Impact of rotavirus vaccination on diarrhoea mortality and hospital admissions in Brazil

Abstract

Summaryobjective To analyse the data reported by the national surveillance system of Brazil, including data on diarrhoea mortality and hospital admissions before and after rotavirus vaccine introduction, and evaluate the impact of its widespread use under operational conditions. methodRetrospective analysis of routinely collected data was reported by several surveillance systems of Brazil, comprising an 8-year period of all diarrhoea-related hospitalisations and deaths in children <5 years old (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009). Linear regressions were used to compare trends of diarrhoea hospitalisations and deaths before and after vaccine introduction (2002-2005 vs. 2006-2009). resultsThere was a long-term reduction in hospitalisations that preceded the introduction of the vaccine. This reduction was more marked in <1-year-old than in 1-to 4-year-old children. All-cause diarrhoea hospitalisations decreased further after vaccine introduction and the decrease was larger in <1-year-old ()35.6%) than in 1-to 4-year-old children ()12.3%). The number of deaths was decreasing before vaccine introduction, and the decrease also accelerated after vaccine introduction, with deaths halving in <1-year-old and decreasing by 32.9% in 1-to 4-year-old children. The linear relationships between hospitalisations and deaths were statistically different before and after vaccine introduction. conclusionsThe data demonstrate a decreasing trend in all-cause diarrhoea-related hospitalisations and deaths in children <5 years of age. These reductions were steeper between 2006 and 2009, highlighting the potential beneficial effect of the rotavirus vaccine associated with all-cause diarrhoeal disease.

The effectiveness of a rotavirus vaccine in preventing hospitalizations and deaths presumably due to acute infectious diarrhea in Brazilian children: a quasi-experimental study

“…Similarly, the decrease in the mortality rate due to gastroenteritis was greater than the decrease in hospitalization rates (47% and 20%, respectively. This result was also in agreement with the fi ndings in the literature (10) (25) . An important reduction in admissions caused by gastroenteritis in children occurred in Europe, even in countries with low immunization coverage, for instance (30) .…”

“…These data were similar to the fi ndings of other studies that showed reductions varying from 17 to 48% (21) (22) (23) (25) . Similarly, the decrease in the mortality rate due to gastroenteritis was greater than the decrease in hospitalization rates (47% and 20%, respectively.…”

“…Another study found a greater reduction in the number of hospitalizations caused by gastroenteritis in children up to 1 year old (35.6%), compared with children 1-4 years old (reduction of 12.3%), after children started being vaccinated. The mortality reduction followed the same pattern, decreasing by 54.5% in children up to 1 year old and by 32.9% in children 1-4 years old (25) . Although the fi rst licensed vaccine in the U.S. was linked to increased cases of intestinal intussusception (17) , the RV1 vaccine proved to be safe.…”

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years

“…Impact studies conducted in Brazil using data from the Datasus have shown a reduction of hospital admissions due to acute diarrhea in children less than 5 years of age. In Brazil, the reduction ranged from 17 to 21.4%; 12,20 in the South and Southeast region, the reduction was 35% in the year 2007; 21 in the Southeast region the reduction was 21%; 12 and in the State of São Paulo the reduction ranged from 21 to 40%. 13,22 In the peak period of rotavirus infection (May and June), the reduction in hospital admissions due to acute diarrhea after the introduction of the vaccine was 82%, suggesting that the effectiveness of the vaccine was good.…”

Pneumococcal vaccines and pneumonias

“…Isto ocorreu também na implantação da vacina de rotavirus, quando houve uma diminuição dos casos de diarreia anterior ao início da imunização 10 . Além disso, a redução de mortalidade por diarreia foi diferente em diferentes regiões, sendo maior nas regiões mais pobres do país 11 .…”