Impact of Routine Rotavirus Vaccination in Germany

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.

Emergence of equine‐like G3 and porcine‐like G9 rotavirus strains in Sarawak, Malaysia: 2019−2021

“…7 However, a two-decade comprehensive analysis in Australia showed that longterm vaccination exerted vaccine-induced selective pressure causing increased diversity of rotavirus strains, 8 suggesting that these strains may evade immunity. Enhanced by gazetting rotavirus as a notifiable disease, countries such as Australia, 9 Argentina, 10 Germany, 11 and India 12 established reporting systems where data on hospital discharges and rotavirus surveillance can estimate the rotavirus burden and support policy making. However, Malaysia lacks a similar system for reporting rotavirus gastroenteritis, and rotavirus vaccine efficacy has not been systematically evaluated, including in clinical trials.…”

Differentiation between Wild-Type Group A Rotaviruses and Vaccine Strains in Cases of Suspected Horizontal Transmission and Adverse Events Following Vaccination

“…RVA vaccinations, as well as previous natural RVA infections [13], do not induce full protection against re-infection with wild-type RVA strains. However, AGE hospitalization rates significantly decreased after vaccination, as did episodes of severe AGE [10,[14][15][16].…”