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Lo Vecchio A, Scarano SM, Palladino R, Del Bene M, Trama U, Affinito G, Buono P, Guarino A. Co-administration with Men-B vaccine increases Rotavirus vaccination coverage: A 5-year regionwide retrospective cohort study (STORM study). Vaccine 2024; 42:287-294. [PMID: 38072758 DOI: 10.1016/j.vaccine.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024]
Abstract
INTRODUCTION In Italy Rotavirus vaccination (RVV) is provided free of charge from 2018, however, the coverage is scattered and suboptimal. The narrow time frame to complete the schedule is a barrier to uptake, and co-administration with other vaccines may potentially increase the coverage. Although the co-administration of RV vaccine and Meningococcal Group B vaccine (MenB) is not included in the product labels, we aimed at studying its impact on RVV coverage. METHODS This Surveillance study on Timing and cOverage of Rotavirus and MenB vaccine co-administration (STORM study) used the Regional Vaccination Registry to collect data about children born in Campania Region between January 2016 and December 2020, and receiving vaccines scheduled in the first year of life. RESULTS Among the 224,110 children enrolled, 60,614 (27.0%) completed the RVV schedule, with a vaccination rate that increased over time from 1.15% in 2016 to 56.92% in 2020. The first and last dose of RVV schedule were administered beyond the recommended time in 6% of the study population, respectively. Co-administration of RV vaccine with MenB vaccine increased from 0.7 % in 2016 to 46.85 % in 2020. Children receiving RV/MenB vaccines concomitantly had a significantly higher chance of completing the RV schedule compared to those receiving RVV alone during a specific appointment (94.78 % vs 72.26 %, Prevalence Ratio -PR- 1.275, 95 %CI 1.245-1.295p < 0.00001). The positive driving effect of RV/MenB co-administration was more evident for children receiving pentavalent (PR 1.288) than monovalent RVV (PR 1.115) which was confirmed when adjusted for confounding variables (i.e., year of vaccination, local district, gender). CONCLUSIONS Although still far from the target, RVV coverage has increased in recent years in Campania Region. Co-administration with MenB vaccine may aid in increasing RVV coverage, especially for pentavalent RVV. Further safety data are needed to support co-administration as a key tool to increase coverage.
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Affiliation(s)
- Andrea Lo Vecchio
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy.
| | - Sara Maria Scarano
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Margherita Del Bene
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Ugo Trama
- Drug Policy and Devices Unit, Regione Campania Health Department, Naples, Italy
| | - Giuseppina Affinito
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pietro Buono
- Department of Maternal and Child Health, General Directorate for Health, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences - Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Le Saux N, Bettinger J, Shulha HP, Sadarangani M, Coyle D, Booth TF, Jadavji T, Halperin SA. The success of publicly funded rotavirus vaccine programs for preventing community- and hospital-acquired rotavirus infections in Canadian pediatric hospitals: an observational study. CMAJ Open 2023; 11:E1156-E1163. [PMID: 38114258 PMCID: PMC10743644 DOI: 10.9778/cmajo.20220245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Canadian immunization programs for rotavirus started in 2011. We sought to determine their effect on the burden of community-acquired admissions and hospital-acquired rotavirus at pediatric hospitals. METHODS The Canadian Immunization Monitoring Program Active (IMPACT) network conducted active surveillance for rotavirus-positive hospital admissions between 2005 and 2020 at 12 pediatric hospitals. We used yearly rates of community-acquired rotavirus per 10 000 admissions and hospital-acquired rotavirus infections per 1000 patient-days to determine changes in the pre- and post-vaccine program periods. RESULTS During the 15-year study period, 5691 rotavirus hospital admissions and hospital-acquired infections were detected, including 4323 (76%) community-acquired infections and 1368 (24%) hospital-acquired infections. The average community-acquired rate in the pre-vaccine period was 60.3 (95% confidence interval [CI] 53.7-68.3) per 10 000 admissions, with a decline to 11.0 (95% CI 7.5-15.1) per 10 000 admissions in the post-vaccine period, resulting in an average reduction of 81.7% (95% CI 74.4%-87.8%). The rate of hospital-acquired rotavirus declined from 0.35 (95% CI 0.29-0.41) per 1000 patient-days in the pre-vaccine period to 0.05 (95% CI 0.03-0.07) per 1000 patient-days in the post-vaccine period, resulting in an 85.3% (95% CI 77.7%-91.9%) average decline. Herd protection was present among children aged 2-16 years. INTERPRETATION Although start dates of rotavirus vaccine programs across provinces varied, there was around an 80% average decrease in both community-acquired and hospital-acquired rotavirus infections at pediatric hospitals in Canada in the 1- to 9-year interval after implementation of rotavirus vaccine programs. Herd protection is an important aspect of rotavirus vaccines for other children who are not vaccine eligible, and rotavirus vaccines continue to provide important benefits both for children and health care systems.
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Affiliation(s)
- Nicole Le Saux
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Julie Bettinger
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Hennady P Shulha
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Doug Coyle
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Timothy F Booth
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Taj Jadavji
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS
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Cunha DCD, Fuller T, Cantelli CP, de Moraes MTB, Leite JPG, Carvalho-Costa FA, Brasil P. Circulation of Vaccine-derived Rotavirus G1P[8] in a Vulnerable Child Cohort in Rio de Janeiro. Pediatr Infect Dis J 2023; 42:247-251. [PMID: 36730107 DOI: 10.1097/inf.0000000000003784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The expansion of rotavirus (RV) immunization in several countries reduced the burden of acute diarrheal disease (ADD) and diarrhea-associated mortality. Although community transmission of live attenuated monovalent rotavirus vaccine (G1P[8] RV1) virus has been demonstrated in children and household contacts, fecal shedding of these strains in neonates and infants under six weeks of age has never been demonstrated. The objective of the study was to assess ADD and rotavirus vaccine strain shedding before and after immunization through 24 months of age. METHODS This was a prospective cohort study in a low-resource community in which stool samples were collected from neonates from 15 to 45 days of age every 2 weeks, after both doses of G1P[8] RV1, and in subsequent ADD episodes until 2 years of age. RV was detected and genotyped in stool samples by RT-PCR. RESULTS We enrolled 242 participants who were followed for an average of 23 months. The specific prevalence of G1P[8] RV1 virus was 3.3% in neonates and infants less than six weeks of age, 50% after the first dose, and 25.6% after the second dose. Among the 70 participants with ADD, G1P[8] RV1 virus was identified in only one participant (1.4% prevalence). CONCLUSIONS In vaccinated children, there were no breakthrough infections with G1P[8] RV1 and ADD was rare supporting high vaccine effectiveness. We observed G1P[8] RV1 virus shedding among neonates and infants before the first vaccine dose, providing evidence of transmission of the vaccine strain from immunized children to those who are not yet vaccinated.
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Affiliation(s)
- Denise Cotrim da Cunha
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Trevon Fuller
- Institute of the Environment and Sustainability, University of California, Los Angeles, Los Angeles, California
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carina Pacheco Cantelli
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - José Paulo Gagliardi Leite
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Filipe Anibal Carvalho-Costa
- Laboratory of Epidemiology and Molecular Systematics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patricia Brasil
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Marti SG, Gibbons L, Reidel S, Stupka J, Degiuseppe J, Argento F, Gómez JA. Rotavirus Vaccine Impact since Its Introduction in the National Immunization Program of Argentina. Infect Dis Ther 2023; 12:513-526. [PMID: 36520328 PMCID: PMC9925648 DOI: 10.1007/s40121-022-00709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Rotavirus (RV) is the most common cause of childhood diarrhea. Argentina introduced RV vaccination in the National Immunization Program in January 2015. This study evaluates the impact of RV vaccine implementation on the burden of acute diarrheal disease (ADD) and RV positive cases, and hospitalizations among children in Argentina. METHODS A counterfactual time-series analysis was performed. Data on ADD (2013-2018) and RV diarrhea (2012-2018) cases in children aged < 5 years were collected from the National Healthcare Surveillance System (clinical and laboratory data). Data on hospital discharges following ADD and RV diarrhea (2011-2017) were retrieved from the Health Statistics and Information Office. All data were classified by the age groups < 1 year, < 2 years, 2-5 years. Vaccine impact was defined as the difference between the predicted time trend (simulated using 2012-2014 data) and the actual post-vaccination data (2015-2018). RESULTS A significant reduction of 22.1% of notified ADD cases and 15.4% of hospital discharges following ADD among children < 2 years was observed in the 3 years after RV vaccine implementation. Data also showed a significant decline of 54.0% and 59.4% of notified RV cases in children < 2 and < 1 years, respectively, and a reduction of 39.3% and 40.8% in RV hospital discharges for the same age groups. CONCLUSION This study shows a significant reduction in notified ADD cases and RV cases and hospital discharges following ADD and RV cases in children < 2 years after RV vaccine introduction in Argentina in 2015.
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Affiliation(s)
| | - Luz Gibbons
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Sara Reidel
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Juan Stupka
- Laboratorio Nacional de Referencia Para Rotavirus y Norovirus, INEI-ANLIS, Dr. Carlos G. Malbran, ANLIS, Buenos Aires, Argentina
| | - Juan Degiuseppe
- Laboratorio Nacional de Referencia Para Rotavirus y Norovirus, INEI-ANLIS, Dr. Carlos G. Malbran, ANLIS, Buenos Aires, Argentina
| | - Fernando Argento
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Rudakova AV, Kharit SM, Rychkova SV, Lobzin YV. Сost-effectiveness of pentavalent rotavirus vaccination in the Russian Federation. jour 2023. [DOI: 10.22625/2072-6732-2022-14-5-69-77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
One of the main causes of acute gastroenteritis in children under 5 years of age is rotavirus infection (RVI). Vaccines against RVI significantly reduce the incidence. Aim. To evaluate the cost-effectiveness of mass vaccination of children with a 5-valent RVI vaccine in the Russian Federation. Materials and methods. The assessment was carried out using modeling based on published data on the effectiveness of the vaccine and epidemiological indicators in the Russian Federation. The analysis was carried out from the perspective of the health care system and society as a whole with a 5-year horizon. The cost of RVI therapy corresponded to the compulsory health insurance tariffs for St. Petersburg for 2022, the price of 1 dose of the vaccine was the registered price, including VAT. Costs and life expectancy, taking into account quality, were discounted at 3.5 % per year. Results. Given the assumptions made, routine vaccination will prevent an average of 468,637 cases of RVI over 5 years. Avoided direct medical costs, i. e. RVI treatment costs will amount to 53,4 %, and lost income due to temporary disability – 46,6 % of the total avoided costs. At the same time, the volume of avoided costs is 61,4 % due to a decrease in morbidity in the vaccinated population, and 38.6 % due to the development of a indirect effect. The predicted avoided costs per 1 vaccinated person is 2,975 thousand rubles. From a societal perspective, the cost-effectiveness of the Rota-V-Aid vaccine will be 364,813 thousand rubles / QALY (quality-adjusted life year), and from a healthcare perspective – 1726,399 thousand rubles / QALY. Thus, in both cases, the cost-effectiveness of RVI vaccination will not exceed the generally accepted threshold of willingness to pay, equal to three times the gross domestic product per capita in the Russian Federation (according to data for 2021 – ~2,7 million rubles). The predicted cost-effectiveness of selective vaccination is significantly lower than that of mass vaccination. Conclusions. Mass vaccination of children with a 5-valent vaccine against RVI will not only reduce the incidence in the Russian Federation, but, taking into account the assumptions made, can also be considered as a cost-effective intervention.
