Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study

Abstract

BackgroundAlmost all diarrhea deaths in young children occur in developing countries. Immunization against rotavirus, the leading cause of childhood severe dehydrating acute diarrhea may reduce the burden of severe diarrhea in developing countries. Ghana introduced rotavirus and pneumococcal vaccination in the national expanded program on immunization in May 2012.MethodsReview of all-cause diarrheal hospitalization data for children aged 59 months and younger at 2 pediatric referral hospitals in southern Ghana from 2008 to 2014. The proportion of acute diarrhea (defined as 3 or more watery, non-bloody stools within 24 hours that has lasted for less than 7 days) cases caused by rotavirus was determined. Temporal trend and age group distribution of all-cause diarrhea and rotavirus gastroenteritis before and after introduction of the new vaccines were compared.ResultsOf the 5847 children hospitalized with all-cause diarrhea during the 74 months (January 2008 – February 2014), 3963 (67.8%) children were recruited for rotavirus surveillance and stool specimens were tested for rotavirus in 3160/3963 (79.7%). Median monthly hospitalization for all-cause diarrhea reduced from 84 [interquartile range (IQR) 62 – 105] during the 52 months pre-vaccination introduction to 46 (IQR 42 - 57) in the 22 months after implementation of vaccination. Significant decline in all-cause diarrhea hospitalization occurred in children aged 0 - 11 months: 56.3% (2711/4817) vs. 47.2% 486/1030 [p = 0.0001, 95% confidence interval (CI) 0.77 – 0.88] and there was significant reduction of rotavirus gastroenteritis hospitalization: 49.7% (1246/2505) vs. 27.8% (182/655) [p = 0.0001, 95% CI 0.32 - 0.47] before and after vaccine introduction respectively.ConclusionsImplementation of rotavirus vaccination program may have resulted in significant reduction of severe diarrhea hospitalization even though this observational study could not exclude the effect of other confounding factors. Continued surveillance is recommended to monitor the progress of this program.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-431) contains supplementary material, which is available to authorized users.

Childhood diarrhea in high and low hotspot districts of Amhara Region, northwest Ethiopia: a multilevel modeling

“…Studies showed rotavirus as the most common cause of vaccine-preventable diarrheal disease during dry seasons [ 1 , 23 ]. Childhood diarrhea among children who received rotavirus vaccine was also less compared to children who did not receive rotavirus vaccine.…”

“…Systematic studies indicated diarrheal diseases, which are widespread in areas with water scarcity, unsafe drinking water supply, poor hygiene, and lack of sanitation which are poorly accessed [ 21 , 22 ]. However, in rotavirus-vaccinated children, occurrence of childhood diarrhea decreased significantly [ 23 – 29 ].…”

Present and Future Human Emissions of Rotavirus and Escherichia coli to Uganda's Surface Waters

“…Vaccination can also reduce emissions, although ignored in our study. Rotavirus vaccination offers reductions in mortality and morbidity in some developing countries, despite efficacy challenges from the wide variability of circulating strains (Enweronu-Laryea et al, 2014;Fischer Walker and Black, 2011). Finally, we highlight that the models aim to estimate annual average daily total emissions.…”

“…We developed future management scenarios for RV and EC emissions of the GloWPa‐H1 and KlaWPa‐H1 models from three actor‐based strategies: (i) the Ministry of Water and Environment sector development plan for the financial year 2019–2020 (MWE, 2016, 2017) to increase onsite sanitation coverage and reach 100% coverage in small towns and rural growth areas, and the Ministry of Health's Uganda Sanitation Fund Program to improve access to basic onsite sanitation, promote household hygiene, and end open defecation (Global Sanitation Fund, 2017); (ii) NWSC's 5‐yr plan to improve sewer coverage from 7 to 30% in their districts of operation between 2016 and 2021 (NWSC, 2016) and comply with treatment effluent discharge standards; and (iii) the UN 2015 SDG resolution 6.3 on halving untreated wastewater by 2030 (United Nations, 2015). Table 2 shows baseline conditions (BS) in 2015 and scenario descriptions for 2030: S1 is “Business as Usual,” S2 is “Industrious,” and S3 is “Low Emissions.” Changes in population, sanitation, and wastewater treatment are developed based on the actor‐based strategies.…”

Modeling of rotavirus transmission dynamics and impact of vaccination in Ghana

“…Vaccine coverage has increased substantially from 42-56% in 2012 to above 90% in 2016, [15,16]. Early vaccine evaluations of RV1 have shown moderate and varied reduction in both rotavirus and all-cause diarrhea hospitalizations among <5-year-olds [15][16][17]. Additional benefits may be derived from rotavirus vaccination if strategies are identified to improve the vaccine effectiveness.…”