Rotavirus Vaccine Greatly Reduced Healthcare Use

Jenni Laidman

June 09, 2014

Rotavirus vaccination reduced diarrhea-related healthcare use in children by as much as 94% in the years after the vaccines were introduced, even conferring protection on unvaccinated children, according to a study published online June 9 in Pediatrics. The decline in healthcare use saved nearly $1 billion in a 4-year period, the researchers estimate.

Eyal Leshem, MD, a National Center for Immunization and Respiratory Diseases and Epidemic Intelligence Service officer, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues conducted a retrospective analysis of US insurance claims data from MarketScan for children younger than 5 years in a cohort of more than 406,000 children from 37 states. The researchers compared rates of healthcare use, including diarrhea-associated hospitalization in the prevaccine years of 2001 to 2006, with the years after the introduction of rotavirus vaccine (2007 - 2011). The researchers also compared hospitalization in vaccinated and unvaccinated children in 2007 to 2011 and healthcare use among unvaccinated children before and after vaccines were introduced.

Rotavirus was the most common cause of severe gastroenteritis in toddlers in the United States, each year causing 20 to 60 deaths, 55,000 to 70,000 hospitalizations, and nearly half a million medical visits. In 2006, the Advisory Committee on Immunization Practices recommended pentavalent rotavirus vaccine in infants, with oral doses at 2, 4, and 6 months of age. In June 2008, the committee added a recommendation for the 2-dose RV1 to be administered at ages 2 and 4 months

By the end of 2010, 58% of children younger than 5 years had received at least 1 dose of pentavalent (RV5) rotavirus vaccine, and 5% had received at least 1 dose of monovalent (RV1) rotavirus coverage. Introduction of the vaccines seemed to have an immediate response, with hospitalization rates for rotavirus falling 75% in 2007 to 2008 compared with the average rate of rotavirus hospitalizations in 2001 to 2006, before the vaccines were introduced. In 2008 to 2009, hospitalization rates were 60% lower than the in prevaccine years; in 2009 to 2010, hospitalization rates were 94% lower; and in 2010 to 2011, hospitalization rates were 80% lower.

Vaccinated children saw the biggest benefit, with rotavirus-coded hospitalizations reduced 92% in 2010 to 2011 among RV5-vaccinated children compared with unvaccinated children and 96% among RV1-vaccinated children.

Still, herd immunity had a substantial benefit for the unvaccinated, with an immediate drop off of 50% in hospitalization among unvaccinated children the first year vaccinations were available (2007 - 2008). In 2009 to 2010, the hospitalization rate for unvaccinated children was 77% lower than in the years before rotavirus vaccination, and in 2010 to 2011, the hospitalization rate was 25% lower. There was no reduction in the 2008 to 2009 season.

The authors estimate that vaccination averted 176,587 hospitalizations nationwide, 242,335 department visits, and 1,116,869 outpatient visits for children younger than 5 years from July 1, 2007, to June 30, 2011. This resulted in a cost savings of $924 million for the 4-year period, they calculate.

One study limitation is the reliance on MarketScan data, the authors write, which means that uninsured and Medicaid populations are not represented in the data.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online June 9, 2014.

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