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Affiliation(s)
- A. V. Rudakova
- Pediatric Research and Clinical Center for Infectious Diseases
| | - S. M. Kharit
- Pediatric Research and Clinical Center for Infectious Diseases
| | - S. V. Rychkova
- Pediatric Research and Clinical Center for Infectious Diseases
| | - Yu. V. Lobzin
- Pediatric Research and Clinical Center for Infectious Diseases
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Maffey L, Confalonieri V, Hasson E, Schweigmann N. City puzzles: Does urban land scape affect genetic population structure in Aedes aegypti? PLoS Negl Trop Dis 2022; 16:e0010549. [PMID: 35793338 PMCID: PMC9292108 DOI: 10.1371/journal.pntd.0010549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 07/18/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022] Open
Abstract
Cities usually offer a suitable environment for the dengue vector Aedes aegypti, providing oviposition sites, accessibility to human hosts and nectar meals. However, large urban centres are highly heterogeneous environments, forming a patched landscape that could affect Ae. aegypti population dynamics and dispersal. Here, we performed a genome-wide analysis using Rad-seq data from 99 Ae. aegypti specimens collected in three areas within Buenos Aires city with varying levels of urbanization/land use: highly urbanized Area 1, intermediate Area 2 and poorly urbanized Area 3. We found an inverse association between urbanization levels and spatial genetic structure. Populations from highly urbanized Area 1 did not present genetic structure whereas two and three clusters were detected in Areas 2 and 3, respectively. In the case of Area 3, initial analyses showed separation in clusters was mostly due to elevated consanguinity within sites although three clusters were still detected after closely related individuals were discarded. Mosquitoes around each site displayed a high degree of isolation, evidencing a close dependence between the vector and human dwellings. Interestingly, specimens from distant boroughs (within the limits of the city) and the city’s outskirts formed a single cluster with inner city sites (Area 1), highlighting the role of passive transport in shaping population structure. Genetic distances were poorly correlated with geographic distances in Buenos Aires, suggesting a stronger influence of passive than active dispersal on population structure. Only Area 2 displayed a significant isolation-by-distance pattern (p = 0.046), with males dispersing more than females (p = 0.004 and p = 0.016, respectively). Kinship analyses allowed us to detect full-siblings located 1.5 km apart in Area 1, which could be due to an extreme event of active female dispersal. Effective population size was higher in Area 2 confirming that cemeteries represent highly favourable environments for Ae. aegypti and need to be specifically targeted. Our results suggest that control programs should take into account urban landscape heterogeneity in order to improve vector control. Arboviral vector Aedes aegypti usually thrives in urban areas due to its close dependence of human dwellings on breeding sites and meals. However, urban landscapes are heterogeneous and present varying levels of urbanization and land use, affecting Ae. aegypti spatial structure and dispersal. We used nuclear Single Nucleotide Polymorphisms to analyze 99 Ae. aegypti specimens from three areas within the city of Buenos Aires: highly urbanized Area 1, intermediate urbanized Area 2 and poorly urbanized Area 3. We found an inverse association between urbanization levels and spatial genetic structure: mosquitoes from Area 1 did not present genetic structure. On the other hand, mosquitoes from Area 2 and 3 displayed 2 and 3 clusters, respectively. Human-mediated transport plays an important role in highly urbanized areas, connecting mosquito populations from distant locations. Potential active dispersal was detected in Area 1 where we found pairs of full-siblings located 1500m apart. In less urbanized areas, the distribution of breeding sites also affected spatial genetic structure. In Area 3, spatial structure was mostly due to consanguinity, but it also reflected the effect of urban landscape on Ae. aegypti population dynamics. Area 2 presented the highest effective population size. This could be partially explained by the advantageous conditions that cemeteries offer to vector populations which can also spill over surrounding neighbourhoods. Our results suggest that vector programs should consider the heterogeneity of urban landscapes to improve the effectiveness of control measures.
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Bencina G, Costantino C, Mameli C, Sabale U, Murtagh J, Newman R, Ahern A, Bhaila R, Sanchez AO, Martinon-Torres F, Carias C. Real-world impact of rotavirus vaccination in European healthcare settings: a systematic literature review. Expert Rev Vaccines 2022; 21:1121-1136. [PMID: 35708263 DOI: 10.1080/14760584.2022.2075851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rotavirus is one of the most common pathogens causing diarrhea in children <5 years and has a major impact on childhood morbidity and mortality. Since the implementation of rotavirus vaccines into childhood immunization programs across Europe, there has been a reduction in rotavirus burden, including hospitalizations, outpatient cases, costs, and deaths. AREAS COVERED A systematic literature review identified publications describing the clinical and economic impact of rotavirus vaccinations across Europe, from their introduction in 2006 to the end of 2020. A total of 3,137 articles were identified, of which 46 were included in the review. Included articles reported the impact of rotavirus vaccination on disease in any age group. EXPERT OPINION Rotavirus vaccination has resulted in substantial reductions in hospitalizations and rotavirus-associated costs across Europe, particularly in children <5 years. There is some evidence of herd protection afforded to older age groups where vaccine uptake is high among infants, highlighting the potential for vaccination to confer a greater societal benefit as programs become more established. Increasing vaccination coverage and continuing investment in widespread rotavirus vaccination programs across countries will likely increase the substantial public health benefits associated with vaccination and further reduce the clinical and economic burden of disease.
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Affiliation(s)
- Goran Bencina
- Center for Observational and Real-World Evidence (CORE), MSD, Madrid, Spain
| | - Claudio Costantino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Excellence Specialties "G. D'Alessandro," University of Palermo, Palermo, Italy.,Department of Science for Health Promotion and Mother Child Care, University of Palermo, Palermo, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Ugne Sabale
- Center for Observational and Real-World Evidence (CORE), MSD, Stockholm, Sweden
| | - Janice Murtagh
- Medical Affairs Vaccines, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | | | | | - Alejandro Orrico Sanchez
- Department of Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain
| | - Federico Martinon-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago, Santiago de Compostela, Spain.,Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Cristina Carias
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc, Kenilworth, NJ, USA
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Karakusevic A, Devaney P, Enstone A, Kanibir N, Hartwig S, Carias CDS. The burden of rotavirus-associated acute gastroenteritis in the elderly: assessment of the epidemiology in the context of universal childhood vaccination programs. Expert Rev Vaccines 2022; 21:929-940. [PMID: 35535677 DOI: 10.1080/14760584.2022.2066524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rotaviruses (RVs) cause acute gastroenteritis (AGE) in infants and young children worldwide and also in older adults (≥60 years), however the burden among this age group is not well understood. Herd immunity through pediatric RV vaccination may reduce the burden of RVGE across all ages, however the impact of pediatric vaccination on burden in older adults is poorly understood. AREAS COVERED This systematic review was undertaken to identify studies related to the following objectives: understand the burden of RV in older adults, RV seroprevalence, and the impact of pediatric vaccination on this burden and highlight evidence gaps to guide future research. Of studies identified, 59 studies from two databases were included in this analysis following a review by two reviewers. EXPERT OPINION RV is an understudied disease in older adults. We found that 0-62% of patients with AGE tested positive for RV, with results varying by setting, country, and patient age. Results also suggest that pediatric vaccination benefits older adults through herd protection. Several studies showed a reduction in RV incidence after vaccination. However, there was variety in results and lack of consistency in outcomes reported. Further studies targeting older adults are needed to better characterize RV burden.
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Affiliation(s)
| | | | | | - Nabi Kanibir
- Global Medical and Scientific Affairs, Msd International GmbH, Luzern, Switzerland
| | - Susanne Hartwig
- Biostatistical and Research Decision Sciences Epidemiology, MSD Vaccins, France
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Standaert B, Strens D, Raes M, Benninghoff B. Explaining the formation of a plateau in rotavirus vaccine impact on rotavirus hospitalisations in Belgium. Vaccine 2022; 40:1948-1957. [PMID: 35190208 DOI: 10.1016/j.vaccine.2022.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Observational data on the reduction in hospitalisations after rotavirus vaccine introduction in Belgium suggest that vaccine impact plateaued at an unexpectedly high residual hospitalisation rate. The objective of this analysis was to identify factors that influence real-world vaccine impact. METHODS Data were collected on hospitalisations in children aged ≤ 5 years with rotavirus disease from 11 hospitals since 2005 (the RotaBIS study). The universal rotavirus vaccination campaign started late in 2006. A mathematical model simulated rotavirus hospitalisations in different age groups using vaccine efficacy and herd effect, influenced by vaccine coverage, vaccine waning, and secondary infection sources. The model used optimisation analysis to fit the simulated curve to the observed data, applying Solver add-in software. It also simulated an 'ideal' vaccine introduction maximising hospitalisation reduction (maximum coverage, maximum herd effect, no waning), and compared this with the best-fit simulated curve. Modifying model input values identified factors with the largest impact on hospitalisations. RESULTS Compared with the 'ideal' simulation, observed data showed a slower decline in hospitalisations and levelled off after three years at a higher residual hospitalisation rate. The slower initial decline was explained by the herd effect in unvaccinated children. The higher residual hospitalisation rate was explained by starting the vaccine programme in November, near the rotavirus seasonal peak. This resulted in low accumulated vaccine coverage during the first rotavirus disease peak season, with the consequential appearance of secondary infection sources. This in turn reduced the herd effect, resulting in a diminished net impact. CONCLUSIONS Our results indicate that countries wishing to maximise the impact of rotavirus vaccination should start vaccinating well ahead of the rotavirus seasonal disease peak. This maximises herd effect during the first year leading to rapid and high reduction in hospitalisations. Secondary infection sources explain the observed data in Belgium better than vaccine waning.
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Verberk JDM, van Dongen JAP, van de Kassteele J, Andrews NJ, van Gaalen RD, Hahné SJM, Vennema H, Ramsay M, Braeckman T, Ladhani S, Thomas SL, Walker JL, de Melker HE, Fischer TK, Koch J, Bruijning-Verhagen P. Impact analysis of rotavirus vaccination in various geographic regions in Western Europe. Vaccine 2021; 39:6671-6681. [PMID: 34635375 DOI: 10.1016/j.vaccine.2021.09.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Universal mass vaccination (UMV) against rotavirus has been implemented in many but not all European countries. This study investigated the impact of UMV on rotavirus incidence trends by comparing European countries with UMV: Belgium, England/Wales and Germany versus countries without UMV: Denmark and the Netherlands. METHODS For this observational retrospective cohort study, time series data (2001-2016) on rotavirus detections, meteorological factors and population demographics were collected. For each country, several meteorological and population factors were investigated as possible predictors of rotavirus incidence. The final set of predictors were incorporated in negative binomial models accounting for seasonality and serial autocorrelation, and time-varying incidence rate ratios (IRR) were calculated for each age group and country separately. The overall vaccination impact two years after vaccine implementation was estimated by pooling the results using a random effects meta-analyses. Independent t-tests were used to compare annual epidemics in the pre-vaccination and post-vaccination era to explore any changes in the timing of rotavirus epidemics. RESULTS The population size and several meteorological factors were predictors for the rotavirus epidemiology. Overall, we estimated a 42% (95%-CI 23;56%) reduction in rotavirus incidence attributable to UMV. Strongest reductions were observed for age-groups 0-, 1- and 2-years (IRR 0.47, 0.48 and 0.63, respectively). No herd effect induced by UMV in neighbouring countries was observed. In all UMV countries, the start and/or stop and corresponding peak of the rotavirus season was delayed by 4-7 weeks. CONCLUSIONS The introduction of rotavirus UMV resulted in an overall reduction of 42% in rotavirus incidence in Western European countries two years after vaccine introduction and caused a change in seasonal pattern. No herd effect induced by UMV neighbouring countries was observed for Denmark and the Netherlands.
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Affiliation(s)
- J D M Verberk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - J A P van Dongen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J van de Kassteele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - N J Andrews
- Statistics, Modelling, and Economics Department, Public Health England (PHE), London, United Kingdom
| | - R D van Gaalen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - S J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H Vennema
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - M Ramsay
- Statistics, Modelling, and Economics Department, Public Health England (PHE), London, United Kingdom
| | - T Braeckman
- Formerly at Service Epidemiology of Infectious Diseases, Department Public Health and Surveillance, Sciensano Institute, Brussels, Belgium
| | - S Ladhani
- Immunisation Department, Public Health England (PHE), London, United Kingdom
| | - S L Thomas
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - J L Walker
- Immunisation Department, Public Health England (PHE), London, United Kingdom; Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
| | - H E de Melker
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - T K Fischer
- Virology Surveillance and Research, Department of Virology and Special Microbiology Diagnostics Statens Serum Institut (SSI), Copenhagen, Denmark and University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - J Koch
- Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - P Bruijning-Verhagen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
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11
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Aziz AB, Zaman K, Kim DR, Park JY, Im J, Ali M, Ahmmed F, Islam MT, Khanam F, Chowdhury F, Ahmed T, Hoque M, Liu X, Pak GD, Tadesse BT, Jeon HJ, Kang S, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD. Re-evaluation of population-level protection conferred by a rotavirus vaccine using the 'fried-egg' approach in a rural setting in Bangladesh. Vaccine 2021; 39:5876-82. [PMID: 34454788 DOI: 10.1016/j.vaccine.2021.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/29/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022]
Abstract
The “fried-egg” analytic approach was applied to a cluster randomized trial (CRT). Overall analysis failed to reveal rotavirus vaccine (RV) herd protection. Same approach unmasked herd protection of other enteric vaccines failed for RV.
