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Drysdale SB, Pollard AJ. Intussusception risk after rotavirus vaccination in England. Vaccine 2018; 34:6114. [PMID: 27899198 DOI: 10.1016/j.vaccine.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford; The NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford OX3 9DU, United Kingdom.
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford; The NIHR Oxford Biomedical Research Centre, Level 2, Children's Hospital, Oxford OX3 9DU, United Kingdom
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Hungerford D, Vivancos R, Read JM, Iturriza-Gόmara M, French N, Cunliffe NA. Rotavirus vaccine impact and socioeconomic deprivation: an interrupted time-series analysis of gastrointestinal disease outcomes across primary and secondary care in the UK. BMC Med 2018; 16:10. [PMID: 29375036 PMCID: PMC5787923 DOI: 10.1186/s12916-017-0989-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rotavirus causes severe gastroenteritis in infants and young children worldwide. The UK introduced the monovalent rotavirus vaccine (Rotarix®) in July 2013. Vaccination is free of charge to parents, with two doses delivered at 8 and 12 weeks of age. We evaluated vaccine impact across a health system in relation to socioeconomic deprivation. METHODS We used interrupted time-series analyses to assess changes in monthly health-care attendances in Merseyside, UK, for all ages, from July 2013 to June 2016, compared to predicted counterfactual attendances without vaccination spanning 3-11 years pre-vaccine. Outcome measures included laboratory-confirmed rotavirus gastroenteritis (RVGE) hospitalisations, acute gastroenteritis (AGE) hospitalisations, emergency department (ED) attendances for gastrointestinal conditions and consultations for infectious gastroenteritis at community walk-in centres (WIC) and general practices (GP). All analyses were stratified by age. Hospitalisations were additionally stratified by vaccine uptake and small-area-level socioeconomic deprivation. RESULTS The uptake of the first and second doses of rotavirus vaccine was 91.4% (29,108/31,836) and 86.7% (27,594/31,836), respectively. Among children aged < 5 years, the incidence of gastrointestinal disease decreased across all outcomes post-vaccine introduction: 80% (95% confidence interval [CI] 70-87%; p < 0.001) for RVGE hospitalisation, 44% (95% CI 35-53%; p < 0.001) for AGE hospitalisations, 23% (95% CI 11-33%; p < 0.001) for ED, 32% (95% CI 7-50%; p = 0.02) for WIC and 13% (95% CI -3-26%; p = 0.10) for GP. The impact was greatest during the rotavirus season and for vaccine-eligible age groups. In adults aged 65+ years, AGE hospitalisations fell by 25% (95% CI 19-30%; p < 0.001). The pre-vaccine risk of AGE hospitalisation was highest in the most socioeconomically deprived communities (adjusted incident rate ratio 1.57; 95% CI 1.51-1.64; p < 0.001), as was the risk for non-vaccination (adjusted risk ratio 1.54; 95% CI 1.34-1.75; p < 0.001). The rate of AGE hospitalisations averted per 1,000 first doses of vaccine was higher among infants in the most deprived communities compared to the least deprived in 2014/15 (28; 95% CI 25-31 vs. 15; 95% CI 12-17) and in 2015/16 (26; 95% CI 23-30 vs. 13; 95% CI 11-16). CONCLUSIONS Following the introduction of rotavirus vaccination, incidence of gastrointestinal disease reduced across the health-care system. Vaccine impact was greatest among the most deprived populations, despite lower vaccine uptake. Prioritising vaccine uptake in socioeconomically deprived communities should give the greatest health benefit in terms of population disease burden.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK. .,Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK. .,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK. .,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.
