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.
:
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis. PLoS Med 8(4): e32767. doi:10.1371/journal.pmed.1001024
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001024
Souhrn
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.
:
Please see later in the article for the Editors' Summary
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