Background Vaccine herd protection assessed in a cluster-randomized trial (CRT) may be masked by disease transmission into the cluster from outside. However, herd effects can be unmasked using a ‘fried-egg’ approach whereby the analysis, restricted to the innermost households of clusters, ‘yolk’, creates an insulating ‘egg-white’ periphery. This approach has been demonstrated to unmask vaccine herd protection in reanalyses of cholera and typhoid vaccine CRTs. We applied this approach to an earlier CRT in Bangladesh of rotavirus vaccine (RV) whose overall analysis had failed to detect herd protection. Herein we present the results of this analysis. Methods In the study area, infants in 142 villages were randomized to receive two doses of RV with routine EPI vaccines (RV villages) or only EPI vaccines (non-RV villages). We analyzed RV protection against acute rotavirus diarrhoea for the entire cluster (P100) and P75, P50, P25 clusters, representing 75%, 50% and 25% of the innermost households for each cluster, respectively. Results During 2 years of follow-up, there was evidence of 27% overall (95 %CI: 7, 43) and 42% total protection (95 %CI: 23, 56) in the P100 cluster, but it did not increase when moved in smaller yolks. There was no evidence of indirect vaccine protection in the yolks at any cluster size. Conclusion Our reanalysis of the CRT using the fried- egg approach did not detect RV herd protection. Whether these findings reflect a true inability of the RV to confer herd protection in this setting, or are due to limitations of the approach, requires further study.
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12
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Frenkel LD. The global burden of vaccine-preventable infectious diseases in children less than 5 years of age: Implications for COVID-19 vaccination. How can we do better? Allergy Asthma Proc 2021; 42:378-385. [PMID: 34474707 DOI: 10.2500/aap.2021.42.210065] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Infectious diseases are a leading cause of morbidity and mortality worldwide. As of 2018, the total world population of children < 5 years of age was roughly estimated at 679 million. Of these children, an estimated 5.3 million died of all causes in 2018, with an estimated 700,000 who died of vaccine-preventable infectious diseases; 99% of the children who died had lived in low- and middle-income countries. The infectious diseases that remain major causes of mortality for which vaccines have been shown to provide proven preventive success include, in order of prevalence, are those caused by Streptococcus pneumoniae, Rotavirus, Bordetella pertussis, measles virus, Haemophilus influenzae type b and influenza virus. Objective: The purpose of the present report was to address the global burden of these six vaccine-preventable infectious diseases in children < 5 years of age, together with implications for the prevention of coronavirus disease 2019 (COVID-19) infection in children. Methods: The current immunization strategies for the prevention of the six vaccine-preventable infectious diseases in children are reviewed as a framework for new strategies of vaccine prevention of COVID-19 in children. Results: The burden of addressing vaccine prevention of future infectious disease in children can be effectively pursued through knowledge gained from past experiences with vaccine usage in these six vaccine-preventable childhood infectious diseases. Conclusion: Issues with regard to the burden of disease mortality, disease transmission, and available vaccines as well as vaccine successes and shortcomings for specific pathogens can serve as important landmarks for effective use of future vaccines. Although much success has been made globally in preventing these childhood deaths, much remains to be done.
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13
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Kristinsdottir I, Haraldsson A, Löve A, Asgeirsdottir TL, Thors V. Burden of rotavirus disease in young children in Iceland - Time to vaccinate? Vaccine 2021; 39:5422-7. [PMID: 34384634 DOI: 10.1016/j.vaccine.2021.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/22/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Acute gastroenteritis poses a significant burden on young children, families, health care facilities and societies. Rotavirus is the most common pathogen, but rotavirus infections are vaccine preventable. Information on the epidemiology of gastroenteritis in Icelandic children has until now not been available and rotavirus vaccination is currently not offered to Icelandic infants. The objective of this study was to assess the burden of rotavirus acute gastroenteritis in young children in Iceland and determine the potential benefit of adding rotavirus vaccine to the Icelandic childhood immunization schedule. METHODS For a two-year period, children < 6 years old attending a children's emergency department for acute gastroenteritis were recruited at the Children's Hospital in Reykjavík, Iceland. Demographic information and Vesikari scores were registered. Stool samples were analyzed for pathogens. Duration of symptoms, treatment given, and secondary household infections were among the collected information. Annual cost of the infections in young children was estimated based on health care expenditures and lost days of parental work. RESULTS 325 children were included in the study, 75% of which were ≤ 24 months old. A pathogen was identified in 80% of cases, of which rotavirus was identified in 54%. Rotavirus caused a more severe disease than other pathogens, more often leading to fluid treatment in the emergency department and admissions. Median duration of rotavirus-illness was six days and caused a median of four days lost from work by parents. The estimated annual cost of rotavirus acute gastroenteritis was €2.9 million. CONCLUSIONS Rotavirus causes significant disease burden in young children. Although rarely life-threatening in high income countries, the costs for society are substantial. The inclusion of rotavirus vaccine in the national immunization schedule will reduce the disease burden and would be cost-saving in Iceland.
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Arakaki L, Tollefson D, Kharono B, Drain PK. Prevalence of rotavirus among older children and adults with diarrhea: A systematic review and meta-analysis. Vaccine 2021; 39:4577-4590. [PMID: 34244008 DOI: 10.1016/j.vaccine.2021.06.073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older children and adults are susceptible to rotavirus, but the extent to which rotavirus affects this population is not fully understood, hindering accuracy of global rotavirus estimations. OBJECTIVE To determine what proportion of diarrhea cases are due to rotavirus among persons ≥ 5 years old and to estimate this proportion by age strata. METHODS We conducted a systematic review and meta-analysis using the PRISMA guidelines. We included studies that reported on conditional rotavirus prevalence (i.e., percent of diarrhea due to rotavirus) in persons ≥ 5 years old who were symptomatic with diarrhea/gastroenteritis and had laboratory confirmation for rotavirus infection. Studies on nosocomial infections and outbreak investigations were excluded. We collected age group-specific conditional rotavirus prevalence and other variables, such as study geography, study setting, and study type. We calculated pooled conditional rotavirus prevalence, corresponding 95% confidence intervals (95% CI), heterogeneity (I2) estimates, and prediction intervals (PI). RESULTS Sixty-six studies from 32 countries met the inclusion criteria. Conditional rotavirus prevalence ranged from 0% to 30% across the studies. The total pooled prevalence of rotavirus among persons ≥ 5 years old with diarrhea was 7.6% (95% CI: 6.2-9.2%, I2 = 99.6%, PI: 0-24%). The pooled prevalence of rotavirus among older children and adolescents was 8.7% (95% CI: 6.2-11.7%, I2 = 96%, PI:0-27%), among younger adults was 5.4% (95% CI: 1.4-11.8%, I2 = 96%, PI:0-31%), and among older adults was 4.7% (95% CI: 2.8-7.0%, I2 = 96%, PI:0-16%). Pooled conditional rotavirus prevalences did not differ by other variables. CONCLUSION In this systematic review and meta-analysis of rotavirus among persons ≥ 5 years old with diarrhea, we found relatively low pooled conditional rotavirus prevalence compared to what is typically reported for children < 5 years; however, results should be interpreted with caution as the wide prediction intervals suggest large heterogeneity.
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Affiliation(s)
- Lola Arakaki
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Epidemiology, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Deanna Tollefson
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Brenda Kharono
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Paul K Drain
- University of Washington, Strategic Analysis, Research, and Training (START) Center, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Global Health, 3980 15th Ave NE, Seattle, WA 98195, United States; University of Washington, Department of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States.
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15
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Inns T, Fleming KM, Iturriza-Gomara M, Hungerford D. Paediatric rotavirus vaccination, coeliac disease and type 1 diabetes in children: a population-based cohort study. BMC Med 2021; 19:147. [PMID: 34183004 PMCID: PMC8240289 DOI: 10.1186/s12916-021-02017-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/26/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Rotavirus infection has been proposed as a risk factor for coeliac disease (CD) and type 1 diabetes (T1D). The UK introduced infant rotavirus vaccination in 2013. We have previously shown that rotavirus vaccination can have beneficial off-target effects on syndromes, such as hospitalised seizures. We therefore investigated whether rotavirus vaccination prevents CD and T1D in the UK. METHODS A cohort study of children born between 2010 and 2015 was conducted using primary care records from the Clinical Practice Research Datalink. Children were followed up from 6 months to 7 years old, with censoring for outcome, death or leaving the practice. CD was defined as diagnosis of CD or the prescription of gluten-free goods. T1D was defined as a T1D diagnosis. The exposure was rotavirus vaccination, defined as one or more doses. Mixed-effects Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Models were adjusted for potential confounders and included random intercepts for general practices. RESULTS There were 880,629 children in the cohort (48.8% female). A total of 343,113 (39.0%) participants received rotavirus vaccine; among those born after the introduction of rotavirus vaccination, 93.4% were vaccinated. Study participants contributed 4,388,355 person-years, with median follow-up 5.66 person-years. There were 1657 CD cases, an incidence of 38.0 cases per 100,000 person-years. Compared with unvaccinated children, the adjusted HR for a CD was 1.05 (95% CI 0.86-1.28) for vaccinated children. Females had a 40% higher hazard than males. T1D was recorded for 733 participants, an incidence of 17.1 cases per 100,000 person-years. In adjusted analysis, rotavirus vaccination was not associated with risk of T1D (HR = 0.89, 95% CI 0.68-1.19). CONCLUSIONS Rotavirus vaccination has reduced diarrhoeal disease morbidity and mortality substantial since licencing in 2006. Our finding from this large cohort study did not provide evidence that rotavirus vaccination prevents CD or T1D, nor is it associated with increased risk, delivering further evidence of rotavirus vaccine safety.
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Affiliation(s)
- Thomas Inns
- St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, UK
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
| | - Kate M Fleming
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gomara
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
- Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland
| | - Daniel Hungerford
- NIHR HPRU in Gastrointestinal Infections at University of Liverpool, Liverpool, UK.
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK.
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, The Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK.
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16
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Gower CM, Stowe J, Andrews NJ, Dunning J, Ramsay ME, Ladhani SN. Sustained declines in age group-specific rotavirus infection and acute gastroenteritis in vaccinated and unvaccinated individuals during the five years since Rotavirus vaccine introduction in England. Clin Infect Dis 2021; 74:437-445. [PMID: 34043765 DOI: 10.1093/cid/ciab460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The introduction of an oral live-attenuated monovalent rotavirus vaccine (Rotarix ®) into the UK infant immunisation programme in July 2013 was associated with large reductions in laboratory-confirmed rotavirus infections and hospitalisations due to acute gastroenteritis (AGE) within 12 months. Here we report the five-year impact of the programme in England. METHODS Individuals with laboratory-confirmed rotavirus infections during 2000-2018 and all-cause hospitalisations for AGE during 2007-2018 were identified using national electronic records. Age-specific incidence rate ratios (IRR) and estimated numbers of cases averted in each of the five post-vaccination years were calculated. RESULTS There were 206,389 laboratory-confirmed rotavirus infections and 3,657,651 hospitalisations for all-cause AGE. Reductions of 69-83% in laboratory-confirmed rotavirus infections in all age groups and 77-88% in infants aged <1 year in each of the five post-vaccine years are reported, with 11,386-11,633 cases averted annually. All-cause AGE hospitalisations were reduced by 12-35% across all age-groups and by 25-48% in <1 year-olds in the five post-vaccine years, with 24,474-49,278 hospitalisations averted annually. There was strong evidence of indirect (herd) protection, with at least 50% and up to 80% of the non-specific end point of all-cause gastroenteritis (AGE) hospitalisations averted being in unvaccinated age-groups, primarily older adults. Seasonal changes include a possible shift from annual to biennial peaks with lower peak incidence and longer seasons. CONCLUSIONS There were large and sustained declines in both laboratory-confirmed rotavirus infections and AGE hospitalisations across all age groups in each of the five years since the introduction of the UK rotavirus programme.
