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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e3182254d19
Original Studies

Baseline Estimates of Diarrhea-associated Mortality Among United States Children Before Rotavirus Vaccine Introduction

Esposito, Douglas H. MD, MPH*†; Holman, Robert C. MS‡; Haberling, Dana L. MSPH‡; Tate, Jacqueline E. MSPH, PhD*; Podewils, Laura Jean MS, PhD§; Glass, Roger I. MD, PhD¶; Parashar, Umesh MB BS, MPH*

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Abstract

Objectives: Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed.

Methods: National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992–2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus.

Results: An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992–1998 and 2005–2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually.

Conclusions: Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States.

© 2011 by Lippincott Williams & Wilkins, Inc.

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