Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa

Abstract

An accelerated and sustained decline in all-cause diarrheal hospitalizations, temporally associated with rotavirus vaccine introduction, was observed in children <2 years of age. However, the impact of other interventions such as improved sanitation and changes in HIV management cannot be discounted.

Impact of rotavirus vaccination on rotavirus hospitalisation rates among a resource‐limited rural population in Mbita, Western Kenya

“…After vaccine introduction, reductions in rotavirus positivity occurred in all age groups studied but were greatest in infants <12 months, who constitute the vaccine‐eligible population. These observations are consistent with reports from other African countries that were among the early adopters of the rotavirus vaccine, reporting greater initial declines in the proportion of rotavirus cases among younger age groups that receive vaccinations in the initial years of the vaccination . Thus, our data provide evidence for a major public health impact of rotavirus vaccination among the infants in view of the fact that gastroenteritis cases within this age bracket are generally more severe and pose a greater risk of morbidity and mortality.…”

“…The pre‐vaccine years were characterised by distinct seasonal peaks in rotavirus‐associated hospitalisations among children aged <5 years, whereas after vaccine introduction, we observed less pronounced peaks in rotavirus hospitalisations, providing additional evidence that the declines can be attributed to the effect of rotavirus vaccinations. Similar observations of diminished peaks in hospitalisations from rotavirus gastroenteritis have been reported elsewhere in Africa after introduction of the vaccine .…”

“…Similarly, there is early evidence to suggest that these vaccines will have a significant impact in preventing and reducing the health burden of severe AGE in developing countries in Africa, despite their lower efficacy in clinical trials in these settings. Post-vaccine introduction studies in these African countries have reported reductions in all-cause gastroenteritis ranging between 18% and 65% [13][14][15][16][17][18][19][20]. Proportions in rotavirus-associated hospitalisations have been shown to decline at rates ranging from 24% to 56%, with most reductions being pronounced in children aged <1 year [17][18][19][21][22][23][24].…”

Rotavirus Vaccines: Current Global Impact and Future Perspectives

“…For example, three years after vaccine introduction, rotavirus hospitalizations in children <5 years of age declined by 69% in Armenia and 64% in Ghana, compared with their respective prevaccine rates [23,24]. Five years after introduction in South Africa, diarrhea hospitalizations in children <5 years of age decreased by 53%, with the most significant reductions in children <12 months and, to a lesser extent, children 12–23 months of age [25]. …”

“…Programmatically, a three-dose schedule corresponds to the existing polio, DTP, Haemophilus influenzae b (Hib), hepatitis B and PCV infant schedule in many countries. A three-dose schedule was not found to significantly improve immunogenicity compared with a 10- and 14-week two-dose schedule during prelicensure trials in Malawi and South Africa (Figure 3) [25,50]; however in Ghana, statistically significantly higher anti-rotavirus IgA levels were observed after a three dose schedule versus a 6- and 10-week two-dose schedule in a postlicensure evaluation [23]. A similarly designed analysis from Pakistan did not show a difference [51].…”