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Affiliation(s)
- Charlotte M Gower
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Julia Stowe
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jake Dunning
- Tuberculosis; Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections; and Travel and Migrant Health Division (TARGET), National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Mary E Ramsay
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Shamez N Ladhani
- Immunisation and Counter-Measures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.,Paediatric Infectious Disease Research Group St. George's University of London, Cranmer Terrace, London SW17 ORE, UK
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Burnett E, Parashar UD, Tate JE. Global Impact of Rotavirus Vaccination on Diarrhea Hospitalizations and Deaths Among Children <5 Years Old: 2006-2019. J Infect Dis 2021; 222:1731-1739. [PMID: 32095831 DOI: 10.1093/infdis/jiaa081] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Since 2006, more than 100 countries have introduced rotavirus vaccine into their immunization programs. We reviewed published data on relative reductions of rotavirus hospitalizations, acute gastroenteritis (AGE) hospitalizations, and AGE deaths among children <5 years old. METHODS Articles published from January 1, 2006 to December 31, 2019 with at least 12 months of data before and after rotavirus vaccine introduction were included. Relative reductions were abstracted into a standardized form. Descriptive statistics are presented as medians and interquartile ranges (IQRs). RESULTS We reviewed 1827 total records and included 105 articles from 49 countries. Among children <5 years old, there was a median reduction of 59% (IQR, 46-74) in rotavirus hospitalizations, 36% (IQR, 23-47) in AGE hospitalizations, and 36% (IQR, 28-46) AGE mortality. Reductions were larger in countries with low child mortality, among younger age groups, and in countries with higher coverage. The median percentage of specimens that tested positive for rotavirus among children <5 years old hospitalized for diarrhea was 40% (IQR, 28-45) before rotavirus vaccine introduction and 20% (IQR, 20-20) 4 years after introduction. CONCLUSIONS Overall, we found sustained impact on rotavirus and AGE hospitalizations and deaths. These results should encourage countries still considering rotavirus vaccine implementation.
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Affiliation(s)
- Eleanor Burnett
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Luangasanatip N, Mahikul W, Poovorawan K, Cooper BS, Lubell Y, White LJ, Teerawattananon Y, Pan-Ngum W. Cost-effectiveness and budget impact analyses for the prioritisation of the four available rotavirus vaccines in the national immunisation programme in Thailand. Vaccine 2021; 39:1402-1414. [PMID: 33531197 DOI: 10.1016/j.vaccine.2021.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rotavirus is a major cause of diarrhoea in children less than five years old in Thailand. Vaccination has been shown to be an effective intervention to prevent rotavirus infections but has yet to be enlisted in the national immunisation programme. This study aimed to assess the cost-utility of introducing rotavirus vaccines, taking all WHO-prequalified vaccines into consideration. METHODS A cost-utility analysis was performed using a transmission dynamic model to estimate, from a societal perspective, the costs and outcomes of four WHO-prequalified rotavirus vaccines: Rotarix®, RotaTeq®, ROTAVAC® and ROTASIIL®. The model was used to simulate the impact of introducing the vaccines among children aged < 1 year and compare this with no rotavirus vaccination. The vaccination programme was considered to be cost-effective if the incremental cost-effectiveness ratio was less than a threshold of USD 5,110 per QALY gained. RESULTS Overall, without the vaccine, the model predicted the average annual incidence of rotavirus to be 312,118 cases. With rotavirus vaccination at a coverage of more than 95%, the average number of rotavirus cases averted was estimated to be 144,299 per year. All rotavirus vaccines were cost-saving. ROTASIIL® was the most cost-saving option, followed by ROTAVAC®, Rotarix® and RotaTeq®, providing average cost-savings of USD 32, 31, 23 and 22 million per year, respectively, with 999 QALYs gained. All vaccines remained cost-saving with lower QALYs gained, even when ignoring indirect beneficial effects. The net saving to the healthcare system when implementing any one of these vaccines would be between USD 13 and 33 million per year. CONCLUSION Rotavirus vaccines should be included in the national vaccination programme in Thailand. Implementing any one of these four WHO-prequalified vaccines would reduce government healthcare spending while yielding health benefits to the population.
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Affiliation(s)
| | - Wiriya Mahikul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kittiyod Poovorawan
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Lisa J White
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand; National Health Foundation, Thailand; Saw Swee Hock School of Public Health (SSHSPH), National University of Singapore (NUS), Singapore
| | - Wirichada Pan-Ngum
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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19
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Standaert B, Strens D, Pereira P, Benninghoff B, Raes M. Lessons Learned from Long-Term Assessment of Rotavirus Vaccination in a High-Income Country: The Case of the Rotavirus Vaccine Belgium Impact Study (RotaBIS). Infect Dis Ther 2020; 9:967-980. [PMID: 33025558 PMCID: PMC7680470 DOI: 10.1007/s40121-020-00345-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The rotavirus (RV) vaccine Belgium Impact Study (RotaBIS) evaluated the vaccine effect on RV-related hospital care in children up to 5 years old over a period of 13 years. Different forces were identified that influence the reduction in hospital care. Our analysis aims to report on the current RotaBIS dataset and explore through model simulation whether, how, and when the results could have been improved. METHODS As performed in previous assessments, this analysis evaluated RV-related events per year, per age group, RV nosocomial infections, hospitalization duration, and herd effect. It subsequently identified results that were surprising or unexpected. To know whether those data could have been improved through specific interventions, we developed a model with the forces acting on the disease transmission and the vaccine effect on RV-related hospital care. Scenario analysis of the forces should explain the current findings and identify ways to optimize the results. RESULTS The RotaBIS data show that annual RV-related hospital cases (n = 1345 pre-vaccination) dropped by 70% (95% confidence interval [CI] 66-74%) by year 5 (n = 395) after vaccine introduction, and by 84% (95% CI 79-89%) by year 10 (n = 217). The herd effect during the first year was limited to 14% extra gain. During the last 5 years, small disease increases were seen biennially. The simulation model indicates that higher vaccine coverage of the major transmitters during the peak season of the first year of vaccination could have reduced RV-related hospital care by nearly 90% at 5 and 10 years after vaccine introduction owing to a higher herd effect. The smaller peaks observed in recent years would have been dramatically reduced. CONCLUSION The current RotaBIS data show a maintained reduction, around 76%, in RV hospitalization cases. Simulations show that these results could have been improved to an important extent with a more optimal initiation of the vaccination program. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01563146 and NCT01563159.
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Affiliation(s)
| | | | | | | | - Marc Raes
- Pediatrics, Jessa Ziekenhuis, Hasselt, Belgium
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20
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Azor-Martinez E, Garcia-Fernandez L, Strizzi JM, Cantarero-Vallejo MD, Jimenez-Lorente CP, Balaguer-Martinez JV, Torres-Alegre P, Yui-Hifume R, Sanchez-Forte M, Gimenez-Sanchez F. Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial. Am J Infect Control 2020; 48:1315-1321. [PMID: 32303373 DOI: 10.1016/j.ajic.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
We aimed to assess the effectiveness of an educational and hand hygiene program in daycare centers (DCCs) and homes on acute gastroenteritis (AGE) incidence in children attending DCCs. METHODS A randomized, controlled, and open study of 911 children aged 0-3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up was employed. Two intervention groups of DCCs families performed educational and hand hygiene measures, 1 with soap and water (soap and water group; n = 274), another with hand sanitizer (hand sanitizer group [HSG]; n = 339), and the control group (CG; n = 298) followed usual handwashing procedures. We compared AGE episode rates with Poisson regression model. RESULTS seven hundred fourteen AGE episodes were registered, significant differences between HSG and CG children were found during December and January. A multivariate model was applied and the adjusted incidence rate ratios by rotavirus vaccination found significant differences when children were previously vaccinated, the children in the soap and water group had a higher risk of AGE episodes (incidence rate ratio: 1.28, 95% confidence interval:1.0-1.64), compared with those in the HSG. CONCLUSIONS This study demonstrated that hand hygiene programs that included hand sanitizer were most effective in the winter months. Further, the largest reduction of AGE episodes occurred in the children that followed hand hygiene programs including hand sanitizer and educational measures for DCC staff, parents, and children, and were vaccinated for rotavirus.
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21
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Celma CC, Beard S, Douglas A, Wong S, Osafo NK, Hannah M, Hale A, Huggins G, Ladhani S, Dunning J. Retrospective analysis on confirmation rates for referred positive rotavirus samples in England, 2016 to 2017: implications for diagnosis and surveillance. ACTA ACUST UNITED AC 2020; 25. [PMID: 33124554 PMCID: PMC7596921 DOI: 10.2807/1560-7917.es.2020.25.43.1900375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Rapid diagnostic tests are commonly used by hospital laboratories in England to detect rotavirus (RV), and results are used to inform clinical management and support national surveillance of the infant rotavirus immunisation programme since 2013. In 2017, the Public Health England (PHE) national reference laboratory for enteric viruses observed that the presence of RV could not be confirmed by PCR in a proportion of RV-positive samples referred for confirmatory detection. Aim We aimed to compare the positivity rate of detection methods used by hospital laboratories with the PHE confirmatory test rate. Methods Rotavirus specimens testing positive at local hospital laboratories were re-tested at the PHE national reference laboratory using a PCR test. Confirmatory results were compared to original results from the PHE laboratory information management system. Results Hospital laboratories screened 70.1% (2,608/3,721) of RV samples using immunochromatographic assay (IC) or rapid tests, 15.5% (578/3,721) using enzyme immunoassays (EIA) and 14.4% (535/3,721) using PCR. Overall, 1,011/3,721 (27.2%) locally RV-positive samples referred to PHE in 2016 and 2017 failed RV detection using the PHE reference laboratory PCR test. Confirmation rates were 66.9% (1,746/2,608) for the IC tests, 87.4% (505/578) for the EIA and 86.4% (465/535) for the PCR assays. Seasonal confirmation rate discrepancies were also evident for IC tests. Conclusions This report highlights high false positive rates with the most commonly used RV screening tests and emphasises the importance of implementing verified confirmatory tests for RV detections. This has implications for clinical diagnosis and national surveillance.
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Affiliation(s)
- Cristina C Celma
- These authors contributed equally to this work.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Stuart Beard
- These authors contributed equally to this work.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Amy Douglas
- Gastrointestinal Pathogens Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Shan Wong
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Nana-Kwame Osafo
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Matthew Hannah
- High Containment Microbiology, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Ashleigh Hale
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Gabrielle Huggins
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisations and Countermeasures, National Infection Service, Public Health England, London, United Kingdom
| | - Jake Dunning
- Gastrointestinal Pathogens Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
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22
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Hughes HE, Elliot AJ, Hughes TC, Hungerford D, Morbey RA, Smith GE, Vivancos R, O'Brien SJ. Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study. PLoS One 2020; 15:e0240021. [PMID: 33031389 DOI: 10.1371/journal.pone.0240021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022] Open
Abstract
Background Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. Methods This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011—June 2013) and 3 years post (July 2013—June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. Results During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0–4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3–10% of ED visits per week. Conclusions ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.