| | - Roberto Vivancos
- Field Epidemiology Services, Public Health England, L3 1DS, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, L69 3GL, Liverpool, UK.,Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG, UK
| | - Miren Iturriza-Gόmara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, L69 3GL, Liverpool, UK
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, L69 7BE, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, L12 2AP, Liverpool, UK
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de Hoog MLA, Vesikari T, Giaquinto C, Huppertz HI, Martinon-Torres F, Bruijning-Verhagen P. Report of the 5th European expert meeting on rotavirus vaccination (EEROVAC). Hum Vaccin Immunother 2018; 14:1027-1034. [PMID: 29211629 PMCID: PMC5893188 DOI: 10.1080/21645515.2017.1412019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Fifth European Expert Meeting on Rotavirus Vaccination was convened in Utrecht, The Netherlands, in March 2017. The 2-day meeting included invited lectures as well as original oral and poster presentations and brought together experts from 21 countries. Summary findings of the meeting include: Rotavirus vaccination programmes in Europe have resulted in reductions of 60–90% in rotavirus outpatient visits and hospitalizations. Long term trends indicate this impact is sustained over the years. Herd effects, protecting unvaccinated children and neonates too young to be vaccinated have been observed in many European countries. Early evidence now also suggests that rotavirus vaccination may be instrumental in the prevention of celiac disease. Special attention should be given to preterm infants, who may age out of the vaccination window before hospital discharge and to HIV infected children who are at increased risk of severe rotavirus AGE. There is a small but increased risk of IS following rotavirus vaccination and parents should therefore be informed about possible signs and symptoms of IS. New insights in rotavirus genetic susceptibility and interactions with microbiome may open opportunities for interventions to improve protection by vaccination, in particular in LMIC. The development of several novel rotavirus vaccines discussed at the meeting is also promising in this respect.
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Affiliation(s)
- Marieke L A de Hoog
- a Julius Center for Health Sciences, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Timo Vesikari
- b Vaccine Research Centre, University of Tampere Medical School , Tampere , Finland
| | - Carlo Giaquinto
- c Department of Women and Child Health, University of Padua , Padua , Italy
| | - Hans-Iko Huppertz
- d Department of Paediatrics , Prof.-Hess-Kinderklinik and Research Laboratory , Bremen , Germany
| | - Federico Martinon-Torres
- e Department of Paediatrics and Healthcare Research Institute of Santiago , University of Santiago de Compostela , Santiago de Compostela , Spain
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[Immunisation schedule of the Spanish Association of Paediatrics: 2018 recommendations]. An Pediatr (Barc) 2018; 88:53.e1-53.e9. [PMID: 29301718 DOI: 10.1016/j.anpedi.2017.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 11/22/2022] Open
Abstract
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics annually publishes the immunisation schedule considered optimal for children resident in Spain, according to available evidence on current vaccines. Regarding funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTPa-IPV-Hib-HB) and 13-valent pneumococcal vaccines are recommended. Administration of the 6-year booster dose with DTPa is recommended, and a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women in every pregnancy between 27 and 32 weeks' gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). MMRV vaccine could be applied as the second dose if available. Coverage of human papillomavirus vaccination in girls aged 12 with a two dose scheme (0, 6 months) should be improved. Information and recommendation for male adolescents about potential beneficial effects of this immunisation should be provided as well. The new 9 genotypes vaccine is now available, expanding the coverage for both gender. Regarding non-funded immunisations, Committee on Vaccines of the Spanish Association of Paediatrics recommends meningococcal B vaccination, with a 3+1 schedule, and requests to be included in the National Immunisation Program. Tetravalent meningococcal vaccine (MenACWY) is recommended to adolescents (14-18 years) who are going to live in countries with systematic vaccination against ACWY serogroups, and people >6 weeks of age with risk factors or travellers to countries with very high incidence. Vaccination against rotavirus is recommended in all infants.
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Rotavirus Infection in the Auckland Region After the Implementation of Universal Infant Rotavirus Vaccination: Impact on Hospitalizations and Laboratory Implications. Pediatr Infect Dis J 2018; 37:e1-e5. [PMID: 28746261 DOI: 10.1097/inf.0000000000001706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In July 2014, New Zealand introduced universal infant vaccination with RotaTeq (Merk & Co.) administered as 3 doses at 6 weeks, 3 and 5 months of age. We sought to assess the impact of rotavirus vaccination on gastroenteritis (GE) hospitalizations in the greater Auckland region and analyze changes in rotavirus testing in the period around vaccine introduction. METHODS Hospitalizations, laboratory testing rates and methods were compared between the pre-vaccine period (2009-2013), post-vaccine period (January 2015 to December 2015) and year of vaccine introduction (2014). RESULTS There was a 68% decline in rotavirus hospitalizations of children <5 years of age after vaccine introduction (from 258/100,000 to 83/100,000) and a 17% decline in all-cause gastroenteritis admissions (from 1815/100,000 to 1293/100,000). Reductions were also seen in pediatric groups too old to have received vaccine. Despite these changes, rotavirus testing rates in our region remained static in the year after vaccine introduction compared with the 2 prior years, and after vaccine introduction, we observed a high rate of false positives 19/58 (33%) in patients with reactive rotavirus tests. CONCLUSIONS Rotavirus vaccine has had a significant early impact on gastroenteritis hospitalizations for children in the Auckland region. However, continued rotavirus testing at pre-vaccine rates risks generating false positive results. Laboratories and clinicians should consider reviewing their testing algorithms before vaccine introduction.
