A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel

Abstract

Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n D 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008)(2009)(2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011-2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0-23 months (60-61%) than in toddlers aged 24-59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.

No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel

“…This percentage was similar before and after the introduction of universal rotavirus immunization in Israel. A substantial 62% reduction was evident in the incidence of rotavirus gastroenteritis hospitalizations during the universal immunization years [26][27][28] compared to the preuniversal immunization years, but rotavirus remained the leading cause of gastroenteritis hospitalizations, being detected in 40.2% and 20.0% before and after the introduction of universal immunization. The coverage of three doses of rotavirus vaccine in Israel is estimated at~80%, 29 which together with good vaccine effectiveness 30 explain the reduction in hospitalizations for rotavirus gastroenteritis.…”

“…Herd immunity possibly explains the 36% reduction in the incidence of rotavirus gastroenteritis hospitalizations in children aged 24-59 who were not eligible for a rotavirus vaccine in the framework of the universal vaccination program. 27,28,31 A 1-y study after the introduction of universal rotavirus immunization in Finland showed that norovirus was detected in 25% of children aged less than 15 y with acute gastroenteritis (both inpatient and outpatient settings), while rotavirus was found in 24%. 22 In agreement with our findings, a reduction in rotavirus gastroenteritis was observed after introducing universal rotavirus immunization compared to the preceding period in Finland, however, as in our study, the percentage of norovirus gastroenteritis was similar between the two periods.…”

“…To estimate the total number of children with norovirus gastroenteritis, a weighted analysis was applied, in which the weights were determined as the inverse of norovirus testing proportion (equivalent to sampling fraction), as described elsewhere. 27 We calculated the annual incidence (per 1000 children) of norovirus gastroenteritis hospitalization using the estimated number of norovirus gastroenteritis hospitalizations in the numerator and the number of children aged 0-59 months living in the study catchment area as the denominator. Data on the population size was estimated using the Central Bureau of Statistics reports on population size by sub-district.…”

“…A prospective hospital-based surveillance study was undertaken in northern Israel to assess the incidence of rotavirus gastroenteritis before and after the introduction of the universal rotavirus immunization program. 26,27,40,41 This platform was utilized to assess the incidence of norovirus gastroenteritis. 7 Details of the study design have been reported.…”

“…7 Details of the study design have been reported. 7,26,27,40,41 In brief, the study target population included children 0-59 months of age residing in the catchment area of three hospitals: Carmel in Haifa, Hillel Yaffe in Hadera, and Laniado in Netanya. 40,41 The current analysis was limited to hospitalizations that occurred from November 2007 until December 2014, the period during which we tested for norovirus.…”