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23
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Morbey RA, Elliot AJ, Smith GE, Charlett A. Adapting Syndromic Surveillance Baselines After Public Health Interventions. Public Health Rep 2020; 135:737-745. [PMID: 33026959 DOI: 10.1177/0033354920959080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Public health surveillance requires historical baselines to identify unusual activity. However, these baselines require adjustment after public health interventions. We describe an example of such an adjustment after the introduction of rotavirus vaccine in England in July 2013. METHODS We retrospectively measured the magnitude of differences between baselines and observed counts (residuals) before and after the introduction of a public health intervention, the introduction of a rotavirus vaccine in July 2013. We considered gastroenteritis, diarrhea, and vomiting to be indicators for national syndromic surveillance, including telephone calls to a telehealth system, emergency department visits, and unscheduled consultations with general practitioners. The start of the preintervention period varied depending on the availability of surveillance data: June 2005 for telehealth, November 2009 for emergency departments, and July 2010 for general practitioner data. The postintervention period was July 2013 to the second quarter of 2016. We then determined whether baselines incorporating a step-change reduction or a change in seasonality resulted in more accurate models of activity. RESULTS Residuals in the unadjusted baseline models increased by 42%-198% from preintervention to postintervention. Increases in residuals for vomiting indicators were 19%-44% higher than for diarrhea. Both step-change and seasonality adjustments improved the surveillance models; we found the greatest reduction in residuals in seasonally adjusted models (4%-75%). CONCLUSION Our results demonstrated the importance of adjusting surveillance baselines after public health interventions, particularly accounting for changes in seasonality. Adjusted baselines produced more representative expected values than did unadjusted baselines, resulting in fewer false alarms and a greater likelihood of detecting public health threats.
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Affiliation(s)
- Roger Antony Morbey
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Alex James Elliot
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Gillian Elizabeth Smith
- 371011 Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - Andre Charlett
- 371011 Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
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24
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Pereira P, Vetter V, Standaert B, Benninghoff B. Fifteen years of experience with the oral live-attenuated human rotavirus vaccine: reflections on lessons learned. Expert Rev Vaccines 2020; 19:755-769. [PMID: 32729747 DOI: 10.1080/14760584.2020.1800459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Rotavirus (RV) disease remains a prominent cause of disease burden in children <5 years of age worldwide. However, implementation of RV vaccination has led to significant reductions in RV mortality, compared to the pre-vaccination era. This review presents 15 years of real-world experience with the oral live-attenuated human RV vaccine (HRV; Rotarix). HRV is currently introduced in ≥80 national immunization programs (NIPs), as 2 doses starting from 6 weeks of age. AREAS COVERED The clinical development of HRV and post-marketing experience indicating the impact of HRV vaccination on RV disease was reviewed. EXPERT OPINION In clinical trials, HRV displayed an acceptable safety profile and efficacy against RV-gastroenteritis, providing broad protection against heterotypic RV strains by reducing the consequences of severe RV disease in infants. Real-world evidence shows substantial, rapid reduction in the number of RV infections and associated hospitalizations following introduction of HRV in NIPs, regardless of economic setting. Indirect effects against RV disease are also observed, such as herd protection, decrease in nosocomial infections incidence, and a reduction of disease-related societal/healthcare costs. However, not all countries have implemented RV vaccination. Coverage remains suboptimal and should be improved to maximize the benefits of RV vaccination.
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25
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Bibera GL, Chen J, Pereira P, Benninghoff B. Dynamics of G2P[4] strain evolution and rotavirus vaccination: A review of evidence for Rotarix. Vaccine 2020; 38:5591-600. [PMID: 32651115 DOI: 10.1016/j.vaccine.2020.06.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/27/2022]
Abstract
Rotavirus (RV) gastroenteritis is a vaccine-preventable disease that creates high medical and economic burden in both developed and developing countries. Worldwide, more than 100 countries have introduced RV vaccines in their national immunization programs, and the remarkable impact of reducing the burden of severe childhood gastroenteritis has been unequivocally demonstrated. Currently, 2 oral vaccines (Rotarix, GSK and RotaTeq, Merck) are widely utilized. Recent temporary increases in the relative prevalence of G2P[4] RV strains have been observed in countries implementing RV vaccination. This comprehensive literature review aims to provide an insight on RV genotype evolution in the context of mass vaccination with Rotarix, particularly in the case of G2P[4]. In the post-vaccine era, strain surveillance data indicated temporal and spatial changes in countries both with and without RV vaccination programs. Annual fluctuations in G2P[4] prevalence seem to occur naturally, with no substantial differences between countries using Rotarix, RotaTeq or mixed vaccination programs. Moreover, Rotarix has been shown to be efficacious and effective against gastroenteritis caused by non-vaccine strains, including G2P[4]. These data indicate that shifts in RV genotype distribution are likely to constitute an inherent process of virus evolution to infect the human gut. Following RV vaccine introduction, incidences of RV gastroenteritis declined dramatically and mass vaccination will likely maintain this status, despite possible fluctuations in the relative distribution of genotypes. There is no conclusive evidence of unusual burst of new or vaccine-escape strains since global RV vaccines use. The emergence of strains with a potential to increase the current burden of RV disease should be continuously monitored and can only be established by exhaustive characterization of strains, including whole genomic sequencing. Given the natural fluctuations in RV strains over time, caution is advised when interpreting temporal changes in RV strain dynamics, as they could mistakenly be attributed to vaccination.
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Tessier E, Campbell H, Ribeiro S, Fry NK, Brown C, Stowe J, Andrews N, Ramsay M, Amirthalingam G. Impact of extending the timing of maternal pertussis vaccination on hospitalized infant pertussis in England, 2014 - 2018. Clin Infect Dis 2020; 73:e2502-e2508. [PMID: 32569365 PMCID: PMC8563224 DOI: 10.1093/cid/ciaa836] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In October 2012 a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20-32 weeks to improve vaccine coverage and protect preterm infants.This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases. METHODS Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre-policy change and post policy change. Data were linked to laboratory-confirmed cases and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis undertaken to assess multiple factors. RESULTS A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations amongst full-term infants was 60 cases pre-policy and 62 cases post policy, respectively while preterm cases declined from 20 to 9 (p=0.06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0- 4 weeks (median of 3 more days than infants 5-8 weeks), premature infants (median of 4 more days than term infants) and cases with coinfections (median of 1 more day than those without coinfection). CONCLUSIONS The number of preterm infants hospitalized with pertussis in England halved after the policy change and preterm infants were no longer over-represented amongst hospitalized cases.
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Affiliation(s)
- Elise Tessier
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Norman K Fry
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Colin Brown
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
| | - Julia Stowe
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
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27
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Gower CM, Dunning J, Nawaz S, Allen D, Ramsay ME, Ladhani S. Vaccine-derived rotavirus strains in infants in England. Arch Dis Child 2020; 105:553-557. [PMID: 31871043 DOI: 10.1136/archdischild-2019-317428] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe infants with acute gastroenteritis symptoms in primary and secondary care who have the Rotarix vaccine-derived G1P[8] rotavirus strain identified in their stools. DESIGN This is a prospective national surveillance conducted by Public Health England (PHE). Rotavirus-positive samples from vaccine-eligible children are routinely submitted to PHE for confirmation, and general practitioners are requested to complete a surveillance questionnaire for all cases. The modified Vesikari Score was used to assess severity of gastroenteritis. SETTING England, July 2013-September 2016. RESULTS 2637 rotavirus strains were genotyped and 215 (8%) identified as the Rotarix vaccine-derived G1P[8] strain. There were no Rotarix vaccine-derived G1P[8] strains detected in unimmunised infants. Rotarix vaccine-derived G1P[8] strains clustered around the time of rotavirus vaccination and were responsible for 82% (107 of 130) of rotavirus-positive samples in 2-month-old infants and 68% (36 of 53) in 3-month-old infants. However, 13 samples were obtained more than 7 weeks after the last vaccination date; 10 of these specimens were from six children who were subsequently diagnosed with severe combined immunodeficiency (SCID). Diarrhoea was the single most common presenting symptom (83.0%) in infants with Rotarix vaccine-derived G1P[8] strains, who were less likely to present with fever, vomiting, dehydration or severe gastroenteritis than infants with wild-type rotavirus infection. CONCLUSIONS Rotavirus identified in stools of infants around the time of their routine immunisations is most likely the Rotarix vaccine-derived G1P[8] strain. Infants with undiagnosed SCID at the time of rotavirus immunisation may experience prolonged gastroenteritis symptoms. Most infants with vaccine strains in their stools more than 7 weeks after immunisation had SCID.
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Affiliation(s)
- Charlotte Mary Gower
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Jake Dunning
- Tuberculosis; Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections; and Travel and Migrant Health Division (TARGET), National Infection Service, Public Health England, London, UK.,Enteric Virus Unit, Virus Reference Department, National Infection Service Laboratories, Public Health England, London, UK
| | - Sameena Nawaz
- Enteric Virus Unit, Virus Reference Department, National Infection Service Laboratories, Public Health England, London, UK
| | - David Allen
- Enteric Virus Unit, Virus Reference Department, National Infection Service Laboratories, Public Health England, London, UK.,Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Elizabeth Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK .,Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
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28
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Arlegui H, Nachbaur G, Praet N, Bégaud B. Quantitative Benefit-Risk Models Used for Rotavirus Vaccination: A Systematic Review. Open Forum Infect Dis 2020; 7:ofaa087. [PMID: 32296726 PMCID: PMC7148003 DOI: 10.1093/ofid/ofaa087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Although rotavirus vaccines have proven to prevent the risk of rotavirus gastroenteritis (RVGE) in children under 5 years old, they are also associated with an increased transient risk of intussusception (IS). Several quantitative benefit-risk models (qBRm) are performed to measure this balance in hospitalizations and deaths prevented versus the ones induced. Method In this study, our objective was to provide a complete overview of qBRm used for rotavirus vaccination. We systematically searched 3 medical literature databases to identify relevant articles, in English, that were published between 2006 and 2019. Results Of the 276 publications screened, 14 studies using qBRm for rotavirus vaccination were retained, based on preselected criteria. Four were performed in low- and middle-income countries. Almost all (13 of 14) displayed the following characteristics: force of infection assumed to be constant over time (static model), indirect effect of rotavirus vaccination (herd effect) not considered, closed model (individuals not allowed to enter and/or exit the model over time), and aggregated level (no tracking of individual's behavior). Most of the models were probabilistic (9 of 14) and reported sensitivity and/or scenario analyses (12 of 14). Input parameter values varied across studies. Selected studies suggest that, depending on the models used, for every IS hospitalization and death induced, vaccination would prevent, respectively, 190-1624 and 71-743 RVGE-related hospitalizations and deaths. Conclusions The benefits of rotavirus vaccination were shown to largely exceed the increased risk of IS, across all studies. Future research aiming to harmonize qBRm for rotavirus vaccination should ensure the comparability of studies and provide additional information for regulatory authorities, physicians, and patients.
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Affiliation(s)
- Hugo Arlegui
- INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Bordeaux, France.,Pharmaco-Epidemiology and Health Outcomes Research, GSK, Rueil-Malmaison, France
| | - Gaëlle Nachbaur
- Pharmaco-Epidemiology and Health Outcomes Research, GSK, Rueil-Malmaison, France
| | - Nicolas Praet
- Clinical Research and Development, GSK, Wavre, Belgium
| | - Bernard Bégaud
- INSERM, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Bordeaux, France
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29
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Markkula J, Hemming-harlo M, Savolainen-kopra C, al-Hello H, Vesikari T. Continuing rotavirus circulation in children and adults despite high coverage rotavirus vaccination in Finland. J Infect 2020; 80:76-83. [DOI: 10.1016/j.jinf.2019.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/26/2019] [Indexed: 12/31/2022]
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30
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Hungerford DJ, French N, Iturriza-Gómara M, Read JM, Cunliffe NA, Vivancos R. Reduction in hospitalisations for acute gastroenteritis-associated childhood seizures since introduction of rotavirus vaccination: a time-series and change-point analysis of hospital admissions in England. J Epidemiol Community Health 2019; 73:1020-1025. [PMID: 31511311 PMCID: PMC6877709 DOI: 10.1136/jech-2019-213055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 01/17/2023]
Abstract
Introduction The incidence of severe childhood diarrhoea has fallen substantially following the introduction of rotavirus vaccine in the UK in July 2013. Since children with rotavirus infection may experience febrile and afebrile seizures, we evaluated the impact of rotavirus vaccination on seizure hospitalisations in children in England. Methods Using data from Hospital Episode Statistics, we employed interrupted time-series analyses to assess changes in monthly hospital admissions for seizures among children aged <5 years from July 2000 to June 2017. Outcome measures comprised all seizures and febrile seizures, with and without a co-diagnosis of acute gastroenteritis (AGE). Models were adjusted for pneumococcal conjugate vaccine (PCV) introduction. Change-point analysis was used to independently identify step-changes in the time-series. Results Among hospitalised children aged <5 years, the incidence of any seizures and febrile seizures with AGE decreased post-vaccine introduction by 23% (95% CI: 11% to 33%) and 31% (95% CI: 19% to 41%), respectively. For febrile seizures with AGE, a single change-point was identified in July 2013 (95% CI: June 2013 to December 2013). Reductions in seizure incidence were higher during the rotavirus season (49%, 95% CI: 37% to 58%) compared with out-of-season (13%, 95% CI: −4 to 28%) and showed no relation to PCV introduction. There were small reductions in any seizures with any co-diagnosis (4%, 95% CI: 0% to 8%) and in febrile seizures with any co-diagnosis (10%, 95% CI: 2% to 16%). Conclusion Rotavirus vaccination has reduced hospitalisations for seizures associated with AGE in England, providing additional evidence of population-level impact of rotavirus vaccination on seizure incidence in high-income countries.