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Immunisation schedule of the Spanish Association of Paediatrics: 2018 recommendations. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Verstraeten T, Cattaert T, Harris J, Lopman B, Tam CC, Ferreira G. Estimating the Burden of Medically Attended Norovirus Gastroenteritis: Modeling Linked Primary Care and Hospitalization Datasets. J Infect Dis 2017; 216:957-965. [PMID: 28961927 PMCID: PMC5853278 DOI: 10.1093/infdis/jix410] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
Background Norovirus is the leading cause of community-acquired and nosocomial acute gastroenteritis. Routine testing for norovirus is seldom undertaken, and diagnosis is mainly based on presenting symptoms. This makes understanding the burden of medically attended norovirus-attributable gastroenteritis (MA-NGE) and targeting care and prevention strategies challenging. Methods We used linked population-based healthcare datasets (Clinical Practice Research Datalink General Practice OnLine Database linked with Hospital Episode Statistics Admitted Patient Care) to model the incidence of MA-NGE associated with primary care consultations or hospitalizations according to age groups in England in the period July 2007–June 2013. Results Mean annual incidence rates of MA-NGE were 4.9/1000 person-years and 0.7/1000 person-years for episodes involving primary care or hospitalizations, respectively. Incidence rates were highest in children aged <5 years: 34.0 consultations/1000 person-years and 3.3 hospitalizations/1000 person-years. Medically attended norovirus-attributable gastroenteritis hospitalization rates were second highest in adults aged >65 years (1.7/1000 person-years). Conclusions In this particular study, the burden of MA-NGE estimated from healthcare datasets was higher than previously estimated in small cohort studies in England. Routinely collected primary care and hospitalization datasets are useful resources to estimate and monitor the burden of MA-NGE in a population over time.
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Affiliation(s)
- Thomas Verstraeten
- P95 Pharmacovigilance and Epidemiology, Heverlee, Belgium
- Correspondence: T. Verstraeten Koning Leopold III Laan 1, 3001 Heverlee, Belgium ()
| | - Tom Cattaert
- P95 Pharmacovigilance and Epidemiology, Heverlee, Belgium
| | - John Harris
- National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool
| | - Ben Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Clarence C Tam
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
- Saw Swee Hock School of Public Health, National University of Singapore
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Yoshikawa T, Matsuki T, Sato K, Mizuno M, Shibata M, Hasegawa S, Morita M, Iwasa M, Gopala K, Holl K. Impact of rotavirus vaccination on the burden of acute gastroenteritis in Nagoya city, Japan. Vaccine 2017; 36:527-534. [PMID: 29248263 DOI: 10.1016/j.vaccine.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/16/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Nagoya city, Japan, rotavirus (RV) vaccination has been available since 2011 with estimated coverage reaching 92% by 2015 after the introduction of a public subsidy in 2012. This study assessed the impact of vaccination on the RV gastroenteritis (RVGE) burden in children aged <5 years old (y) by comparing RVGE hospitalizations and outpatient visits during pre-vaccination (2007-2011), transition (2011-2012) and subsidization (2012-2016) periods. METHODS All hospitalizations and outpatient visits in children aged <5 y from 2 administrative districts of Nagoya city were identified from the hospital-based electronic databases of 4 hospitals. RVGE cases were identified by diagnostic code and/or positive results of diagnostic kits. RESULTS Compared to the pre-vaccination period, there was a decrease in RVGE hospitalizations for children <5 y from 5.59 per 1000 person-year (kPY) to 3.65/kPY in the subsidization period (i.e. 34.69%). In children <1 y, the incidence of RVGE hospitalizations decreased continuously from 6.62/kPY in the pre-vaccination period to 1.84/kPY in the subsidization period (i.e. 72.19%). The highest decrease was observed in the subsidization season i.e. when high coverage was reached: 69% and 75.57% in the 2013/2014 season for 2-3 y and 3-4 y, and 74.03% in the 2014/2015 season for 4-5 y, respectively. Proportion of RVGE outpatient visits decreased by 87.44% for children <1 y and 57.05% for <5 y from the pre-vaccination to the subsidization period. This decrease started the first year of subsidization for children <1 y, 1-2 y and 2-3 y (78.89%, 18.86% and 5.80%) and the second year (2013/2014 season) for children 3-4 y and 4-5 y (87.73% and 51.78%). CONCLUSIONS Although yearly fluctuations have been observed, the introduction of vaccination significantly decreased pediatric RVGE hospitalizations and outpatient visits, especially in the age group eligible for vaccination. During the second and third year of subsidization, we observed a herd protection effect on other age groups <5 y who were not eligible for vaccination. Clinicaltrial.gov.registered#:NCT01733862.
