Ротавирусная инфекция у детей — нерешенная проблема. Обзор рекомендаций по вакцинопрофилактике

These clinical guidelines were developed by the professional association of pediatric specialists «Union of Pediatricians of Russia» and approved by the Association’s Executive Committee at the Congress of Pediatricians of Russia «Actual Problems of Pediatrics». Clinical guidelines are devoted to the problem of rotavirus infection, the relevance of which is determined by the high prevalence level and significant contribution of infectious diarrhea to the mortality pattern of children in the first 5 years of life. We present epidemiological data and detailed information on the infectious agent and pathogenesis of rotavirus infection progression. A detailed picture of clinical manifestations as well as extraintestinal complications is presented. The approach to specific prophylaxis has been reasoned. Practical recommendations for immunization as well as various regimens for administering the vaccine, depending on the age and condition of the patient, are given.Данные клинические рекомендации разработаны профессиональной ассоциацией детских специалистов «Союз педиатров России» и утверждены Исполкомом ассоциации на Съезде педиатров России «Актуальные проблемы педиатрии». Клинические рекомендации посвящены проблеме ротавирусной инфекции, актуальность которой определяется высоким уровнем распространенности и значительным вкладом инфекционной диареи в структуру смертности детей первых 5 лет жизни. Приводятся эпидемиологические данные, подробно описаны особенности возбудителя, патогенез развития ротавирусной инфекции. Представлена развернутая картина клинических проявлений, а также внекишечных осложнений. Обоснована тактика специфической профилактики. Даны практические рекомендации по проведению иммунизации, а также различные схемы введения вакцины в зависимости от возраста и состояния пациента

Evaluation of the Cost-Effectiveness of Vaccination of Children with 5-valent Vaccine against Rotavirus Infection in the Russian Federation

One of the main causes of the incidence of intestinal infections in children under 5 years infection is rotavirus. Vaccines against rotavirus infection substantially reduce morbidity.The objective of this study is to analyze cost-effectiveness of vaccination of children with 5-valent vaccine against rotavirus infection in the Russian Federation.Methods. The evaluation was carried out using modelling on the  basis of published data on the effectiveness of vaccines and  epidemiological data for the Russian Federation. In the base case analysis was performed from the position of the society as a  whole. During the sensitivity analysis cost-effectiveness was also  evaluated from the position of the health system. The evaluation was performed on the period of survival of vaccinated children. The costof therapy corresponded to the rates of OMS in St. Petersburg in 2017, the price of 1 dose of vaccine accounted for in the calculationof 1450 rubles. Costs and life expectancy with regard to quality were discounted at 3.5% per year.Results. Taking into account the accepted assumptions, the mass  vaccination will prevent the vaccinated population in the average  4675 RVI outpatient cases and 1732 RVI cases requiring  hospitalization per 100 thousand children the first year of life, with  90% coverage. In unvaccinated populations will be prevented 4128  outpatient cases and 1212 RVI cases requiring hospitalization. The  projected amount of avoided costs in general — 2.94 thousand RUB  per 1 child (54% in the vaccinated cohort, 46% in unvaccinated  population). Cost-effectiveness will be in the evaluation from the  perspective of society as a whole of 260.1 thousand RUB counting on an quality adjusted life year (QALY), and the evaluation from the perspective of the health system — 653.0 thousand roubles/QALY. Thus, in both cases, costeffectiveness of rotavirus vaccination per 1  QALY will not exceed the generally accepted threshold willingness-to- pay equal to three times the gross domestic product in Russia (2016  — 1.76 million RUB). The projected economic efficiency of selective  vaccination 4.94 times lower than one of mass vaccination.Conclusions. Mass vaccination of children with 5-valent vaccine against RVI will not only reduce the incidence in the Russian  Federation, but, given the adopted assumptions, may also be  considered as a cost-effective intervention

Rotavirus Infection in Children is an Unsolved Problem. Review of Guidelines for Vaccinal Prevention

These clinical guidelines were developed by the professional association of pediatric specialists «Union of Pediatricians of Russia» and approved by the Association’s Executive Committee at the Congress of Pediatricians of Russia «Actual Problems of Pediatrics». Clinical guidelines are devoted to the problem of rotavirus infection, the relevance of which is determined by the high prevalence level and significant contribution of infectious diarrhea to the mortality pattern of children in the first 5 years of life. We present epidemiological data and detailed information on the infectious agent and pathogenesis of rotavirus infection progression. A detailed picture of clinical manifestations as well as extraintestinal complications is presented. The approach to specific prophylaxis has been reasoned. Practical recommendations for immunization as well as various regimens for administering the vaccine, depending on the age and condition of the patient, are given