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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*

The Pediatric Infectious Disease Journal: November 2011 - Volume 30 - Issue 11 - p 942-947
doi: 10.1097/INF.0b013e3182254d19
Original Studies

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.


From the *Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; †Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA; ‡Division of High-Consequence Pathogens and Pathology, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA; §International Research and Programs Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA; and ¶Fogarty International Center, National Institutes of Health, Bethesda, MD.

Accepted for publication May 19, 2011.

Supported by the Centers for Disease Control and Prevention.

The authors have no other funding or conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC).

Address for correspondence: Douglas H. Esposito, MD, MPH, Centers for Disease Control and Prevention, 1600 Clinton Road NE, MS E-03, Atlanta, GA 30333. E-mail:

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© 2011 by Lippincott Williams & Wilkins, Inc.