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Affiliation(s)
- Tetsushi Yoshikawa
- Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Taizo Matsuki
- GSK, 1-8-1 Akasaka, Minato-ku, Tokyo 107-0052, Japan.
| | - Keiko Sato
- GSK, 1-8-1 Akasaka, Minato-ku, Tokyo 107-0052, Japan.
| | - Mihoko Mizuno
- Daido Hospital, 9 Hakusui-cho, Minami-ku, Nagoya, Aichi 457-8511, Japan.
| | - Motohiro Shibata
- Japan Community Healthcare Organization Chukyo Hospital, 1-1-10, Sanjo, Minami-ku, Nagoya, Aichi 457-8510, Japan.
| | - Shinji Hasegawa
- Nagoya Memorial Hospital, 4-305, Hirabari, Tempaku-ku, Nagoya, Aichi 468-8520, Japan.
| | - Makoto Morita
- Nagoya Memorial Hospital, 4-305, Hirabari, Tempaku-ku, Nagoya, Aichi 468-8520, Japan.
| | - Mitsuji Iwasa
- Japanese Red Cross Nagoya Daini Hospital, 2-9, Myomi-cho, Showa-ku, Nagoya, Aichi 466-8650, Japan.
| | - Kusuma Gopala
- GSK, #5, Embassy Links, Cunningham Road, SRT Road, Bangalore 560052, India.
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Sandmann FG, Jit M, Robotham JV, Deeny SR. Burden, duration and costs of hospital bed closures due to acute gastroenteritis in England per winter, 2010/11-2015/16. J Hosp Infect 2017; 97:79-85. [PMID: 28552406 PMCID: PMC5564405 DOI: 10.1016/j.jhin.2017.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 05/22/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bed closures due to acute gastroenteritis put hospitals under pressure each winter. In England, the National Health Service (NHS) has monitored the winter situation for all acute trusts since 2010/11. AIM To estimate the burden, duration and costs of hospital bed closures due to acute gastroenteritis in winter. METHODS A retrospective analysis of routinely collected time-series data of bed closures due to diarrhoea and vomiting was conducted for the winters 2010/11 to 2015/16. Two key issues were addressed by imputing non-randomly missing values at provider level, and filtering observations to a range of dates recorded in all six winters. The lowest and highest values imputed were taken to represent the best- and worst-case scenarios. Bed-days were costed using NHS reference costs, and potential staff absence costs were based on previous studies. FINDINGS In the best-to-worst case, a median of 88,000-113,000 beds were closed due to gastroenteritis each winter. Of these, 19.6-20.4% were unoccupied. On average, 80% of providers were affected, and had closed beds for a median of 15-21 days each winter. Hospital costs of closed beds were £5.7-£7.5 million, which increased to £6.9-£10.0 million when including staff absence costs due to illness. CONCLUSIONS The median number of hospital beds closed due to acute gastroenteritis per winter was equivalent to all general and acute hospital beds in England being unavailable for a median of 0.88-1.12 days. Costs for hospitals are high but vary with closures each winter.
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Affiliation(s)
- F G Sandmann
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK.
