirus hospitalizations, acute gastroenteritis (AGE) hospitalizations, and AGE deaths among children <5 years old.

Methods: Articles published from January 1, 2006 to December 31, 2019 with at least 12 months of data before and after rotavirus vaccine introduction were included. Relative reductions were abstracted into a standardized form. Descriptive statistics are presented as medians and interquartile ranges (IQRs).

Results: We reviewed 1827 total records and included 105 articles from 49 countries. Among children <5 years old, there was a median reduction of 59% (IQR, 46-74) in rotavirus hospitalizations, 36% (IQR, 23-47) in AGE hospitalizations, and 36% (IQR, 28-46) AGE mortality. Reductions were larger in countries with low child mortality, among younger age groups, and in countries with higher coverage. The median percentage of specimens that tested positive for rotavirus among children <5 years old hospitalized for diarrhea was 40% (IQR, 28-45) before rotavirus vaccine introduction and 20% (IQR, 20-20) 4 years after introduction.

Conclusions: Overall, we found sustained impact on rotavirus and AGE hospitalizations and deaths. These results should encourage countries still considering rotavirus vaccine implementation.

Keywords: acute gastroenteritis; impact; literature review; rotavirus; rotavirus vaccine.

Figure 1.

Summary of literature search and selection criteria.

Figure 2.

Global map showing countries that contributed data by child mortality strata and the number of data points by vaccine type.

Figure 3.

Median reduction in rotavirus hospitalizations, acute gastroenteritis hospitalizations, and acute gastroenteritis deaths among children <1 year and <5 years.

Figure 4.

Percentage reduction of acute gastroenteritis and rotavirus hospitalizations by national <5 year old child mortality level among children <1 and <5 years old

Figure 5.

Percentage of specimens that tested positive for rotavirus among children hospitalized for diarrhea by year relative to rotavirus vaccine introduction among 4 age groups.

Figure 6.

Median percent reduction in acute gastroenteritis and rotavirus hospitalizations from the pre-rotavirus vaccine introduction baseline by age group and year relative to rotavirus vaccine introduction. The area below and to the right of the black line indicates when an entire age group would be eligible for vaccination.