BackgroundLibya introduced rotavirus vaccine in October 2013. We examined pre-vaccine incidence of rotavirus hospitalizations and associated economic burden among children < 5 years in Libya to provide baseline data for future vaccine impact evaluations.MethodsProspective, hospital-based active surveillance for rotavirus was conducted at three public hospitals in two cities during August 2012 - April 2013. Clinical, demographic and estimated cost data were collected from children <5 hospitalized for diarrhea; stool specimens were tested for rotavirus with a commercial enzyme immunoassay. Annual rotavirus hospitalization incidence rate estimates included a conservative estimate based on the number of cases recorded during the nine months and an extrapolation to estimate 12 months incidence rate. National rotavirus disease and economic burden were estimated by extrapolating incidence and cost data to the national population of children aged <5 years.ResultsA total of 410 children <5 years of age with diarrhea were enrolled, of whom 239 (58%) tested positive rotavirus, yielding an incidence range of 418-557 rotavirus hospitalizations per 100,000 children <5 years of age. Most (86%) rotavirus cases were below two years of age with a distinct seasonal peak in winter (December-March) months. The total cost of treatment for each rotavirus patient was estimated at US$ 679 (range: 200–5,423). By extrapolation, we estimated 2,948 rotavirus hospitalizations occur each year in Libyan children <5 years of age, incurring total costs of US$ 2,001,662 (range: 1,931,726-2,094,005).ConclusionsRotavirus incurs substantial morbidity and economic burden in Libya, highlighting the potential value of vaccination of Libyan children against rotavirus.

BackgroundRotavirus infection is a major cause of childhood diarrhea in Libya. The objective of this study is to evaluate the cost-effectiveness of rotavirus vaccination in that country.MethodsWe used a published decision tree model that has been adapted to the Libyan situation to analyze a birth cohort of 160,000 children. The evaluation of diarrhea events in three public hospitals helped to estimate the rotavirus burden. The economic analysis was done from two perspectives: health care provider and societal. Univariate sensitivity analyses were conducted to assess uncertainty in some values of the variables selected.ResultsThe three hospitals received 545 diarrhea patients aged≤5 with 311 (57%) rotavirus positive test results during a 9-month period. The societal cost for treatment of a case of rotavirus diarrhea was estimated at US$ 661/event. The incremental cost-effectiveness ratio with a vaccine price of US$ 27 per course was US$ 8,972 per quality-adjusted life year gained from the health care perspective. From a societal perspective, the analysis shows cost savings of around US$ 16 per child.ConclusionThe model shows that rotavirus vaccination could be economically a very attractive intervention in Libya.

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In Libya, most health service sectors are publicly owned and provide preventive, curative and rehabilitation services to all citizens free of charge under supervision of ABSTRACT Background: In Libya, routine access to rotavirus testing is not available and clinicians treat presumptively, leading to inappropriate treatments. This study describes the management of rotavirus infection among Libyan children in public hospitals. Methods: A prospective cross-sectional study was conducted to describe the management of rotavirus among children in three public hospitals in Libya from August 2012 to April 2013. We reviewed internal documents to determine if protocols were in place to guide management of diarrheal illness. Children under five presenting with diarrhea had stool samples collected and tested for rotavirus. Comparisons of treatments were made by rotavirus status and level of dehydration; mild, moderate and severe. Results: A total of 545 diarrhea patients below 5 years of age were enrolled in the study. Of those, 311 (57%) cases were infected by rotavirus. Treatment was administered without investigating the cause of diarrhea. Intravenous fluids (IVF) treatment was the most common treatment for rotavirus cases and was administered to 306 (98%) of cases. Antibiotics were administered to about 137 (44%) of rotavirus cases. Antibiotics were more likely to be administered with more severe dehydration. Conclusions: Presumptive treatment with antibiotics was very common in Libyan. Protocols for management of diarrheal illness and rotavirus cases in children need to be established for effective treatment.