| | - M Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - J V Robotham
- Modelling and Economics Unit, Public Health England, London, UK
| | - S R Deeny
- Modelling and Economics Unit, Public Health England, London, UK; The Health Foundation, London, UK
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Yandle Z, Coughlan S, Drew RJ, O’Flaherty N, O’Gorman J, De Gascun C. Circulating rotavirus genotypes in the Irish paediatric population prior to the introduction of the vaccination programme. Ir J Med Sci 2017; 186:1003-1007. [DOI: 10.1007/s11845-017-1604-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/24/2017] [Indexed: 02/07/2023]
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Jacob J, Joseph TK, Srinivasan R, Kompithra RZ, Simon A, Kang G. Direct and Indirect Costs of Pediatric Gastroenteritis in Vellore, India. Indian Pediatr 2017; 53:642-4. [PMID: 27508545 DOI: 10.1007/s13312-016-0903-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine costs of pediatric gastroenteritis in out-patient and in-patient facilities. METHODS Cross-sectional survey of children with acute gastroenteritis attending out-patient clinic (n=30) or admitted in the ward (n=30) for management in the Christian Medical College, Vellore, India from July-September 2014 to estimate direct (drugs, tests, consultation/hospitalization) and indirect (travel, food, lost wages) costs associated with the episode. RESULTS Median direct and indirect costs were Rs 590 and Rs 190 for out-patient management and Rs 7258 and Rs. 610 for hospitalization, constituting 1.1% and 11% of median annual household income, respectively. CONCLUSIONS Escalating healthcare costs need tracking for evaluation of interventions.
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Affiliation(s)
- Joby Jacob
- Division of Gastrointestinal Sciences, and *Department of Child Health; Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Dr Gagandeep Kang, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, TN 632 004, India.
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Thomas SL, Walker JL, Fenty J, Atkins KE, Elliot AJ, Hughes HE, Stowe J, Ladhani S, Andrews NJ. Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted. Vaccine 2016; 35:680-686. [PMID: 28007397 PMCID: PMC5267482 DOI: 10.1016/j.vaccine.2016.11.057] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/11/2016] [Accepted: 11/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Introduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme. METHODS We used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged <5years in the first year of the vaccination programme by comparing observed numbers of AGE cases in 2013-2014 to numbers predicted from the time-series models. We then estimated the healthcare costs averted for general practice consultations, ED visits and hospitalisations. RESULTS In general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa=0.85; 95%CI=0.76-0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53-0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588-113,561) AGE visits by children aged <5years were averted in 2013-14, associated with an estimated £12.5million (9,209-16,198) reduction in healthcare costs. CONCLUSIONS The marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.
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Affiliation(s)
- Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Jemma L Walker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Justin Fenty
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Katherine E Atkins
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Public Health England, 6th Floor 5 St Philips Place, Birmingham B3 2PW, UK
| | - Helen E Hughes
- Real-time Syndromic Surveillance Team, Public Health England, 6th Floor 5 St Philips Place, Birmingham B3 2PW, UK
| | - Julia Stowe
- Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez Ladhani
- Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick J Andrews
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Gagnon M, Vimont A, Darveau A, Fliss I, Jean J. Study of the Ability of Bifidobacteria of Human Origin to Prevent and Treat Rotavirus Infection Using Colonic Cell and Mouse Models. PLoS One 2016; 11:e0164512. [PMID: 27727323 PMCID: PMC5058500 DOI: 10.1371/journal.pone.0164512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/25/2016] [Indexed: 12/11/2022] Open
Abstract
Rotavirus is the leading cause of severe acute gastroenteritis among children worldwide. Despite effective vaccines, inexpensive alternatives such as probiotics are needed. The aim of this study was to assess the ability of probiotic candidate Bifidobacterium thermophilum RBL67 to inhibit rotavirus infection. Bacterial adhesion to intestinal cells and interference with viral attachment were evaluated in vitro. B. thermophilum RBL67 displayed adhesion indexes of 625 ± 84 and 1958 ± 318 on Caco-2 and HT-29 cells respectively and was comparable or superior to four other bifidobacteria, including B. longum ATCC 15707 and B. pseudolongum ATCC 25526 strains. Incubation of B. thermophilum RBL67 for 30 min before (exclusion) and simultaneously (competition) with human rotavirus strain Wa decreased virus attachment by 2.0 ± 0.1 and 1.5 ± 0.1 log10 (by 99.0% and 96.8% respectively). Displacement of virus already present was negligible. In CD-1 suckling mice fed B. thermophilum RBL67 challenged with simian rotavirus SA-11, pre-infection feeding with RBL 67 was more effective than post-infection feeding, reducing the duration of diarrhea, limiting epithelial lesions, reducing viral replication in the intestine, accelerating recovery, and stimulating the humoral specific IgG and IgM response, without inducing any adverse effect. B. thermophilum RBL67 had little effect on intestinal IgA titer. These results suggest that humoral immunoglobulin might provide protection against the virus and that B. thermophilum RBL67 has potential as a probiotic able to inhibit rotavirus infection and ultimately reduce its spread.