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Affiliation(s)
- Daniel James Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
| | - Neil French
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Centre for Health Informatics, Computing and Statistics, Lancaster University, Faculty of Health and Medicine, Lancaster, UK
| | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
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Moreno-Pérez D, Álvarez García FJ, Álvarez Aldeán J, Cilleruelo Ortega MJ, Garcés Sánchez M, García Sánchez N, Hernández Merino Á, Méndez Hernández M, Merino Moína M, Montesdeoca Melián A, Ruiz-Contreras J; en representación del Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP). [Immunisation schedule of the Spanish Association of Paediatrics: 2019 recommendations]. An Pediatr (Barc) 2019; 90:56.e1-9. [PMID: 30609975 DOI: 10.1016/j.anpedi.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] 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. As regards funded immunisations, the 2+1 strategy (2, 4, 11 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, with 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 2-dose scheme should be used for MMR (12 months and 3-4 years) and varicella (15 months and 3-4 years). MMRV vaccine could be applied as the second dose. Vaccination against HPV is recommended in both genders, preferably at 12 years of age. A stronger effort should be made to improve vaccination coverage. The new 9-valent vaccine is now available, expanding the coverage for both genders. Tetravalent meningococcal vaccine (MenACWY) is recommended at 12 months and 12-14 years, with a catch-up up at 19 years of age. It is also recommended in infants older than 6 weeks of age with risk factors, or travellers to countries with high incidence of ACWY meningococcal serogroups. As regards non-funded immunisations, it is recommended meningococcal B vaccination, with a 2+1 schedule, and requests that it be included in the National Immunisation Program. Vaccination against rotavirus is recommended in all infants.
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Kobayashi M, Miyazaki M, Ogawa A, Tatsumi M. Sustained reduction in rotavirus-coded hospitalizations in children aged <5 years after introduction of self-financed rotavirus vaccines in Japan. Hum Vaccin Immunother 2019; 16:132-137. [PMID: 31298962 PMCID: PMC7012068 DOI: 10.1080/21645515.2019.1638204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This is an extension of our previous study, which evaluated the incidence of seasonal rotavirus gastroenteritis (RVGE) hospitalizations in children aged <5 years from 2009 to 2015 in Japan. Here, we evaluated the incidence of RVGE hospitalizations in children aged <10 years during the rotavirus season (January‒June) from 2009 to 2017 in Japan, before and after the monovalent and pentavalent rotavirus vaccines were introduced in November 2011 and July 2012, using the same health insurance claims database and study methods. In children aged <5 years, the incidence of RVGE hospitalizations greatly declined in 2014 after vaccine introduction, consistent with our previous findings, and the decline was sustained until 2017. However, in children aged ≥5‒<10 years, no apparent trend for a continuous decline in RVGE hospitalizations was observed during the study period. Improved RV vaccination coverage may lead to a further reduction in severe RVGE in Japan.
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Affiliation(s)
| | - Makoto Miyazaki
- Risk Assessment & Pharmacoepidemiology, MSD K.K., Tokyo, Japan
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Hallowell BD, Parashar UD, Curns A, DeGroote NP, Tate JE. Trends in the Laboratory Detection of Rotavirus Before and After Implementation of Routine Rotavirus Vaccination - United States, 2000-2018. MMWR Morb Mortal Wkly Rep 2019; 68:539-543. [PMID: 31220058 PMCID: PMC6586368 DOI: 10.15585/mmwr.mm6824a2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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34
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Martinón-Torres F, Bosch X, Rappuoli R, Ladhani S, Redondo E, Vesikari T, García-Sastre A, Rivero-Calle I, Gómez-Rial J, Salas A, Martín C, Finn A, Butler R. TIPICO IX: report of the 9 th interactive infectious disease workshop on infectious diseases and vaccines. Hum Vaccin Immunother 2019; 15:2405-2415. [PMID: 31158041 PMCID: PMC6816368 DOI: 10.1080/21645515.2019.1609823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Ninth Interactive Infectious Disease workshop TIPICO was held on November 22–23, 2018, in Santiago de Compostela, Spain. This 2-day academic experience addressed current and topical issues in the field of infectious diseases and vaccination. Summary findings of the meeting include: cervical cancer elimination will be possible in the future, thanks to the implementation of global vaccination action plans in combination with appropriate screening interventions. The introduction of appropriate immunization programs is key to maintain the success of current effective vaccines such as those against meningococcal disease or rotavirus infection. Additionally, reduced dose schedules might improve the efficiency of some vaccines (i.e., PCV13). New vaccines to improve current preventive alternatives are under development (e.g., against tuberculosis or influenza virus), while others to protect against infectious diseases with no current available vaccines (e.g., enterovirus, parechovirus and flaviviruses) need to be developed. Vaccinomics will be fundamental in this process, while infectomics will allow the application of precision medicine. Further research is also required to understand the impact of heterologous vaccine effects. Finally, vaccination requires education at all levels (individuals, community, healthcare professionals) to ensure its success by helping to overcome major barriers such as vaccine hesitancy and false contraindications.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme (e-oncología), Catalan Institute of Oncology, L'Hospitalet de Llobregat , Barcelona , Spain.,Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Rino Rappuoli
- R&D Centre, GlaxoSmithKline , Siena , Italy.,Department of Medicine, Imperial College London , London , UK
| | - Shamez Ladhani
- Immunisation Department, Public Health England , London , UK
| | - Esther Redondo
- International Vaccination Center of Madrid , Madrid , Spain.,Grupo de Actividades Preventivas y Salud Pública SEMERGEN , Madrid , Spain
| | - Timo Vesikari
- Faculty of Medicine and Life Sciences, Vaccine Research Center, University of Tampere , Tampere , Finland
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Irene Rivero-Calle
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - José Gómez-Rial
- Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - Antonio Salas
- Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain.,Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, of the Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago (SERGAS) , Galicia , Spain
| | - Carlos Martín
- Faculty of Medicine, Microbiology Department, University of Zaragoza , Zaragoza , Spain.,CIBER of Respiratory Diseases, Instituto de Salud Carlos III , Madrid , Spain
| | - Adam Finn
- Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine and Population Health Sciences, University of Bristol , Bristol , UK
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Affiliation(s)
- Gordon L Nichols
- Climate Change Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot OX11 0RQ, UK.
| | - Giovanni Lo Iacono
- School of Veterinary Medicine, Department of Veterinary Epidemiology and Public Health, University of Surrey, Surrey, UK
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Heinsbroek E, Hungerford D, Cooke RPD, Chowdhury M, Cargill JS, Bar-Zeev N, French N, Theodorou E, Standaert B, Cunliffe NA. Do hospital pressures change following rotavirus vaccine introduction? A retrospective database analysis in a large paediatric hospital in the UK. BMJ Open 2019; 9:e027739. [PMID: 31097487 PMCID: PMC6530452 DOI: 10.1136/bmjopen-2018-027739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Hospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated changes in 'hospital pressures' (demand on healthcare resources and staff) following rotavirus vaccine introduction in a paediatric setting in the UK. DESIGN Retrospective hospital database analysis between July 2007 and June 2015. SETTING A large paediatric hospital providing primary, secondary and tertiary care in Merseyside, UK. PARTICIPANTS Hospital admissions aged <15 years. Outcomes were calculated for four different patient groups identified through diagnosis coding (International Classification of Disease, 10th edition) and/or laboratory confirmation: all admissions; any infection, acute gastroenteritis and RVGE. METHODS Hospital pressures were compared before and after rotavirus vaccine introduction: these included bed occupancy, hospital-acquired infection rate, unplanned readmission rate and outlier rate (medical patients admitted to surgical wards due to lack of medical beds). Interrupted time-series analysis was used to evaluate changes in bed occupancy. RESULTS There were 116 871 admissions during the study period. Lower bed occupancy in the rotavirus season in the postvaccination period was observed for RVGE (-89%, 95% CI 73% to 95%), acute gastroenteritis (-63%, 95% CI 39% to 78%) and any infection (-23%, 95% CI 15% to 31%). No significant overall reduction in bed occupancy was observed (-4%, 95% CI -1% to 9%). No changes were observed for the other outcomes. CONCLUSIONS Rotavirus vaccine introduction was not associated with reduced hospital pressures. A reduction in RVGE hospitalisation without change in overall bed occupancy suggests that beds available were used for a different patient population, possibly reflecting a previously unmet need. TRIALS REGISTRATION NUMBER NCT03271593.
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Affiliation(s)
- Ellen Heinsbroek
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
| | - Daniel Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- Field Service-North West, National Infection Service, Public Health England, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - Richard P D Cooke
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Margaret Chowdhury
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - James S Cargill
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neil French
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, UK
| | | | | | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, members of Liverpool Health Partners, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
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Hungerford D, Allen DJ, Nawaz S, Collins S, Ladhani S, Vivancos R, Iturriza-Gómara M. Impact of rotavirus vaccination on rotavirus genotype distribution and diversity in England, September 2006 to August 2016. Euro Surveill 2019; 24:1700774. [PMID: 30755297 PMCID: PMC6373066 DOI: 10.2807/1560-7917.es.2019.24.6.1700774] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionRotavirus vaccination with the live-attenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. Since then, there have been significant reductions in rotavirus gastroenteritis incidence.AimWe assessed the vaccine's impact on rotavirus genotype distribution and diversity 3 years post-vaccine introduction.MethodsEpidemiological and microbiological data on genotyped rotavirus-positive samples between September 2006 and August 2016 were supplied by EuroRotaNet and Public Health England. Multinomial multivariable logistic regression adjusting for year, season and age was used to quantify changes in genotype prevalence in the vaccine period. Genotype diversity was measured using the Shannon's index (H') and Simpson's index of diversity (D).ResultsWe analysed genotypes from 8,044 faecal samples. In the pre-vaccine era, G1P[8] was most prevalent, ranging from 39% (411/1,057) to 74% (527/709) per year. In the vaccine era, G1P[8] prevalence declined each season (35%, 231/654; 12%, 154/1,257; 5%, 34/726) and genotype diversity increased significantly in 6-59 months old children (H' p < 0.001: D p < 0.001). In multinomial analysis, G2P[4] (adjusted multinomial odds ratio (aMOR): 9.51; 95% confidence interval (CI): 7.02-12.90), G3P[8] (aMOR: 2.83; 95% CI: 2.17-3.81), G12P[8] (aMOR: 2.46; 95% CI: 1.62-3.73) and G4P[8] (aMOR: 1.42; 95% CI: 1.02-1.96) significantly increased relative to G1P[8].ConclusionsIn the context of reduced rotavirus disease incidence, genotype diversity has increased, with a relative change in the dominant genotype from G1P[8] to G2P[4] after vaccine introduction. These changes will need continued surveillance as the number and age of vaccinated birth cohorts increase in the future.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - David J Allen
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sameena Nawaz
- Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Collins
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom,NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
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Walker JL, Andrews NJ, Atchison CJ, Collins S, Allen DJ, Ramsay ME, Ladhani SN, Thomas SL. Effectiveness of oral rotavirus vaccination in England against rotavirus-confirmed and all-cause acute gastroenteritis. Vaccine X 2019; 1:100005. [PMID: 31384727 PMCID: PMC6668223 DOI: 10.1016/j.jvacx.2019.100005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022] Open
Abstract
Rotarix® had very good vaccine effectiveness (VE) in UK public health use. Two-dose VE against confirmed infection in young children was 77% (95%CI:66–85%) The vaccine programme was exceptionally successful (>90% vaccine uptake, high VE) Thus, it is highly likely that most acute gastroenteritis (AGE) was no longer due to rotavirus. This explains the lack of demonstrable VE against all-cause AGE.
