Impact of Rotavirus Vaccine on Childhood Diarrheal Hospitalization After Introduction Into the South African Public Immunization Program

Msimang, Veerle M. Y. MSc*; Page, Nicola PhD*; Groome, Michelle J. MD, MSc†‡; Moyes, Jocelyn MD, MSc*; Cortese, Margaret M. MD§; Seheri, Mapaseka PhD; Kahn, Kathleen MD, PhD‖**††; Chagan, Meera MD, PhD‡‡; Madhi, Shabir A. MD, PhD*†‡; Cohen, Cheryl MD, MSc*

Pediatric Infectious Disease Journal: December 2013 - Volume 32 - Issue 12 - p 1359–1364
doi: 10.1097/INF.0b013e3182a72fc0
Vaccine Reports

Background: Oral rotavirus vaccine was introduced into the South African routine immunization program in August 2009 administered at 6 and 14 weeks with no catch-up. We described the change in rotavirus-associated diarrheal hospitalizations among children <5 years at 3 sentinel sites from 2009 through 2011.

Methods: During 2009 through 2011, we compared the proportion of enrolled children aged <5 years hospitalized with acute gastroenteritis and testing rotavirus positive. We used hospital data to determine the change in diarrhea hospitalizations and estimated total numbers of rotavirus hospitalizations by adjusting for nonenrolled patients. Stool samples were tested for rotavirus using enzyme immunoassay.

Results: In 2009 (May–December), 46% (404/883) of samples among children <5 years tested rotavirus positive, decreasing to 33% (192/580) (P < 0.001) in 2010 and 29% (113/396) (P < 0.001) in 2011. Compared with May–December 2009, total diarrhea hospitalizations among children aged <5 years was one-third lower in May–December of 2010 and 2011. Among infants, adjusted rotavirus hospitalizations were 61% (n = 267) and 69% (n = 214) lower, respectively, in 2010 and 2011 when compared with 2009 (n = 689), and 45 and 50 percentage points greater than the reduction in rotavirus-negative cases. Among children <5 years, rotavirus hospitalizations were 54% and 58% lower in 2010 and 2011, compared with 2009 (40 and 44 percentage points greater than reduction in rotavirus-negative cases). Rotavirus reductions occurred in rural and urban settings.

Conclusion: Using published estimates of rotavirus hospitalization burden, we estimate that at least 13,000 to 20,000 hospitalizations in children <2 years were prevented in the 2 years after rotavirus vaccine introduction.

From the *National Institute for Communicable Diseases of the National Health Laboratory Services; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; §National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; MRC/Diarrhoeal Pathogens Research Unit, University of Limpopo Medunsa Campus, Pretoria; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; **Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden; ††INDEPTH Network, Accra, Ghana; and ‡‡Department of Paediatrics, University of Kwazulu-Natal, Durban, South Africa.

Accepted for publication July 1, 2013.

This surveillance work was supported by an unconditional grant for the conduct of Sentinel Site Rotavirus Surveillance from GlaxoSmithKline (GSK).

N.P. reports receiving fees for speaking engagements by GSK and Merck (MSD) Pty (Ltd). S.A.M. has received honorarium from GSK and MERCK. All authors have submitted the PIDJ Form for Disclosure of Potential Conflict of Interest. Conflicts that the editors consider relevant to the content of the article have been disclosed in the Acknowledgment section.

The funding sources had no involvement in the research, writing or the decision to submit the article for publication. The findings and conclusions in this report are those of the authors. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Veerle M. Y. Msimang, MSc, Veterinary Epidemiology and Public Health, National Institute for Communicable Diseases, 1 Modderfontein Road, Private Bag X4, Sandringham 3121, South Africa. E-mail:

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© 2013 by Lippincott Williams & Wilkins, Inc.