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Affiliation(s)
- Mélanie Gagnon
- Institute of Nutrition and Functional Foods, Department of Food Science, Laval University, Quebec, Quebec, Canada
| | - Allison Vimont
- Institute of Nutrition and Functional Foods, Department of Food Science, Laval University, Quebec, Quebec, Canada
| | - André Darveau
- Department of Biochemistry, Microbiology and Bioinformatics, Laval University, Quebec, Quebec, Canada
| | - Ismaïl Fliss
- Institute of Nutrition and Functional Foods, Department of Food Science, Laval University, Quebec, Quebec, Canada
| | - Julie Jean
- Institute of Nutrition and Functional Foods, Department of Food Science, Laval University, Quebec, Quebec, Canada
- * E-mail:
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64
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Standaert B, Strens D, Li X, Schecroun N, Raes M. The Sustained Rotavirus Vaccination Impact on Nosocomial Infection, Duration of Hospital Stay, and Age: The RotaBIS Study (2005-2012). Infect Dis Ther 2016; 5:509-524. [PMID: 27714677 PMCID: PMC5125134 DOI: 10.1007/s40121-016-0131-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction The benefits of rotavirus (RV) vaccination in developed countries have focused on reductions in mortality, hospitalization and medical visits, and herd protection. We investigated other aspects related to RV-induced nosocomial infection, duration of hospital stay, age shift, and sustained vaccine impact (VI) over time. Method RotaBIS (Rotavirus Belgian Impact Study; ClinicalTrials.gov identifier, NCT01563146) annually collects retrospective data on hospitalization linked to RV testing in children up to 5 years old from 11 pediatric wards located all over Belgium. Data from 2005 to 2012 have been split in pre- (2005–2006) and post-vaccination (2007–2012) period. Information was collected on age, gender, RV test result, nosocomial infection caused by RV and duration of hospital stay. Results Over the 6-year period after the introduction of the RV vaccine, an 85% reduction in nosocomial infections was observed (221 in 2005 to 33 in 2012, p < 0.001). A significant reduction of almost 2 days in average duration of hospital stay per event was observed overall (7.62 days in 2005 to 5.77 days in 2012, p < 0.001). The difference is mainly explained by the higher reduction in number of nosocomial infections. A pronounced age shift (+24%, p < 0.01) of RV nosocomial infection to infants ≤2 months old was observed, increasing with length of post-vaccination period. VI was maintained over the follow-up (±79% VI per birth cohort). A decrease was seen depending on age, 85% (95% CI 76–91%) in the youngest to 63% (95% CI 22–92%) in the oldest age group. Conclusion The higher reduction in nosocomial infection may affect the overall average duration of hospital stay for RV infection. No change in VI by birth cohort, but a reduction by age group was observed. These findings could be important for decision-makers considering the introduction of universal mass RV vaccination programs. Trial registration ClinicalTrials.gov identifier,
NCT01563146. Funding GlaxoSmithKline Biologicals SA (Rixensart, Belgium).
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Affiliation(s)
| | | | - Xiao Li
- GSK Vaccines, Wavre, Belgium
| | - Nadia Schecroun
- Keyrus Biopharma (c/o GSK Vaccines, Wavre, Belgium), Lasne, Belgium
| | - Marc Raes
- Pediatrics, Jessa Hospital, Hasselt, Belgium
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65
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Burnett E, Yen C, Tate JE, Parashar UD. Rotavirus vaccines: current global impact and future perspectives. Future Virol 2016; 11:699-708. [PMID: 27840654 PMCID: PMC5102270 DOI: 10.2217/fvl-2016-0082] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 11/21/2022]
Abstract
As of May 2016, 81 countries have introduced Rotarix or RotaTeq rotavirus vaccines into their national immunization program. Despite initially slow uptake in some countries and differences in vaccine effectiveness (VE) between high-, low- and middle-income countries, impact of the vaccines has been swift and striking in all settings, with good VE against vaccine-type and nonvaccine-type strains. Newly published research indicates poor nutrition is associated with decreased VE and breastfeeding at the time of vaccination does not affect vaccine response. Vaccines in development and proposed alternate schedules also promise to address limitations of the current vaccines and optimize rotavirus disease prevention.