Background The monovalent oral rotavirus vaccine Rotarix® was introduced into the UK infant immunisation programme in 2013. We estimated vaccine effectiveness (VE) in the first two years of the programme. Methods We used a test-negative case-control design and enhanced national surveillance data for 1869 vaccine-eligible children tested for rotavirus infection to obtain adjusted odds ratios and VE against laboratory-confirmed rotavirus infections. Linked anonymised UK primary care and hospitalisation data from the Clinical Practice Research Datalink (40,723 children) and random-effects Poisson regression were used in a cohort study to estimate VE against all-cause acute gastroenteritis (AGE) and AGE hospitalisations. Results VE against laboratory-confirmed infection was 69% (95% Confidence Interval: 40–84%) for one dose and 77% (95%CI: 66–85%) for two doses. Two-dose VE in children aged <12 months and ≥12 months was 85% (95%CI: 74–91%) and 54% (95%CI: 15–75%), respectively. In contrast, we found no evidence that the vaccine was effective against all-cause AGE (VE = −20%, 95%CI: −36% to −5%), or against AGE hospitalisations (VE = 35%, 95% CI: −86% to 77%). Conclusions In this first detailed assessment of VE of the Rotarix® vaccine in the English national programme, we show that Rotarix® was highly effective in preventing laboratory-confirmed rotavirus infection in young children. This provides reassurance about the vaccine’s performance in real-life settings and gives key information for future cost-effectiveness analyses. The high VE against rotavirus-specific AGE, and the exceptionally successful implementation of the national rotavirus vaccine programme (with >90% vaccine coverage), explains the lack of VE against all-cause AGE because most AGE in the post-vaccine era would not have been due to rotavirus, although some underestimation of VE could also have occurred due to differential healthcare utilisation by vaccinated and unvaccinated infants. This highlights the importance of using specific vaccine-preventable endpoints for these scenarios.
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Affiliation(s)
- Jemma L Walker
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.,Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Christina J Atchison
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sarah Collins
- Immunisation and Countermeasures, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - David J Allen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Shamez N Ladhani
- Immunisation and Countermeasures, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Sara L Thomas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Moreno-Pérez D, Álvarez García FJ, Álvarez Aldeán J, Cilleruelo Ortega MJ, Garcés Sánchez M, García Sánchez N, Hernández Merino Á, Méndez Hernández M, Merino Moína M, Montesdeoca Melián A, Ruiz-Contreras J. Immunisation schedule of the Spanish Association of Paediatrics: 2019 recommendations. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Adams NL, Rose TC, Elliot AJ, Smith G, Morbey R, Loveridge P, Lewis J, Studdard G, Violato M, O'Brien SJ, Whitehead M, Taylor-Robinson DC, Hawker JI, Barr B. Social patterning of telephone health-advice for diarrhoea and vomiting: analysis of 24 million telehealth calls in England. J Infect 2018; 78:95-100. [PMID: 30267800 PMCID: PMC6428660 DOI: 10.1016/j.jinf.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Gastrointestinal (GI) infections are common and most people do not see a physician. There is conflicting evidence of the impact of socioeconomic status (SES) on risk of GI infections. We assessed the relationship between SES and GI calls to two National Health Service (NHS) telephone advice services in England. METHODS Over 24 million calls to NHS Direct (2010-13) and NHS 111 (2013-15) were extracted from Public Health England (PHE) syndromic surveillance systems. The relationship between SES and GI calls was assessed using generalised linear models (GLM). RESULTS Adjusting for rurality and age-sex interactions, in NHS Direct, children in disadvantaged areas were at lower risk of GI calls; in NHS 111 there was a higher risk of GI calls in disadvantaged areas for all ages (0-4 years RR 1.27, 95% CI 1.25-1.29; 5-9 years RR 1.43, 95% CI 1.36-1.51; 10-14 years RR 1.36, 95% CI 1.26-1.41; 15-19 years RR 1.59, 95% CI 1.52-1.67; 20-59 years RR 1.50, 95% CI 1.47-1.53, 60 years and over RR 1.12, 95% CI 1.09-1.14). CONCLUSIONS Disadvantaged areas had higher risk of GI calls in NHS 111. This may relate to differences in exposure or vulnerability to GI infections, or propensity to call about GI infections.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK; National Infection Service, Public Health England, London, UK.
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Paul Loveridge
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, UK
| | - James Lewis
- Emergency Response Department, Science and Technology, Health Protection Directorate, Public Health England, Porton Down, Salisbury, UK
| | - Gareth Studdard
- NHS England, West Midlands Integrated Urgent Care, Birmingham, UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
| | - Jeremy I Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; National Infection Service, Field Service, Public Health England, Birmingham, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK; Department of Public Health and Policy, University of Liverpool, UK
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Bruijning-Verhagen P, van Dongen JAP, Verberk JDM, Pijnacker R, van Gaalen RD, Klinkenberg D, de Melker HE, Mangen MJJ. Updated cost-effectiveness and risk-benefit analysis of two infant rotavirus vaccination strategies in a high-income, low-endemic setting. BMC Med 2018; 16:168. [PMID: 30196794 PMCID: PMC6130096 DOI: 10.1186/s12916-018-1134-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Since 2013, a biennial rotavirus pattern has emerged in the Netherlands with alternating high and low endemic years and a nearly 50% reduction in rotavirus hospitalization rates overall, while infant rotavirus vaccination has remained below 1% throughout. As the rotavirus vaccination cost-effectiveness and risk-benefit ratio in high-income settings is highly influenced by the total rotavirus disease burden, we re-evaluated two infant vaccination strategies, taking into account this recent change in rotavirus epidemiology. METHODS We used updated rotavirus disease burden estimates derived from (active) surveillance to evaluate (1) a targeted strategy with selective vaccination of infants with medical risk conditions (prematurity, low birth weight, or congenital conditions) and (2) universal vaccination including all infants. In addition, we added herd protection as well as vaccine-induced intussusception risk to our previous cost-effectiveness model. An age- and risk-group structured, discrete-time event, stochastic multi-cohort model of the Dutch pediatric population was used to estimate the costs and effects of each vaccination strategy. RESULTS The targeted vaccination was cost-saving under all scenarios tested from both the healthcare payer and societal perspective at rotavirus vaccine market prices (€135/child). The cost-effectiveness ratio for universal vaccination was €51,277 at the assumed vaccine price of €75/child, using a societal perspective and 3% discount rates. Universal vaccination became cost-neutral at €32/child. At an assumed vaccine-induced intussusception rate of 1/50,000, an estimated 1707 hospitalizations and 21 fatal rotavirus cases were averted by targeted vaccination per vaccine-induced intussusception case. Applying universal vaccination, an additional 571 hospitalizations and < 1 additional rotavirus death were averted in healthy children per vaccine-induced intussusception case. CONCLUSION While universal infant rotavirus vaccination results in the highest reductions in the population burden of rotavirus, targeted vaccination should be considered as a cost-saving alternative with a favorable risk-benefit ratio for high-income settings where universal implementation is unfeasible because of budget restrictions, low rotavirus endemicity, and/or public acceptance.
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Affiliation(s)
- P Bruijning-Verhagen
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands. .,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - J A P van Dongen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J D M Verberk
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - R Pijnacker
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - R D van Gaalen
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - D Klinkenberg
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - H E de Melker
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - M-J J Mangen
- Department of Epidemiology and Surveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Doll MK, Quach C, Buckeridge DL. Evaluation of the Impact of a Rotavirus Vaccine Program on Pediatric Acute Gastroenteritis Hospitalizations: Estimating the Overall Effect Attributable to the Program as a Whole and as a Per-Unit Change in Rotavirus Vaccine Coverage. Am J Epidemiol 2018; 187:2029-2037. [PMID: 29757352 DOI: 10.1093/aje/kwy097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 04/25/2018] [Indexed: 12/29/2022] Open
Abstract
Estimation of the overall effect of a vaccine program is essential, but the effect is typically estimated for a whole program. We estimated the overall effect of the Quebec rotavirus vaccine program, launched in November 2011, and the effect for each 10% increase in rotavirus vaccine coverage on pediatric hospitalizations for all-cause acute gastroenteritis. We implemented negative binomial regressions adjusted for seasonality, long-term trends, and infection dynamics, to estimate the effect of the vaccine program as: 1) a dichotomous variable, representing program presence/absence, and linear term to account for changes in trend in the period after the program began; and 2) a continuous variable, representing rotavirus vaccine coverage. Using exposure 1, the vaccine program was associated with a 51.2% (95% confidence interval (CI): 28.5, 66.7) relative decline in adjusted weekly hospitalization rates for all-cause acute gastroenteritis as of December 28, 2014. Using exposure 2, a 10% increase in rotavirus ≥1-dose coverage was associated with a 7.1% (95% CI: 3.5, 10.5) relative decline in adjusted weekly rates, with maximum coverage of 87.0% associated with a 47.2% (95% CI: 26.9, 61.9) relative decline. Estimation of the overall effect attributable to a change in vaccine coverage might be a useful addition to standard measurement of the overall effect.
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Affiliation(s)
- Margaret K Doll
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Caroline Quach
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Quebec, Canada
- Infection Control and Prevention Unit, Division of Pediatric Infectious Diseases and Medical Microbiology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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de Lusignan S, Konstantara E, Joy M, Sherlock J, Hoang U, Coyle R, Ferreira F, Jones S, O’Brien SJ. Incidence of household transmission of acute gastroenteritis (AGE) in a primary care sentinel network (1992-2017): cross-sectional and retrospective cohort study protocol. BMJ Open 2018; 8:e022524. [PMID: 30139907 PMCID: PMC6112382 DOI: 10.1136/bmjopen-2018-022524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Acute gastroenteritis (AGE) is a highly transmissible condition. Determining characteristics of household transmission will facilitate development of prevention strategies and reduce the burden of this disease.We are carrying out this study to describe household transmission of medically attended AGE, and explore whether there is an increased incidence in households with young children. METHODS AND ANALYSIS This study used the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network, comprising data from 1 750 167 registered patients (August 2017 database). We conducted a novel analysis using a 'household key', to identify patients within the same household (n=811 027, mean 2.16 people). A 25-year repeated cross-sectional study will explore the incidence of medically attended AGE overall and then a 5-year retrospective cohort study will describe household transmission of AGE. The cross-sectional study will include clinical data for a 25-year period-1 January 1992 until the 31 December 2017. We will describe the incidence of AGE by age-band and gender, and trends in incidence. The 5-year study will use Poisson and quasi-Poisson regression to identify characteristics of individuals and households to predict medically attended AGE transmitted in the household. This will include whether the household contained a child under 5 years and the age category of the first index case (whether adult or child under 5 years). If there is overdispersion and zero-inflation we will compare results with negative binomial to handle these issues. ETHICS AND DISSEMINATION All RCGP RSC data are pseudonymised at the point of data extraction. No personally identifiable data are required for this investigation. The protocol follows STrengthening the Reporting of OBservational studies in Epidemiology guidelines (STROBE). The study results will be published in a peer-review journal, the dataset will be available to other researchers.
