A time series analysis by Manish Patel and colleagues shows that the introduction of rotavirus vaccination in Brazil is associated with reduced diarrhea-related deaths and hospital admissions in children under 5 years of age

AC Linhares

AD Oxman

Alessandra Araújo Siqueira

AT Curns

Ben Lopman

Brendan Flannery

Catherine Yen

CR Luz

DD Reidpath

Eduardo Hage Carmo

FC Barros

GE Armah

GM Ruiz-Palacios

Greice Madeleine Ikeda do Carmo

JA Boom

JB Correia

JE Tate

Jennifer Cortes

JG Temporao

Juan José Cortez-Escalante

K Zaman

LH de Oliveira

Lorenz von Seidlein

Lucia Helena de Oliveira

M Patel

M Zeller

Manish Patel

MM Patel

O de Palma

P McCullagh

RE Black

RG Gurgel

RQ Gurgel

SA Madhi

SB Lambert

T Nakagomi

T Vesikari

TM Lanzieri

UD Parashar

V Munford

V Richardson

Wanderson Kleber de Oliveira

English

PubMed

In 2006, Brazil began routine immunization of infants <15 wk of age with a
                        single-strain rotavirus vaccine. We evaluated whether the rotavirus
                        vaccination program was associated with declines in childhood diarrhea
                        deaths and hospital admissions by monitoring disease trends before and after
                        vaccine introduction in all five regions of Brazil with varying disease
                        burden and distinct socioeconomic and health indicators.National data were analyzed with an interrupted time-series analysis that
                        used diarrhea-related mortality or hospitalization rates as the main
                        outcomes. Monthly mortality and admission rates estimated for the years
                        after rotavirus vaccination (2007–2009) were compared with expected
                        rates calculated from pre-vaccine years (2002–2005), adjusting for
                        secular and seasonal trends. During the three years following rotavirus
                        vaccination in Brazil, rates for diarrhea-related mortality and admissions
                        among children <5 y of age were 22% (95% confidence
                        interval 6%–44%) and 17% (95% confidence
                        interval 5%–27%) lower than expected, respectively. A
                        cumulative total of ∼1,500 fewer diarrhea deaths and 130,000 fewer
                        admissions were observed among children <5 y during the three years after
                        rotavirus vaccination. The largest reductions in deaths
                        (22%–28%) and admissions (21%–25%)
                        were among children younger than 2 y, who had the highest rates of
                        vaccination. In contrast, lower reductions in deaths (4%) and
                        admissions (7%) were noted among children two years of age and older,
                        who were not age-eligible for vaccination during the study period.After the introduction of rotavirus vaccination for infants, significant
                        declines for three full years were observed in under-5-y diarrhea-related
                        mortality and hospital admissions for diarrhea in Brazil. The largest
                        reductions in diarrhea-related mortality and hospital admissions for
                        diarrhea were among children younger than 2 y, who were eligible for
                        vaccination as infants, which suggests that the reduced diarrhea burden in
                        this age group was associated with introduction of the rotavirus vaccine.
                        These real-world data are consistent with evidence obtained from clinical
                        trials and strengthen the evidence base for the introduction of rotavirus
                        vaccination as an effective measure for controlling severe and fatal
                        childhood diarrhea.
                   

do Carmo Greice Madeleine Ikeda

Yen Catherine

Cortes Jennifer

Siqueira Alessandra Araújo

de Oliveira Wanderson Kleber

Cortez-Escalante Juan José

Lopman Ben

Flannery Brendan

de Oliveira Lucia Helena

Hage Carmo Eduardo

Patel Manish

Public Library of Science (PLOS)

Decline in Diarrhea Mortality and Admissions after Routine Childhood
                    Rotavirus Immunization in Brazil: A Time-Series Analysis

Crossref

PLoS Medicine

Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis

BACKGROUND: In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. We evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators. METHODS AND FINDINGS: National data were analyzed with an interrupted time-series analysis that used diarrhea-related mortality or hospitalization rates as the main outcomes. Monthly mortality and admission rates estimated for the years after rotavirus vaccination (2007-2009) were compared with expected rates calculated from pre-vaccine years (2002-2005), adjusting for secular and seasonal trends. During the three years following rotavirus vaccination in Brazil, rates for diarrhea-related mortality and admissions among children <5 y of age were 22% (95% confidence interval 6%-44%) and 17% (95% confidence interval 5%-27%) lower than expected, respectively. A cumulative total of ~1,500 fewer diarrhea deaths and 130,000 fewer admissions were observed among children <5 y during the three years after rotavirus vaccination. The largest reductions in deaths (22%-28%) and admissions (21%-25%) were among children younger than 2 y, who had the highest rates of vaccination. In contrast, lower reductions in deaths (4%) and admissions (7%) were noted among children two years of age and older, who were not age-eligible for vaccination during the study period. CONCLUSIONS: After the introduction of rotavirus vaccination for infants, significant declines for three full years were observed in under-5-y diarrhea-related mortality and hospital admissions for diarrhea in Brazil. The largest reductions in diarrhea-related mortality and hospital admissions for diarrhea were among children younger than 2 y, who were eligible for vaccination as infants, which suggests that the reduced diarrhea burden in this age group was associated with introduction of the rotavirus vaccine. These real-world data are consistent with evidence obtained from clinical trials and strengthen the evidence base for the introduction of rotavirus vaccination as an effective measure for controlling severe and fatal childhood diarrhea

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Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis

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