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Affiliation(s)
- Eleanor Burnett
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Catherine Yen
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Jacqueline E Tate
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
| | - Umesh D Parashar
- Division of Viral Disease, Centers for Disease Control & Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329-4027, USA
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66
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Armstrong G, Gallagher N, Cabrey P, Graham AM, McKeown PJ, Jackson S, Dallat M, Smithson RD. A population based study comparing changes in rotavirus burden on the Island of Ireland between a highly vaccinated population and an unvaccinated population. Vaccine 2016; 34:4718-4723. [DOI: 10.1016/j.vaccine.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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67
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Yamin D, Atkins KE, Remy V, Galvani AP. Cost-Effectiveness of Rotavirus Vaccination in France-Accounting for Indirect Protection. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:811-819. [PMID: 27712709 DOI: 10.1016/j.jval.2016.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 04/14/2016] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Vaccination against rotavirus has shown great potential for reducing the primary cause of severe childhood gastroenteritis. Previous economic evaluations of rotavirus vaccination in France have not modeled the potential impact of vaccines on disease burden via reduced transmission. OBJECTIVE To determine the cost-effectiveness of the introduction of pentavalent rotavirus vaccination into the French infant vaccination schedule. METHODS We developed an age-structured model of rotavirus transmission calibrated to 6 years of French gastroenteritis incidence and vaccine clinical trial data. We evaluated the cost-effectiveness of pentavalent rotavirus vaccination considering that 75% of infants would receive the three-dose vaccine course. RESULTS Our model predicts that rotavirus vaccination will decrease rotavirus gastroenteritis incidence and associated clinical outcomes in vaccinated and unvaccinated individuals, delay the seasonal peak of infection, and increase the age of infection. From the societal perspective, our base-case scenario predicts that vaccination coverage would be cost-effective at €115 or €135 per vaccine course at €28,500 and €39,500/quality-adjusted life-year (QALY) gained, respectively, and suggests that almost 95% of the financial benefits will be recouped within the first 5 years following vaccination implementation. From the third-party payer perspective, incremental cost-effectiveness ratios ranged from €12,500 to €20,000/QALY, respectively. Our uncertainty analysis suggests that findings were sensitive to various assumptions including the number of hospitalizations, outpatient visits, and the extent of QALY losses per rotavirus episode. CONCLUSIONS Introducing pentavalent rotavirus vaccination into the French infant vaccination schedule would significantly reduce the burden of rotavirus disease in children, and could be cost-effective under plausible conditions.
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Affiliation(s)
- Dan Yamin
- Department of Industrial Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA.
| | - Katherine E Atkins
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
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68
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Degiuseppe JI, Reale EA, Stupka JA. Rotavirus epidemiology and surveillance before vaccine introduction in Argentina, 2012-2014. J Med Virol 2016; 89:423-428. [PMID: 27487415 DOI: 10.1002/jmv.24650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 01/11/2023]
Abstract
Group A Rotavirus has been widely described as one of the most important infantile diarrheal pathogens worldwide. In Argentina, it is responsible for over 200,000 acute diarrhea cases and from 30 to 50 deaths annually in children under 5 years. The aim of this study is to analyze frequency, seasonality, age group distribution, and circulating genotypes based on data notified in the 2012-2014 period and in turn to assess the pre-vaccine scenario, considering that rotavirus vaccine was introduced in 2015. Data were taken from the Viral Diarrhea Notification module of the Argentine SNVS-SIVILA surveillance tool. Analyses of circulating genotypes were performed on rotavirus-positive stool specimens by conventional binary characterization of the outermost capsid genes. Overall data showed rotavirus detection in about 25% of samples tested, and higher rates in children under 2 years old were observed. Rotavirus positive cases were distributed according to a typical winter seasonal pattern. A heterogeneous regional pattern of prevalence was also observed, with higher rates detected in the North region. Genotype co-circulation and annual fluctuation were observed. In general, G1P[8], G2P[4], G3P[8], and G12P[8] were the most frequently detected genotypes. This study represents the last survey taken of a population considered to be naïve. J. Med. Virol. 89:423-428, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Juan Ignacio Degiuseppe
