Impact of Routine Rotavirus Vaccination in Germany

Evaluation Five Years After Its Introduction

Abstract

Background: 

Routine rotavirus (RV)-vaccination is recommended in Germany since August 2013. Five years later, we evaluated the recommendation by examining vaccine uptake and the impact on RV-gastroenteritis (RVGE) burden in all age groups and on intussusceptions in infants.

Methods: 

We estimated RV-vaccine uptake in the 2014–2018 birth cohorts using statutory health insurance prescription data. For impact assessment, we analyzed RVGE-surveillance data of the German infectious diseases notification system. We compared age-specific RVGE-incidences of different severity between pre-vaccination (2005/06–2007/08) and routine vaccination period (2013/14–2017/18) calculating incidence rate ratios (IRR) using Poisson regression. To determine the effect on intussusception, we used hospital discharge data (2006–2017) and compared incidences between pre-vaccination and routine vaccination period using Poisson regression.

Results: 

Vaccination coverage increased from 59% (2014) to 80% (2018). Incidences of RVGE-outpatient cases, RVGE-hospitalization and nosocomial RVGE among <5-year-olds decreased by 74% (IRR = 0.26; 95% CI: 0.26–0.27), 70% (IRR = 0.30; 95% CI: 0.30–0.31) and 70% (IRR = 0.30; 95% CI: 0.30–0.31), respectively. Incidence of RVGE-outpatient cases in age groups ineligible for RV-vaccination decreased by 38% (IRR 0.62; 95% CI: 0.61–0.63). Compared with the pre-vaccination period, incidence of intussusception in the first year of life decreased by 28% (IRR = 0.73; 95% CI: 0.68–0.79) while at age of the first vaccine-dose (7th–12th week of age) increase in incidence of intussusception was non-significant (IRR = 1.29; 95% CI: 0.93–1.78).

Conclusions: 

Routine RV-vaccination is well accepted in Germany. Since implementation of routine RV-vaccination, RVGE significantly decreased in <5-year-olds and in non-vaccinated older age groups through herd protection. The decline of intussusceptions in the first life year suggests a potential vaccination-associated protection against gastrointestinal infections that might trigger intussusceptions. These encouraging results should be communicated to doctors and parents for further improvement of vaccine uptake and protection of more infants.