Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review

Abstract

Background: Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. Methods: Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010-December 2013 (pre-rotavirus vaccine) and January 2016-September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre-and post-rotavirus vaccine introduction. Results: The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12•8% vs. 7•2%, p < 0•001) and allcause under-five mortality (15•9% vs. 5•7%, p = 0•006) pre-and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction. Conclusions: AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.

Welcome evidence of vaccine impact in the Pacific

“…Second is the dramatic reduction in mortality despite a more modest reduction in all-cause diarrhoea hospitalisation. This belies the substantial contribution that rotavirus makes to severe diarrhoeal disease and death and argues convincingly for prioritising rotavirus vaccine introduction even in middle income countries [5] , [6] .…”

Constipation: A Pristine Universal Pediatric Health Delinquent

“…Childhood death due to diarrhea has declined globally [1][2][3][4]. The incidence of diarrheal disorders is also declining due to improved sanitation [1,5,6] and rotavirus vaccination [7,8]. Among functional gastrointestinal diseases (FGID) of children, constipation has recently become highly prevalent worldwide [9,10].…”

Engineering and Development of VP4-VP7 Rotavirus Fusion Protein in Pichia pastoris

“…Rotavirus (RV) infection is the major cause of dehydration and acute diarrhea in young children worldwide. According to the World Health Organization (WHO) estimates, approximately 215,000 infants and young children die each year from RV infections that are preventable by vaccines [1]. RVs are particles with multi-layered icosahedral capsid nonenveloped, double-stranded RNA (dsRNA) genomes [2].…”