Global Estimates of Rotavirus Hospitalizations Among Children Below 5 Years in 2019 and Current and Projected Impacts of Rotavirus Vaccination

Abstract

Background: Rotavirus vaccine impact on rotavirus hospitalizations is not well documented globally. We performed a systematic review to estimate the number of rotavirus hospitalizations that (1) occur annually, (2) are currently prevented by rotavirus vaccines, and (3) could be prevented with improved vaccine coverage and universal vaccine introduction.

Methods: We systematically reviewed articles indexed in the PubMed database published from January 1, 2000, to December 31, 2019. We included all primary peer-reviewed studies with rotavirus hospitalization rates for children below 5 years that reported data prior to vaccine introduction, utilized at least one continuous year of data collection, and collected hospitalization data after 2000 using active surveillance. We grouped pre-vaccine country estimates by childhood mortality strata and calculated the median rate among each group. We then assigned the mortality stratum-specific hospitalization rates to each country and calculated the number of rotavirus hospitalizations by country, mortality strata, and World Health Organization region.

Results: Our search strategy identified 4590 manuscripts, of which 32 were included in the final dataset. In 2019, an estimated 1 760 113 (interquartile range [IQR]: 1 422 645-2 925 372) rotavirus hospitalizations occurred globally, with 524 871 (IQR: 415 987-814 835) prevented by rotavirus vaccination. With universal introduction of rotavirus vaccines and increased vaccine coverage, we estimate that an additional 751 609 (IQR: 607 671-1 318 807) rotavirus hospitalizations can be prevented annually.

Conclusions: This analysis highlights the continued burden of rotavirus hospitalizations among children below 5 years. A large, preventable proportion of this burden could be eliminated by expanding introductions to new countries and increasing rotavirus vaccine coverage to levels seen with other childhood vaccinations.

Keywords: diarrhea; epidemiology; global; impact; rotavirus; vaccine.

Figure 1.

Prisma Article Inclusion Diagram

Figure 2.

The projected number of rotavirus hospitalizations in the absence of vaccination (red circle), the estimated number of rotavirus hospitalizations prevented by vaccine introduction (blue circle), and the potential additional hospitalizations that could be prevented by increased vaccine introduction and higher vaccine coverage (purple circle), by WHO member countries in 2019.

Figure 3.

The estimated number of rotavirus hospitalizations prevented by rotavirus vaccine, the estimated number of additional hospitalizations that could be prevented through improved vaccine coverage and global introduction, and the number of residual rotavirus hospitalizations that would remain due to vaccine coverage and vaccine effectiveness limitations, by mortality strata in 2019.

Figure 4.

The estimated number of rotavirus hospitalizations prevented by rotavirus vaccine, the estimated number of additional hospitalizations that could be prevented through improved vaccine coverage and global introduction, and the number of residual rotavirus hospitalizations that would remain due to vaccine coverage and vaccine effectiveness limitations, by mortality strata in 2019.