Rotavirus vaccination impact, Ireland, implications for vaccine confidence and screening

Abstract

Background Rotavirus vaccine efficacy is well established. However, it is important to consistently demonstrate the positive impact of vaccination programmes in order to optimize uptake rates and combat vaccine hesitancy. Methods Routine data were used to examine rotavirus vaccine effectiveness in Ireland, including changes in age-specific crude incidence rates (CIRs), hospitalizations and hospital length of stay. National intussusception incidence was interrogated. Vaccination status of vaccine-eligible cases of rotavirus infection was determined. Results Nationally, a reduction in the CIR of rotavirus infection of 77.2% [95% confidence interval (CI) 57.8–88.5%, P<0.001] was observed post-inclusion of the rotavirus vaccine in the primary immunization schedule. A decrease in hospitalizations of 85.5% (95% CI 79.3–90.2%, P<0.001), 86.5% (95% CI 82.9–89.4%, P<0.001) and 78.5% (95% CI 74.7–81.9%, P<0.001) was observed in children aged <1, <2 and <5 years, respectively. Most hospitalizations occurred in infants too young to have been vaccinated. There was no significant difference in median length of stay for children hospitalized with rotavirus infection. Decreased CIRs and hospitalization rates in unvaccinated children aged between 2 and 5 years suggest community immunity. Vaccine non-protection was 0.13%. No increase in the national CIR of intussusception was observed. Conclusions Inclusion of the rotavirus vaccine in the Irish primary immunization schedule has resulted in a significant reduction in the burden of rotavirus infection. However, vaccine hesitancy remains a concern. With new vaccination programmes, risk of vaccine harms should be considered and mitigated in order to protect individuals and the integrity of the programme.

Prevalence, Pattern and Genetic Diversity of Rotaviruses among Children under 5 Years of Age with Acute Gastroenteritis in South Africa: A Systematic Review and Meta-Analysis

“…Our meta-analysis findings indicate that significant reductions in the numbers of hospital-admitted and outpatient cases, as well as an overall decline in the proportion of diarrhea episodes due to rotavirus, occurred among under-five children in South Africa following the introduction of the rotavirus vaccine to the national childhood immunization programs, as previously corroborated [45,48]. These observations are consistent with metaanalysis findings in sub-Saharan Africa [72], Ireland [73], and the Caribbean countries [71], and also provide further evidence that rotavirus vaccinations are associated with a reduction in rotavirus-diarrhea morbidity, emergency visits, and hospitalizations. Contrary to the findings from the subgroup analysis of the study settings, the little change of the pooled RV prevalence pre-and post-RV vaccine introduction may be due to the contributions of community-based cases not represented in either the hospital or outpatient cases, or uneven routine childhood immunization coverage among the Provinces, which has been consistently reported [74][75][76].…”

Impact of rotavirus vaccination on intussusception hospital admissions in England

“…Resembling findings from a number of other post-licensure ecological studies [4], [16], [17], [18], [19], [20], we found that there was a reduction in the rate of intussusception hospital admissions in the 0-12 months and 0-36 months age groups, which remained significant for infants but not for the 0-36 months age group as a whole after accounting for the preexisting baseline temporal trend.…”

“…Despite this elevated risk, data from ecological analyses suggests that longer term hospitalization rates for intussusception have not increased following introduction of RV1 and RV5 [16], [17], [18], [19], [20].…”

Group A Rotavirus Detection and Genotype Distribution before and after Introduction of a National Immunisation Programme in Ireland: 2015–2019

“…In addition, since the introduction of the vaccine, there was a reduction in visits to three large pediatric emergency departments with acute gastroenteritis, where median weekly presentations in 2017–2018 (126; interquartile range (IQR), 103–165) were lower than in 2012–2016 (160; IQR 128–214) ( p < 0.001) [ 31 ]. Furthermore, an 86% (95% CI 79.3–90.2%) decrease in hospitalizations due to rotavirus has been reported nationally in those aged <1 year [ 32 ]. In our study, we found that the median age of wild-type rotavirus infection significantly increased in the years following vaccination, from 1.2 years in 2015 to 2.9 years in 2019 ( p < 0.0001).…”