Rotavirus Vaccine Linked to Fewer Hospitalizations for Kids

Susan London

June 10, 2015

The rotavirus vaccine appears to have been highly effective in reducing all-cause gastroenteritis hospitalizations among young children in the United States, according to new research published in the June 9 issue of JAMA. And the benefit has increased over time.

Routine rotavirus vaccination began among US children in 2006. Previous research found that implementation was associated with reduced healthcare use shortly after the practice began.

Now, investigators led by Eyal Leshem, MD, from the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, assessed rates of all-cause acute gastroenteritis hospitalizations and rotavirus-coded hospitalizations among children younger than 5 years from 26 states for the years 2000 to 2012.

The authors analyzed data from State Inpatient Databases of the Healthcare Cost and Utilization Project, which capture hospitalizations in community and academic hospitals. They used diagnostic codes to ascertain the reasons for hospitalizations.

Overall, there were 1,201,458 all-cause acute gastroenteritis hospitalizations among children younger than 5 years during the study period. Of this total, 199,812 (17%) were specifically rotavirus-coded hospitalizations.

Temporal patterns showed that from 2007 onward, the seasonal peaks in rates of both types of hospitalizations were much smaller than those of prevaccine years. Furthermore, the authors saw the emergence of a biennial pattern, with lower and delayed rotavirus seasonal peaks during 2010 and 2012.

"The biennial pattern observed during postvaccine years might be explained by accumulation of susceptible, nonimmune population during seasons of markedly decreased transmission," the investigators propose.

The mean annual acute gastroenteritis hospitalization rate was 76 per 10,000 among children younger than 5 years before introduction of the vaccine. Relative to that rate, the rate declined by 31% (95% confidence interval [CI], 30% - 31%) in 2008, 33% (95% CI, 32% - 33%) in 2009, 48% (95% CI, 47% - 48%) in 2010, 47% (95% CI, 47% - 48%) in 2011, and 55% (95% CI, 54% - 55%) in 2012 (P < .001). Reductions were similar among boys and girls, children of different races/ethnicities, and all age groups; benefit was greatest for children between the ages of 6 and 23 months.

The mean annual rotavirus-coded hospitalization rate was 16 per 10,000 among children younger than 5 years before introduction of the vaccine. Relative to that rate, the rate declined by 70% (95% CI, 69% - 71%) in 2008, 63% (95% CI, 62% - 64%) in 2009, 90% (95% CI, 90% - 90%) in 2010, 79% (95% CI, 79% - 80%) in 2011, and 94% (95% CI, 94% - 95%) in 2012.

"With an increase in vaccine coverage, herd protection may have contributed to larger declines in rotavirus hospitalizations," the investigators speculate. "In 2012, when vaccine coverage was highest, the greatest reductions were observed for all-cause acute gastroenteritis (55%) and rotavirus-coded (94%) hospitalizations."

They conclude, "The most recent reported coverage of 73% for a full rotavirus vaccine series is lower than that of other established childhood vaccines so our findings support continued efforts to increase rotavirus vaccine coverage."

The authors have disclosed no relevant financial relationships.

JAMA. 2015;313:2282-2284. Abstract

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