- Laboratorio de Gastroenteritis Virales, Instituto Nacional de Enfermedades Infecciosas (INEI-ANLIS "Dr. Carlos G. Malbrán"), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ezequiel Agustín Reale
- Laboratorio de Gastroenteritis Virales, Instituto Nacional de Enfermedades Infecciosas (INEI-ANLIS "Dr. Carlos G. Malbrán"), Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Andrés Stupka
- Laboratorio de Gastroenteritis Virales, Instituto Nacional de Enfermedades Infecciosas (INEI-ANLIS "Dr. Carlos G. Malbrán"), Ciudad Autónoma de Buenos Aires, Argentina
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- Laboratorio de Gastroenteritis Virales, Instituto Nacional de Enfermedades Infecciosas (INEI-ANLIS "Dr. Carlos G. Malbrán"), Ciudad Autónoma de Buenos Aires, Argentina
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69
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Bennett A, Bar-Zeev N, Cunliffe NA. Measuring indirect effects of rotavirus vaccine in low income countries. Vaccine 2016; 34:4351-3. [PMID: 27443593 PMCID: PMC5047945 DOI: 10.1016/j.vaccine.2016.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
Widespread introduction of rotavirus vaccines has led to major reductions in the burden of rotavirus gastroenteritis worldwide. Vaccine effectiveness is diminished, however, in low income countries, that harbour the greatest burden of rotavirus attributed morbidity and mortality. Indirect effects of rotavirus vaccine (herd immunity and herd protection) could increase population level impact and improve vaccine cost effectiveness in such settings. While rotavirus vaccine indirect effects have been demonstrated in high and middle income countries, there are very little data from low income countries where force of infection, population structures and vaccine schedules differ. Targeted efforts to evaluate indirect effects of rotavirus vaccine in low income countries are required to understand the total impact of rotavirus vaccine on the global burden of rotavirus disease.
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Affiliation(s)
- Aisleen Bennett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O Box 30960, Chichiri, Blantyre 3, Malawi; Institute of Infection & Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O Box 30960, Chichiri, Blantyre 3, Malawi; Institute of Infection & Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK
| | - Nigel A Cunliffe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O Box 30960, Chichiri, Blantyre 3, Malawi; Institute of Infection & Global Health, University of Liverpool, 8 West Derby Street, Liverpool L69 7BE, UK.
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Stowe J, Andrews N, Ladhani S, Miller E. The risk of intussusception following monovalent rotavirus vaccination in England: A self-controlled case-series evaluation. Vaccine 2016; 34:3684-9. [PMID: 27286641 DOI: 10.1016/j.vaccine.2016.04.050] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the risk of intussusception after monovalent rotavirus vaccine (RV1) given to infants aged 2 and 3 months in England. METHODS Hospital Episode Statistics (HES) were used to identify infants aged 48-183 days admitted between 11/03/2013 and 31/10/2014 with intussusception. Diagnosis was confirmed from medical records and HES procedure codes. Vaccination status was obtained from general practitioners. The risk of admission within 1-7 and 8-21 days of vaccination was analysed using the self-controlled case-series (SCCS) method with age effect adjustment by including historical data before RVI introduction in July 2013. RESULTS A total of 119 cases were identified during the study period and intussusception confirmed in 95 of whom 39 were vaccinated 1-21 days before onset. An increased relative incidence (RI) in this period was found, 4.53 (95% confidence interval 2.34-8.58) and 2.60 (1.43-4.81) respectively after the 1st and 2nd doses with an attributable risk of 1.91 and 1.49 per 100,000 doses respectively. The peak risk was 1-7 days after the first dose, RI 13.81 (6.44-28.32), with an estimated 93% of the 15 cases being vaccine-attributable. Mean interval between onset and admission, and clinical features were similar between vaccine-associated and background cases. Despite intussusception being a contraindication to rotavirus vaccination, 10 infants received a further dose; none had a recurrence. The RIs in a meta-analysis combing our results with Australia, Mexico, Brazil and Singapore using RV1, a 2, 4 month schedule and SCCS gave pooled RI estimates of 2.35 (1.45-3.8) and 1.77 (1.29-2.43) in the 21 day period after the 1st and 2nd doses, respectively. The earlier age at the 2nd dose in England did not affect the risk. CONCLUSION We estimate that the RVI programme causes around 21 intussusception admissions annually in England but, since it prevents around 25,000 gastro-intestinal infection admissions, its benefit/risk profile remains strongly positive.
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Affiliation(s)
- Julia Stowe
- Immunisation and Blood safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom.
| | - Nick Andrews
- Statistics and Modelling Economics Unit, Public Health England, London NW9 5EQ, United Kingdom
| | - Shamez Ladhani
- Immunisation and Blood safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Elizabeth Miller
- Immunisation and Blood safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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