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
. 2020 Mar 12;20(1):207.
doi: 10.1186/s12879-020-4874-6.

Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review

Jana Lai  1   2 , Cattram Nguyen  3   4 , Beia Tabwaia  5 , Agnes Nikuata  6 , Nikarawa Baueri  5 , Eretii Timeon  5 , Mohammed Diaaldeen  7 , Tinai Iuta  7 , Murat Hakan Ozturk  8 , Aaron Moore  9 , Alice Hall  9 , Batmunkh Nyambat  10 , Stephanie Davis  11 , Ataur Rahman  8 , Wendy Erasmus  8 , Kimberley Fox  10   12 , Fiona Russell  3   13
Affiliations

Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review

Jana Lai et al. BMC Infect Dis. .

Abstract

Background: Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken.

Methods: Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010-December 2013 (pre-rotavirus vaccine) and January 2016-September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction.

Results: The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction.

Conclusions: AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.

Keywords: Diarrheal disease; Hospital; Kiribati; Rotavirus vaccine; Severe acute malnutrition.

PubMed Disclaimer

Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Annual incidence rate of under 5 AGE1 admissions to TCH2 in the pre- (January 2010–December 2013) and post-rotavirus vaccine (January 2016–September 2017) periods3, Tarawa, Kiribati. 1AGE = acute gastroenteritis. 2 TCH = Tungaru Central Hospital. 3 Rotavirus vaccine was introduced in August 2015
Fig. 2
Fig. 2
Interrupted time series analysis of the monthly incidence rate of under 5 AGE1 admissions in the pre- (January 2010–December 2013) and post-rotavirus vaccine (January 2016–September 2017) periods2, Tarawa, Kiribati. 1AGE = acute gastroenteritis. 2 Rotavirus vaccine was introduced in August 2015. Legend: The purple solid line is the pre-rotavirus vaccine trend based on the model fitted to the observed data in the pre- vaccine period; the purple dashed line is extrapolated from the model fitted to the pre- vaccine data and represents the counterfactual trend that would be expected if the vaccine had not been introduced; the orange solid line is the post-vaccine trend based on the model fitted to the observed data two years post- vaccine introduction
Fig. 3
Fig. 3
Interrupted time series analysis of the monthly incidence rate of under 5 with outpatient AGE1 during the pre- (January 2010–August 2015) and post-rotavirus vaccine (September 2015–September 2017) periods2, Kiribati. 1AGE = acute gastroenteritis. 2 Vertical line on figure denotes the month rotavirus vaccine was introduced. Legend: The purple solid line is the pre-rotavirus vaccine trend based on the model fitted to the observed data in the pre-vaccine period; the purple dashed line is extrapolated from the model fitted to the pre-vaccine data and represents the counterfactual trend that would be expected if the vaccine had not been introduced; the orange solid line is the post-vaccine trend based on the model fitted to the observed data post- vaccine introduction
Fig. 4
Fig. 4
Interrupted time series analysis of the monthly incidence rate of under 5 s admitted with SAM1 in the pre- (January 2010–December 2013) and post-rotavirus vaccine (January 2016–September 2017) periods3, TCH2, Kiribati.1 SAM = severe acute malnutrition. 2 TCH = Tungaru Central Hospital. 3 Vertical line on figure denotes the month rotavirus vaccine was introduced. Legend: The purple solid line is the pre-rotavirus vaccine trend based on the model fitted to the observed data in the pre-vaccine period; the purple dashed line is extrapolated from the model fitted to the pre-vaccine data and represents the counterfactual trend that would be expected if the vaccine had not been introduced; the orange solid line is the post-vaccine trend based on the model fitted to the observed data two years post-vaccine introduction
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, Armah G, Bines JE, Brewer TG, Colombara DV, Kang G, Kirkpatrick BD, Kirkwood CD, Mwenda JM, Parashar UD, Pertri WA, Riddle MS, Steele D, Thompson RL, Walson JL, Sanders JW, Mokdad AH, Murray CJL, Hay SI, Reiner RC. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatr. 2018;172(10):505–511. doi: 10.1001/jamapediatrics.2018.1960. - DOI - PMC - PubMed
    1. Grimwood K, Lambert SB, Milne RJ. Rotavirus infections and vaccines: burden of illness and potential impact of vaccination. Paediatr Drugs. 2010;12(4):235–256. doi: 10.2165/11537200-000000000-00000. - DOI - PubMed
    1. Heymann DL. Control of communicable disease manual. 20. United States of America: American Public Health Association; 2015.
    1. Crawford SE, Ramani S, Tate JE, Parashar UD, Svensson L, Hagbom M, Franco MA, Greenburg HB, O’Ryan M, Kang G, Desselberger U, Estes MK. Rotavirus infection. Nat Rev Dis Primers. 2017;3:17083. doi: 10.1038/nrdp.2017.83. - DOI - PMC - PubMed
    1. Esona MD, Gautam R. Rotavirus. Clin Lab Med. 2015;35:363–391. doi: 10.1016/j.cll.2015.02.012. - DOI - PubMed

MeSH terms

Substances