Worldwide, rotavirus infection has been a leading cause of severe diarrhea morbidity and mortality. Two rotavirus vaccines have been used in the National Immunization Program (NIP) in Mexico; two-dose Rotarix from 2006 to 2011 and three-dose RotaTeq since 2011. This study assessed coverage (receiving at least one dose or full dose series) in eligible infants, compliance (% completing dose series and % completing series on schedule) in eligible infants vaccinated with Rotarix (2010) versus RotaTeq (2012), using Mexican Social Security Institute data nationwide and by regions.In 2010, 80.7% received at least one dose of Rotarix, 75.6% received both doses and 57.0% received both doses on schedule. In 2012, 85.7% received at least one dose of RotaTeq, 61.0% received all three doses and 43.2% received all three doses on schedule. More eligible infants received all doses with Rotarix versus RotaTeq (p < 0.001). Among infants vaccinated with Rotarix versus RotaTeq, 93.7% versus 71.1% completed full series (p < 0.001), and 75.5% versus 70.9% completed full series on schedule (p = 0.105), respectively. The full series coverage and compliance decreased in all regions with RotaTeq compared with Rotarix. In conclusion, rotavirus vaccination has successfully reduced morbidity and mortality in children under 5 years in Mexico. This study found significant differences in full series coverage and compliance among infants and a higher proportion of completed scheduled at an earlier age in Mexico when comparing a two-dose vaccine in 2010 with a three-dose vaccine in 2012. Such differences might need to be taken into consideration to maximize NIP benefits, including early protection of the rotavirus vaccination program.

Background Hepatitis A virus (HAV) infection is a leading cause of viral hepatitis in children, yet the HAV vaccine is not included in the national immunization program (NIP) in Mexico. This study addresses an identified evidence gap of the burden of hepatitis A disease, complications, and associated costs in Mexico by analyzing surveillance and healthcare data. Data review included disease morbidity (incidence and hospitalization), mortality, and healthcare resource utilization costs. Methods In this observational, retrospective database study, we conducted a systematic screening, extraction, and analysis of outcome data from the national surveillance system in Mexico from January 2000 to December 2019. Results During the analysis period (2000–2019), the average incidence rate/year of HAV cases was 14.7 (5.4–21.5) per 100,000 inhabitants. Children 1–9 years of age (YoA) had the highest average incidence rate/year with 47.8 (14.7–74.5). The average hospitalization rate/year due to HAV infection was 5.8% (2.9–9.6%). Although the highest burden of HAV continued to be in children (1–9 YoA), an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10–64 YoA) was observed. The annual average fatality rate was estimated to be 0.44% (0.26–0.83%) of which 28.8% of deaths were concentrated in adults ≥ 65 YoA. The total direct costs of medical attention due to HAV and related complications were estimated at $382 million Mexican pesos. Conclusion The overall results suggest an uptrend in HAV infections in adolescents/adults compared to children in Mexico. Therefore, as the overall incidence risk of HAV infection decreases, the mean age of infection increases. This consequently increases the risk of severity and complications in older age groups, thus increasing the demand for healthcare resources. Our findings provide evidence for including the inactivated HAV vaccine in the Mexican NIP.

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Background In Mexico, Hepatitis A virus (HAV) infection is the leading cause of viral hepatitis in children, yet the pediatric HAV vaccine is not included in the national immunization program (NIP). Since 2013, 1-dose HAV vaccine is only given to infants of agricultural workers and in day-care centers. Mexico has intermediate HAV endemicity, yet the real burden of symptomatic HAV is unknown. The objective of this study is to describe the burden of HAV infection and severe complications in children and adults in Mexico. Methods A retrospective database study was performed using the national surveillance system from all public health institutions in Mexico. Data on laboratory/clinically confirmed HAV cases, hospitalizations, and deaths, including for severe complications (Fulminant Hepatic Failure, Acute Liver Failure, Liver transplant), from 2000 to 2019 were analyzed (Table 1). Descriptive analyses were performed to estimate the disease burden and direct medical costs due to HAV per year for all ages, sex, and region. Table 1. Definition HAV-associated disease based on ICD-10 codes HAV, Hepatitis A Virus; ICD-10, International Classification of Diseases 10 Classification System Results During the analysis period, the average annual incidence was 29.4 per 100,000 population (range: 43.0–10.9); the average hospitalization rate/year was 5.8% (range: 2.9%– 9.6%); and the average fatality rate/year was 0.44% (range: 0.23%–0.83%) (Figures 1a-b). Overall, there was a decreasing trend in HAV incidence over 2000–2017, with a recent increase in 2017–2019. As the incidence risk of HAV infection decreased, the mean age of infection increased. The biggest burden of HAV continued to be in children (1–9 years-old), yet there was an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10–64 years-old) (Figures 2-3). The total direct medical costs (2019) due to HAV and related complications was estimated at &3.8 million Mexican pesos, which represented about 0.063% of total 2019 expenditure of the federal public budget for the health function. Figure 1. (a) Hospitalization rate (%) due to HAV infection by year in Mexico. (b) Fatality rate (%) due to HAV infection by year in Mexico. HAV, Hepatitis A Virus Figure 2. Incidence of HAV cases by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age Figure 3. Hospitalizations due to HAV infection and complications by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age Conclusion In addition to Mexico’s intermediate HAV endemicity and improved sanitary conditions, these results describe an increase of HAV infection from children to adolescents/adults, which increases the risk for more severe and complicated disease and greater demand on healthcare resources. Our findings support the evidence for HAV vaccine inclusion in the NIP in Mexico. Disclosures Gerardo Luna-Casas, MD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Gilberto Sanchez-Gonzalez, PhD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Maria Yolanda Cervantes Apolinar, MD, The GSK Group of Companies (Employee, Shareholder) Gloria Huerta, MD, The GSK Group of Companies (Employee, Shareholder) Adriana Guzman Holst, MPH, The GSK Group of Companies (Employee)