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Affiliation(s)
- Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
| | | | - Mark Joy
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Julian Sherlock
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Uy Hoang
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Rachel Coyle
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Filipa Ferreira
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon Jones
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Center for Healthcare Innovation and Delivery Science, Department of Population Health, NYU School of Medicine, New York City, New York, USA
| | - Sarah J O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
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Bollaerts K, De Smedt T, Donegan K, Titievsky L, Bauchau V. Benefit-Risk Monitoring of Vaccines Using an Interactive Dashboard: A Methodological Proposal from the ADVANCE Project. Drug Saf 2018; 41:775-786. [PMID: 29582392 PMCID: PMC6061437 DOI: 10.1007/s40264-018-0658-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION New vaccines are launched based on their benefit-risk (B/R) profile anticipated from clinical development. Proactive post-marketing surveillance is necessary to assess whether the vaccination uptake and the B/R profile are as expected and, ultimately, whether further public health or regulatory actions are needed. There are several, typically not integrated, facets of post-marketing vaccine surveillance: the surveillance of vaccination coverage, vaccine safety, effectiveness and impact. OBJECTIVE With this work, we aim to assess the feasibility and added value of using an interactive dashboard as a potential methodology for near real-time monitoring of vaccine coverage and pre-specified health benefits and risks of vaccines. METHODS We developed a web application with an interactive dashboard for B/R monitoring. The dashboard is demonstrated using simulated electronic healthcare record data mimicking the introduction of rotavirus vaccination in the UK. The interactive dashboard allows end users to select certain parameters, including expected vaccine effectiveness, age groups, and time periods and allows calculation of the incremental net health benefit (INHB) as well as the incremental benefit-risk ratio (IBRR) for different sets of preference weights. We assessed the potential added value of the dashboard by user testing amongst a range of stakeholders experienced in the post-marketing monitoring of vaccines. RESULTS The dashboard was successfully implemented and demonstrated. The feedback from the potential end users was generally positive, although reluctance to using composite B/R measures was expressed. CONCLUSION The use of interactive dashboards for B/R monitoring is promising and received support from various stakeholders. In future research, the use of such an interactive dashboard will be further tested with real-life data as opposed to simulated data.
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Affiliation(s)
- Kaatje Bollaerts
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III laan 1, 3001, Leuven, Belgium.
| | - Tom De Smedt
- P95 Pharmacovigilance and Epidemiology Services, Koning Leopold III laan 1, 3001, Leuven, Belgium
| | - Katherine Donegan
- Medicines and Healthcare products Regulatory Agency, Buckingham Palace Road 151, London, SW1W 9SZ, United Kingdom
| | - Lina Titievsky
- Worldwide Research and Development, Pfizer Inc, East 42nd St 235, New York City, NY 10017, NY, USA
| | - Vincent Bauchau
- GlaxoSmithKline Vaccines, Avenue Fleming 20, 1300, Wavre, Belgium
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Biggart R, Finn A, Marlow R. Lack of impact of rotavirus vaccination on childhood seizure hospitalizations in England - An interrupted time series analysis. Vaccine 2018; 36:4589-4592. [PMID: 29937243 DOI: 10.1016/j.vaccine.2018.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
Abstract
Observational studies have linked a reduction in childhood seizures (CS) to the introduction of rotavirus vaccination (RV). England is opportunely placed to explore this due to well-defined introduction, high uptake of RV and centralised Hospital Episodes Statistics recording all admissions. We investigated the association between seizures and vaccine use through interrupted time-series analysis of all CS admissions in children <3 years old (ICD-10 codes; G40∗-G41∗, R56.0∗) during 2007-2017. We did not detect a statistically significant association between the introduction of RV and admission with febrile (p = 0.84), afebrile (p = 0.83) or all CS (p = 0.93), even when limited to peak rotavirus seasonality (March). This is the first ecological study in a country that exclusively uses the monovalent vaccine. Although a negative finding, we would argue that if an effect cannot be detected at this population level then it is unlikely to be clinically or economically significant but generates hypotheses of potential non-specific effects.
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Affiliation(s)
| | - Adam Finn
- Population Health Sciences, University of Bristol, UK
| | - Robin Marlow
- Population Health Sciences, University of Bristol, UK
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Abstract
Two vaccines available for protection against rotavirus gastroenteritis (RVGE), Rotarix and RotaTeq, have contributed to a large decrease in the incidence of paediatric diarrhoea in countries where they have been used. However, they have also led to a small increase in the risk of intussusception. Methods: We compare the number of prevented hospitalisations for RVGE to the number of vaccine-induced hospitalised intussusceptions in France. Results: With 9.5% coverage (French 2015 estimation), vaccination was estimated to prevent, annually, a median of 1,074 hospitalisations (2.5th and 97.5th percentiles (2.5th–97.5th): 810–1,378) and 1.4 deaths (2.5th–97.5th: 1.2–1.6) from RVGE. It was also estimated to cause, annually, 5.0 hospitalisations (2.5th–97.5th: 3.2–7.7) and 0.005 deaths (2.5th–97.5th: 0.001–0.015) from intussusception. The benefit–risk ratio is therefore 214 (2.5th–97.5th: 128–362) for hospitalisations and 273 (2.5th–97.5th: 89–1,228) for deaths. Under a hypothetical 92% coverage, rotavirus vaccination with Rotarix would avoid 10,459 (2.5th–97.5th: 7,702–13,498) hospitalisations for RVGE and induce 47.0 (2.5th–97.5th: 25.1–81.4) hospitalisations for intussusception annually, thereby preventing 13.7 (2.5th–97.5th: 11.1–15.2) deaths and inducing 0.05 (2.5th–97.5th: 0.01–0.15) deaths. Conclusion: The benefit–risk ratio in France is similar to that of other European countries.
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Affiliation(s)
- Adnane Lamrani
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France
| | - Pascale Tubert-Bitter
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France
| | - Catherine Hill
- Centre de Recherche en Epidémiologie et Santé des Population (CESP), Inserm, Villejuif, France
| | - Sylvie Escolano
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Villejuif, France
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van Gaalen RD, van de Kassteele J, Hahné SJM, Bruijning-Verhagen P, Wallinga J. Determinants of Rotavirus Transmission: A Lag Nonlinear Time Series Analysis. Epidemiology 2017; 28:503-13. [PMID: 28333764 DOI: 10.1097/EDE.0000000000000654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Rotavirus is a common viral infection among young children. As in many countries, the infection dynamics of rotavirus in the Netherlands are characterized by an annual winter peak, which was notably low in 2014. Previous study suggested an association between weather factors and both rotavirus transmission and incidence. From epidemic theory, we know that the proportion of susceptible individuals can affect disease transmission. We investigated how these factors are associated with rotavirus transmission in the Netherlands, and their impact on rotavirus transmission in 2014. We used available data on birth rates and rotavirus laboratory reports to estimate rotavirus transmission and the proportion of individuals susceptible to primary infection. Weather data were directly available from a central meteorological station. We developed an approach for detecting determinants of seasonal rotavirus transmission by assessing nonlinear, delayed associations between each factor and rotavirus transmission. We explored relationships by applying a distributed lag nonlinear regression model with seasonal terms. We corrected for residual serial correlation using autoregressive moving average errors. We inferred the relationship between different factors and the effective reproduction number from the most parsimonious model with low residual autocorrelation. Higher proportions of susceptible individuals and lower temperatures were associated with increases in rotavirus transmission. For 2014, our findings suggest that relatively mild temperatures combined with the low proportion of susceptible individuals contributed to lower rotavirus transmission in the Netherlands. However, our model, which overestimated the magnitude of the peak, suggested that other factors were likely instrumental in reducing the incidence that year.
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Rosettie KL, Vos T, Mokdad AH, Flaxman AD, Khalil I, Troeger C, Weaver MR. Indirect Rotavirus Vaccine Effectiveness for the Prevention of Rotavirus Hospitalization: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2018; 98:1197-1201. [PMID: 29436336 PMCID: PMC5928826 DOI: 10.4269/ajtmh.17-0705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/31/2017] [Indexed: 11/28/2022] Open
Abstract
Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects remains unknown. We systematically reviewed the literature and quantified indirect rotavirus vaccine effectiveness (VE) for preventing rotavirus hospitalization in children aged less than 5 years. From 148 identified abstracts, 14 studies met our eligibility criteria. In our main analysis using a random-effects model, indirect rotavirus VE was 48% (95% confidence interval [CI]: 39-55%). In a subgroup analysis by country income level, indirect VE was greater in high-income countries (52%; 95% CI: 43-60%) than in low- and middle-income countries (LMICs) (25%; 95% CI: 5-41%). In a sensitivity analysis using a quality-effects model, the indirect VE in LMICs was not statistically significant (25%; 95% CI: 0-44%). Our findings highlight the importance of increasing rotavirus vaccine coverage, particularly in LMICs where evidence for indirect VE is limited and rotavirus burden is high.
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Affiliation(s)
- Katherine L. Rosettie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Abraham D. Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Marcia R. Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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Karampatsas K, Osborne L, Seah ML, Tong CYW, Prendergast AJ. Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study. PLoS One 2018; 13:e0194009. [PMID: 29565992 PMCID: PMC5863974 DOI: 10.1371/journal.pone.0194009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Rotavirus is the leading cause of acute gastroenteritis in children and is associated with neurological complications such as seizures and encephalopathy. The aim of this study was to investigate the presentation and complications of rotavirus compared to non-rotavirus gastroenteritis in UK children. Methods This was a retrospective, case-control, hospital-based study conducted at three sites in east London, UK. Cases were children aged 1 month to 16 years diagnosed with acute gastroenteritis between 1 June 2011 and 31 December 2013, in whom stool virology investigations confirmed presence of rotavirus by PCR. They were matched by age, gender and month of presentation to controls with rotavirus-negative gastroenteritis. Results Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis tended to present more frequently with metabolic acidosis (pH 7.30 vs 7.37, P = 0.011) and fever (74% versus 46%; P = 0.005) and were more likely to require hospitalisation compared to children with non-rotavirus gastroenteritis (93% versus 73%; P = 0.019). Neurological complications were the most common extra-intestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% versus 15%, respectively; P = 0.24). Encephalopathy occurred only in children with rotavirus infection (n = 3, 6%). Conclusion Rotavirus causes longer and more severe disease compared to other viral pathogens. Seizures and milder neurological signs were surprisingly common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus gastroenteritis. Rotavirus vaccination may reduce seizures and presentation to hospital, but vaccines against other pathogens causing gastroenteritis are required.
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Affiliation(s)
- Konstantinos Karampatsas
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- * E-mail:
| | - Leanne Osborne
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - May-Li Seah
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Cheuk Y. W. Tong
- Department of Virology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Andrew J. Prendergast
- Department of Paediatrics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
- Blizard Institute, Queen Mary University of London, London, United Kingdom
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Poelaert D, Pereira P, Gardner R, Standaert B, Benninghoff B. A review of recommendations for rotavirus vaccination in Europe: Arguments for change. Vaccine 2018; 36:2243-2253. [PMID: 29576308 DOI: 10.1016/j.vaccine.2018.02.080] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/15/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND More than 10 years after the authorisation of two rotavirus vaccines of demonstrated efficacy and with a strongly positive benefit-risk profile, uptake in Europe remains low. Only 13 countries in Europe provide a fully-funded rotavirus universal mass vaccination (UMV) programme, three provide a partially-funded programme, and one provides full funding for a reduced programme targeting at-risk infants. Around 40% of countries in Europe currently have no existing recommendations for rotavirus vaccine use in children from the national government. METHODS We provide an overview of the status of rotavirus vaccine recommendations across Europe and the factors impeding uptake. We consider the evidence for the benefits and risks of vaccination, and argue that cost-effectiveness and cost-saving benefits justify greater access to rotavirus vaccines for infants living in Europe. RESULTS Lack of awareness of the direct and indirect burden caused by rotavirus disease, potential cost-saving from rotavirus vaccination including considerable benefits to children, families and society, and government/insurer cost constraints all contribute to complacency at different levels of health policy in individual countries. CONCLUSIONS More than 10 years after their introduction, available data confirm the benefits and acceptable safety profile of infant rotavirus UMV programmes. Europe serves to gain considerably from rotavirus UMV in terms of reductions in healthcare resource utilization and related costs in both vaccinated subjects and their unvaccinated siblings through herd protection.
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